The Alzheimer’s Dementia Patients’ Observed Illness Course and Experience in Ghana and Care Lessons to Be Learnt: A Mental Health Professional’s Perspective

Alzheimer’s disease (AD) and associated dementia patient numbers continue to increase globally with associated economic costs to healthcare systems. Of note is the increase in numbers in lower and middle-income countries (LMICs) including Sub-Saharan African (SSA) countries, which already face challenges with their health budgets from communicable and non-communicable diseases. Ghana, an SSA country, faces the problem of healthcare budgetary difficulties and the additional impact of AD as a consequence of increasing population strata of old aged persons (OAPs) due to the demographic transition effect. This article uses examples of known patients’ illness courses to give a perspective on the lived experience of patients with dementia (PWD) in Ghana, living amongst a populace with a culture of stigmatization of PWD, and a relatively fragile public mental health system (PMHS) for those with mental illness, including AD. The lived experience of AD patients is characterised by stigmatisation, discrimination, non-inclusiveness, diminished dignity and human rights abuses in the face of their mental disability, and eventually death. This article is an advocacy article giving voice to the voiceless and all persons suffering from AD and other dementias in Ghana, whilst pleading for a call to action from healthcare professionals and responsible state agencies.

Qualitative exploration of home life experiences and care needs among elderly patients with temporary intestinal stomas

BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs.Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer.However,the ileostomy is susceptible to peri-stoma skin complications,as well as fluid,electrolyte,and nutritional imbalances,posing challenges to effective management.The successful selfmanagement of patients is intricately linked to their adjustment to temporary colostomy;nonetheless,there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront.AIM To investigate the lived experiences,perceptions,and care requirements of temporary colostomy patients within their home environment,with the ultimate goal of formulating a standardized management protocol.METHODS Over the period of June to August 2023,a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai,China.Employing a phenomenological research approach,a semi-structured interview guide was developed,and qualitative interviews were conducted using in-depth interview techniques.The acquired data underwent coding,analysis,organization,and summarization following Colaizzi’s seven-step method.RESULTS The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes:Firstly,Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression;secondly,patients exhibit limited self-care capabilities and face information deficits,resulting in heightened reliance on healthcare professionals;thirdly,patients demonstrate the potential for internal motivation through proactive self-adjustment;and finally,patients express a significant need for emotional and social support.CONCLUSION Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens,inadequate self-care abilities,informational deficits,and emotional needs.Identifying factors influencing patients’self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.

Patients Involved in Funding Research.A Look Back at the Unique Experience of the ECLAIR Working Group of Canceropole CLARA

This article aims to share an innovative experience of organizing and funding research involving those most directly affected:patients.The“ECLAIR”working group of the Canceropole Lyon Auvergne-Rhone-Alpes(CLARA)was created at the end of 2020 with the goal of contributing to the development of a call for projects on the patient experience in oncology,which was launched in January 2021.Initially composed of 8 members,including 7 patients,coordinated by a project manager from CLARA,the ECLAIR working group actively participated in drafting the specifications of the call for projects,developing the eligibility criteria for applications,revising the evaluation and selection criteria for projects,and monitoring the selected projects.This experience was repeated twice.With significant freedom of action,the working group made two decisions that strongly demonstrate the commitment to supporting research partnerships and the active involvement of those affected:firstly,by making partnership a mandatory requirement for the eligibility of applications,and secondly,by conducting the selection of projects themselves,after an independent scientific evaluation phase.Seeking to shed light on the“black box”of partnership,the article also presents the concrete modalities of interaction among the working group members,the adjustments made between different editions of the call for projects,and the relationships maintained with CLARA.

Impact of hepatitis B immunoglobulin mode of administration on treatment experiences of patients after liver transplantation: Results from an online survey

BACKGROUND Hepatitis B immunoglobulin(HBIG)in combination with a potent nucleos(t)ide analog is considered the standard of care for prophylaxis against hepatitis B virus(HBV)reinfection after liver transplantation for HBV-associated disease.AIM To evaluate patients’satisfaction,preferences,and requirements for subcutaneous(SC),intramuscular(IM),and intravenous(IV)HBIG treatments.METHODS A self-completion,cross-sectional,online,22-question survey was conducted to examine perceptions and satisfaction with current HBIG treatment in adults receiving HBIG treatment following liver transplantation for HBV-associated disease in France,Italy,and Turkey.Hypothetical HBIG products with different administration modes were evaluated using target product profile assessment and a conjoint(trade-off)exercise.RESULTS Ninety patients were enrolled;32%,17%,and 51%were SC,IM,and IV HBIG users,respectively.Mean duration of treatment was 36.2 months.SC HBIG had the least negative impact on emotional well-being and social life and was perceived as the most convenient,easiest to administer,least painful,and had the highest self-rating of treatment compliance.More IM HBIG users than SC or IV HBIG users reported that administration frequency was excessive(67%,28%,and 28%,respectively).In the target product profile assessment,76%of patients were likely to use hypothetical SC HBIG.In the conjoint exercise,administration route,frequency,and duration were key drivers of treatment preferences.CONCLUSION Ease,frequency,duration,and side effects of HBIG treatment administration were key drivers of treatment preferences,and SC HBIG appeared advantageous over IM and IV HBIG for administration ease,convenience,and pain.A hypothetical SC HBIG product elicited a favorable response.Patient demographics,personal preferences,and satisfaction with HBIG treatment modalities may influence long-term treatment compliance.

Exploring the meaning of care among lived experiences of patients with blindness:an interpretive phenomenological study

Objective:To explore the meaning of care experienced by people with blindness in hospitals.Methods:Interpretive phenomenology along with the 6-step method of van Manen was used to conduct the study.Using purposeful sampling,15 people with legal blindness were interviewed.Thematic analysis was used to isolate the meaning of care.Results:Five themes emerged:(a)nurses in the eyes of patients with blindness;(b)negligence in the caring moments;(c)being cared for in ambiguity;(d)Uncoordinated care;and(e)Psychological discomfor t.These sub-themes were condensed into an overarching theme titled as“marginalized patients inside the stereotypical healthcare system.”Conclusions:Lived experiences of patients with blindness revealed that hospitals provide stereotypic or inappropriate care for this minority group in society.Health professionals par ticularly nurses should be skilled to provide person-centered and coordinated care for patients with blindness.

Nursing Experience of Early Application of Nasoenteric Tube for Enteral Nutrition in Critically Ill ICU Patients

Objective:To investigate the effective nursing measures of early application of nasoenteric tube for enteral nutrition in critically ill patients in ICU,and to summarize the nursing experience.Methods:The study was carried out in June 2023–November 2023.62 samples of ICU critically ill patients were selected,all of whom used enteral nutrition by mesenteric tube and were grouped into an observation group(n=31)and a control group(n=31)by using the numerical table randomization method.The patients in the control group were basic nursing interventions,and the patients in the observation group were comprehensive quality care,comparing the nutritional indexes,complication rates,and nursing satisfaction between the two groups.Results:All nutritional indicators of the observation group were higher than those of the control group after nursing intervention(P<0.05);the complication rate of the observation group was lower than that of the control group(P<0.05);the nursing satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion:Comprehensive quality nursing care during the early application of a gastroenteric tube for enteral nutrition in critically ill patients in the ICU can improve nutritional indexes,reduce the incidence of complications and improve nursing satisfaction.

An Evaluation Scale of Medical Services Quality Based on “Patients' Experience”

An evaluation scale of medical services quality was developed on the basis of ＂patients＇ experience＂. The questionnaires were developed by, among others, searching relevant literature, col- lecting well-established assessment scales, measuring patients＇ experience and satisfaction, brain-storming, literature analysis. Delphi method was adopted for expert consultation. Scale items were screened and revised. The key indexes were converted. Field surveys were conducted for testing the reliability and validity of the scale. Our modified evaluation scale for measuring medical services quality based on ＂patients＇ experience＂ included 6 dimensions （tangibility, reliability, responsiveness, assurance, empathy and continuity）, and 50 items. The novel scale based on ＂patients＇ experience＂ may better serve the purpose of assessin~ medical services quality.

The Use of Smart Textiles in the Healthcare Space: Towards an Improvement of the User-Patient Experience

This article explores the role of smart textiles in transforming healthcare environments into spaces that prioritize patient well-being. We will examine the advantages of smart textiles in healthcare settings, such as the real-time monitoring of vital signs through connected clothing. Additionally, we will introduce metadesign as a design approach that considers the interactions between users, healthcare environments, and technologies to create fulfilling experiences. By combining the advanced features of smart textiles with a patient-centered metadesign approach, it becomes possible to create care spaces that cater to patient needs. The objective of this article is to present the integration of metadesign in the design of smart textiles as a process aimed at enhancing the quality of the patient user experience. In this process, we will emphasize the collaborative approach and embrace technological innovation to harness the potential for ongoing improvement and provide users with high-quality experiences. Lastly, we will underscore the significance of adopting a multidimensional approach to evaluate the impact of smart textiles on the patient user experience.

A qualitative study on experience of nurses caring for patients with delirium in ICUs in China:Barriers,burdens and decision making dilemmas

Purpose:The purpose was to explore the experiences of nurses caring for patients with delirium in ICU in China.Methods:Semi-structured qualitative interviews were conducted with 14 ICU nurses in Beijing,China.Audio recordings of the transcripts were coded and analysed thematically.Results:The emergent themes reflected clearly similar experiences and were titled as follows:Internal and external barriers to care;Care burden:workload,psychological pressure and injury;Dilemmas in decision-making:balancing risks and benefits.Conclusions:The results of this qualitative study have provided a rich description of the perceptions of a sample of nurses caring for patients with dementia in Beijing.Clearly,the nurses suffered from their work experiences in several aspects:they lacked the knowledge and skills required assessing and managing the patients as early as possible;they were physically and psychologically stressed while looking after the patients and faced with dilemmas and compromises in their decision-making.

Implantable port thrombosis in cancer patients: a monocentric experience

Objective: Implantable port thrombosis(IPT) in cancer patients is a relatively rare but severe complication. Several factors are reportedly associated with the occurrence of thrombosis. We aimed to describe the prevalence and the anatomoclinical features of IPT observed in cancer patients who were treated in a medical oncology department in Tunisia.Methods: A total of 600 cancer patients who had port implantation from January 2013 to December 2015 were retrospectively identified. Cases with symptomatic/incidental IPT(radiologically confirmed) were further identified. Epidemiological and anatomoclinical features were collected from patient records and the department database.Results: We observed that 33 of the 600 patients had IPT; thus, the prevalence was 5.5%. The median age was 57 years, and the gender ratio was 0.43. Overweight or obesity was observed in 73% of the patients. IPT occurred mainly in patients with breast(36.4%) and colorectal(33.3%) cancers, which were mostly nonmetastatic(79%). At least one identified classical thromboembolic risk factor was found in 13 patients(smoking in 9, tamoxifen in 2). IPT was symptomatic in 93% of the cases, occurring within an average time of 56 days. Implantable ports were removed because of infection in 2 cases and nonfunctionality in 3 cases. IPT treatment was based on low-molecular-weight heparins(94%) and antivitamin K(6%) for an average of 130 days. Four patients had post-therapy complications: one thrombosis recurrence and three infections.Conclusions: IPT cases in the 600 patients were observed to occur in obese nonmetastatic cancer patients within the first 3 months after IP implantation.

Therapeutic experience of 289 elderly patients with biliary diseases

AIM To present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases. METHODS A total of 289 elderly patients with biliary diseases were enrolled in this study. The clinical data relating to these patients were collected in our hospital from June 2013 to May 2016. Patient age, disease type, coexisting diseases, laboratory examinations, surgical methods, postoperative complications and therapeutic outcomes were analyzed. RESULTS The average age of the 289 patients with biliary diseases was 73.9 +/- 8.5 years (range, 60-102 years). One hundred and thirty-one patients (45.3%) had one of 10 different biliary diseases, such as gallbladder stones, common bile duct stones, and cholangiocarcinoma. The remaining patients (54.7%) had two types of biliary diseases. One hundred and seventy-nine patients underwent 9 different surgical treatments, including pancreaticoduodenectomy, radical resection of hilar cholangiocarcinoma and laparoscopic cholecystectomy. Ten postoperative complications occurred with an incidence of 39.3% (68/173), and hypopotassemia showed the highest incidence (33.8%, 23/68). One hundred and sixteen patients underwent non-surgical treatments, including anti-infection, symptomatic and supportive treatments. The cure rate was 97.1% (168/173) in the surgical group and 87.1% (101/116) in the non-surgical group. The difference between these two groups was statistically significant (chi(2) = 17.227, P < 0.05). CONCLUSION Active treatment of coexisting diseases, management of indications and surgical opportunities, appropriate selection of surgical procedures, improvements in perioperative therapy, and timely management of postoperative complications are key factors in enhancing therapeutic efficacy in elderly patients with biliary diseases.

Neuropathy experienced by colorectal cancer patients receiving oxaliplatin: A qualitative study to validate the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity scale

BACKGROUND Although oxaliplatin is widely established as a standard treatment in colorectal cancer(CRC),oxaliplatin-induced neuropathy has emerged as a prominent doselimiting side effect associated with quality of life decrements.Ongoing monitoring and management of neuropathy is important for CRC patient quality of life and adherence to treatment.Therefore,a validated self-reported measure of neuropathy would aid in the management and assessment of oxaliplatininduced neuropathy in clinical practice and research.We sought to evaluate the content validity of the 13-item Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale(FACT/GOGNtx)for CRC patients receiving oxaliplatin.AIM To understand the neuropathy experiences of CRC patients and assess content validity of the FACT/GOG-Ntx.METHODS Semi-structured concept elicitation and cognitive debriefing interviews were conducted with 31 CRC patients experiencing peripheral neuropathy from current or previous oxaliplatin treatment.Interview data were analyzed using a constant comparative approach,and data were mapped to the FACT/GOG-Ntx to assess content validity.RESULTS Mean age of the sample was 54(range 34-82).The sample was primarily Caucasian(84%)and consisted of nearly equal numbers of men and women.Participants described 28 unique neuropathy symptoms;hand tingling(experienced by 87%of respondents);feet tingling(81%);hand numbness(68%);and feet numbness(84%)were most frequently mentioned.Neuropathy symptoms occurring on the feet were most often identified as most bothersome by participants.Eleven of the 13 FACT/GOG-Ntx items exhibited moderate to strong evidence of content validity.Two items related to trouble hearing and ringing in the ears had weak support;however,these items represent severe neuropathy and could be useful for a patient reported outcome measure.CONCLUSION The FACT/GOG-Ntx represents the key neuropathy experiences of CRC patients treated with oxaliplatin.

Community Hospital Experience of Surgical Times and Outcomes in Patients Undergoing Cesarean Deliveries for Non-Reassuring Fetal Tracing: A Retrospective Cohort

Background: Current guidelines recommend regional anesthesia versus general as a method of choice for women undergoing cesarean deliveries (CS). However, little is known about the surgical times in the operating room and a choice of anesthesia for cesarean deliveries. Objective: This study was designed to compare times from the arrival to the OR to the delivery of the fetus between regional and general anesthesia along with maternal and fetal outcomes, for patients undergoing cesarean sections for non-reassuring fetal tracing. Study Design: Records were reviewed for patients who underwent cesarean delivery for non-reassuring fetal heart rate tracing from February 2012 to May 2018. A total of 190 charts were selected. Seven patients who received epidural or spinal anesthesia and then converted to general anesthesia (GA) were excluded. The primary outcomes were: 1) entering the operating room to skin incision (min);2) the time from entering the operating room to delivery of the fetus (min). These times were compared among the patients who underwent epidural, spinal and general anesthesia. The secondary criteria included time from skin incision to delivery of the fetus (min), estimated blood loss (ml), Apgars scores, Arterial/venous cord pH, NICU admissions and fetal complications. ANOVA or Kruskal-Wallis Test was used for the continuous variable and Fisher’s exact test was used for the categorical variable to test the differences between groups. Logistic regression model was used for the binary outcomes after adjusting for age, BMI and number of prior laparotomies. Results: Infants in the GA group were delivered significantly faster when compared to epidural and spinal group separately with a P-value of 0.001. The mean time from arrival to OR to delivery of the newborn in GA group was 12.7 minutes, compared to 27 minutes in epidural group and 32.7 minutes in the spinal group. Time intervals from time in the OR to incision and time from incision to delivery of the fetus were also calculated and were significantly shorter in the GA group when compared to spinal and epidural groups, P Conclusion: The induction of general anesthesia for emergency cesarean section resulted in shorter times to delivery compared to spinal and epidural. General anesthesia was associated with lower, albeit not statistically significant Apgar scores and higher NICU admissions, and had similar cord gases compared to neuraxial anesthesia group.

Proactive psychological and psychiatric support of patients with chronic noncommunicable diseases in a randomised trial:a Ukrainian experience

Background Presently, approaches for the early treatment of pathological anxiety in patients with chronic non-communicable diseases are lacking, thus delaying the initiation of symptom management at the early onset of the illness. Proactive psychological and psychiatric support, to alleviate subclinical symptoms of anxiety and to improve the quality of life in patients with chronic non-communicable diseases, is a promising candidate for the role of such therapy.Aims To investigate and determine the effectiveness of proactive psychological and psychiatric support for alleviating subclinical symptoms of anxiety and improving quality of life, in patients with chronic non-communicable diseases.Methods The study design was a monocentric randomised controlled trial with parallel groups. The study, involving 193 inpatients with chronic non-communicable diseases, complied with the ethical and deontological norms in accordance with the principles set out in the Declaration of Helsinki. Instruments used in the study included the Hamilton Anxiety Scale (HAM-A) to assess subclinical symptoms, the Scale of Somatic Symptoms and the Chaban Quality of Life Scale. Block randomisation was used to randomise patients to a 2-month-long study group with a proactive counselling psychiatry model care or a control group with standard regulated treatment for chronic non-communicable diseases. The allocation ratio was 1.15:1 owing to the expectancy of a higher percentage of dropout in the intervention group.Results After 60 days of treatment (T2), there was a statistically significant difference in all clinical parameters between the study and control groups. The median HAM-A value differed between the groups by 4.87 points, with statistically significant lower results in the study group. The comparison of the study group’s scale values on day 1 and day 60 demonstrated statistically significant changes in all three indicators.Conclusions Our results support existing evidence for the effectiveness of proactive psychological and psychiatric support to reduce subclinical anxiety and somatisation symptoms and to improve the quality of life for patients with common chronic non-communicable diseases. However, continued research on the effectiveness of proactive psychological and psychiatric support for patients with chronic non-communicable diseases is needed.

Self-experience of buried seeds at auricular points in depressive patients with sleep disorder: a qualitative research

Objective To explore the self-experience of burying seeds at auricular points in depressive patients with sleep disorder,so as to seek possible approaches to improve the quality of care.Methods Eleven patients involved in a three-week randomized controlled clinical trial were purposefully interviewed by the experienced,qualified counselor.The process of thematic analysis was applied in this study,the self-experience was discussed and recorded,transcribed,and analyzed accordingly.Results Four themes related to self-experience were extracted,these included the deficiency in relevant support,passive acceptance,distrust,expectation and further advice.Conclusion There was an urgent demand of humane care and emotional support,which might improve compliance of the treatment to some extent in terms of health education.Additionally,medical practitioners should provide the patient with comprehensive support,professional health education,as well as standardize training program for TCM operator and control the operation’s quality.

Experiences and Challenges While Managing the Inpatient Psychiatry Unit Dedicated for COVID-19 Patients

The COVID-19 pandemic has significantly changed the mental health care. Treating psychiatric patients with COVID-19 poses multiple challenges in the inpatient psychiatric setting in terms of mitigating transmission of the virus. Gracie Square Hospital, a freestanding psychiatric hospital located in New York City, devoted a unit to treating COVID-19 patients requiring inpatient psychiatric treatment. This paper describes our experiences and challenges while managing the psychiatric COVID-19 unit that may serve as a model for other health care facilities during the COVID-19 pandemic.

Management of neurosurgical patients during coronavirus disease 2019 pandemics:The Ljubljana,Slovenia experience

The novel coronavirus disease 2019(COVID-19)is an emerging disease,caused by severe acute respiratory syndrome coronavirus-2.It bears unique biological characteristics,clinical symptoms and imaging manifestations,therefore presenting an important and urgent threat to global health.As a result,a new public health crisis arose,threatening the world with the spread of the 2019 novel coronavirus.Despite the maximal worldwide public health responses aimed at containing the disease and delaying its spread,many countries have been confronted with a critical care crisis,and even more,countries will almost certainly follow.In Slovenia,the COVID-19 has struck the health system immensely and among all the specialities,neurosurgery has also been experiencing difficulties in the service,not only in regular,elective surgeries but especially during emergencies.The management of these neurosurgical patients has become more difficult than ever.We describe our protocol in the management of neurosurgical patients in the University Medical Centre Ljubljana,Slovenia and how neurosurgical pathology was tackled during the pandemics.

COVID-19 Pandemic: Psychosocial Distress and Social Burdens Experienced by Cancer Patients at Cancer Diseases Hospital, Lusaka, Zambia

Background: Cancer diagnosis has been reported in some studies to have a significant psychosocial impact on both the patients and their caregivers. The estimated prevalence of psychosocial distress is between 35% and 55%. Commonly encountered psychological issues include and are not limited to fear, anxiety, and emotional distress. Many sources of emotional distress in patients with cancer during the COVID-19 pandemic have been reported to include poorly controlled symptoms arising from a lack of access to symptom control services and treatment. Social distress is associated with social isolation, separation from family and loss of employment. Cancer patients and society have been reported to experience anxiety, despair, and stress due to the COVID-19 restrictions on community movement and hospital appointment rescheduling. The objective of this study was to explore psychosocial distress and social burdens experienced by cancer patients during the COVID-19 pandemic. Methods: A descriptive phenomenological design was employed to describe “lived experiences of patients with Cancer” during the COVID-19 Pandemic. A total of 20 participants with Cancer and COVID-19 positive were purposefully selected and interviewed. Thematic analysis was utilized for data analysis by the use of themes generated from participants’ responses. Findings: Five major themes emerged: fear, self-isolation compliance, anxiety, low income and emotional distress. The findings of the study indicated that participants experienced fear, emotional distress and anxiety when diagnosed with COVID-19. Conclusion: The experiences of psychosocial distress and social burdens were a result of a lack of psychosocial support by both caregivers and health care workers. This study recommends appropriate health education concerning psychosocial support for cancer patients and the need to have appropriate clinical protocols and materials in allaying anxiety and fear in cancer patients during the COVID-19 pandemic.

Patients’ Experiences of Trust in the Patient-Nurse Relationship——A Systematic Review of Qualitative Studies

Aims and Objectives: To report a synthesis of the literature on the meaning of trust in the context of patients’ experiences of nursing. The review question was “How do patients describe the meaning of trust in the nursing relationship?” Background: Trust is essential in nursing as it has the potential to create opportunities for the human being to gain faith, hope and meaning in life as well as open up for new experiences. Trust is an interpersonal and essential element of all patient-nurse relationships and requires nurses to create a trusting relationship with the patients. Design: Systematic qualitative literature review. Methods: Systematic searches were conducted for the period January 2002 to December 2012, updated in January 2014. 20 papers were included. Results: Four categories emerged: Attitudes related to trust, indicating that trust is fundamental and existential;Experiences of trust, concerning how trust can be sensed;The patient-nurse relationship, revealing the qualities of the person who creates trust;and Where trust occurs, illuminating the contextual relevancies of trust. Conclusions: Patients’ experiences of trust in nursing are dependent on the nurses’ knowledge, level of commitment in the dialogue to creating and developing the relationship and contextual issues. Implications for nursing practice: Reflection on a trusting relationship with the patient is necessary for a deeper conceptual understanding of trust in nursing. Clinical nurse researchers nurse supervisors, managers and nurse educatorsshould discuss different areas of trust during nursing supervision and focus-group meetings as well as with nursing graduates to ensure that nurses develop knowledge of how to create a trusting patient-nurse relationship.

Nursing students’ experiences of caring for dying patients and their families: a systematic review and meta-synthesis

Objective: Nurses play important roles in caring for dying patients and their families. Difficulties students confronted when facing dying patients challenge the quality of nursing education. A better understanding of students' experiences would enhance teachers' ability in helping students. This study aims to describe available evidence about nursing students' experiences when caring for dying patients and their families.Methods: A review of qualitative studies published between 2005 and 2017 was undertaken using the following databases: MEDLINE, CINAHL, ProQuest Central, ScienceDirect, and CNKI. The keywords included were nursing students, experience, care, end-of-life, and dying. Qualitative Assessment and Review Instrument was used to assess the quality of the studies by two independent reviewers. The data from the studies were analyzed by meta-synthesis.Results: Eighteen English and two Chinese studies were selected in this review. Four themes were emerged:(1) Students with dying patients: students did not have enough ability in symptoms control, comfort supply, and therapeutic communication for dying patients.(2) Students with the patients' families: students advocated more caring for patients' families.(3) Students with the surroundings: professional medical staffs, especially the nursing preceptors, were key roles in constructing a supporting system for students.(4) Students with themselves: nursing students underwent various negative feelings and adopted both negative and positive strategies to cope with such feelings;students experienced professional and personal development during the caring for dying patients.Conclusions: Nursing students' abilities in terminal symptom control, comfort supply, and therapeutic communication should be improved by more theoretic learning and simulation practice. The nursing preceptors were key roles in constructing a supporting system for students and helping them to control the negative emotions when facing dying patients.