Objective: To ascertain that standard antenatal care (Focused antenatal care) is being received at the Primary Health Care level in urban and rural areas of Ekiti State and to determine the facilitating factors and ch...Objective: To ascertain that standard antenatal care (Focused antenatal care) is being received at the Primary Health Care level in urban and rural areas of Ekiti State and to determine the facilitating factors and challenges to the practice of FANC in urban and rural areas. Design: Cross sectional. Setting: Primary Health Centers Participants: Pregnant women and Heads of health facilities. Methods: Two hundred respondents each from urban and rural areas primary health centres were proportionately selected from 18 primary health centers using simple random sampling. Exit interviews were conducted using the antenatal care exit interview form of the Safe Motherhood Needs Assessment package. In-depth Interviews were conducted with the heads of selected facilities. Data was analysed using descriptive statistics and Chi square test and content analysis for indepth interview. Results: More respondents 58 (29.3%) from the urban areas had the minimum contents compared to 41 (20.7%) of the rural respondents (p < 0.05) and 178 (90.8%) of the urban were taught a range of health education topics compared to 177 (88.5%) (p = 0.45). Urban respondents were about 1.6 times more likely to receive the minimum contents than rural respondents. In-depth interview results explicated the facilitating factors and challenges to focused antenatal care in the study areas. Conclusion: The findings of this study is consistent with other studies establishing the fact that better health service is available to urban residents than rural residents;however, this study has succeeded in comparing the documented standard of antenatal care with what was being practiced in the selected PHCs of the state. The basic contents of focused antenatal care in Ekiti state were received by a small proportion of the respondents, suggesting that focused antenatal care had not fully translated into quality service;one major challenge to the delivery of standard antenatal care was inadequate number of skilled health workers especially in the rural areas. The gap between quality and utilisation of antenatal in urban and rural areas is gradually being closed up;this success should be improved upon and maintained.展开更多
Background: With the inflation of economic constraints on health care and demand to increase care quality, there is an increasing need to develop a clear understanding of what actions by health professionals are perce...Background: With the inflation of economic constraints on health care and demand to increase care quality, there is an increasing need to develop a clear understanding of what actions by health professionals are perceived as threatening quality care. Objective: To explore graduate nursing and pastoral care student’s perceptions of missed care in Norway. Research design: A qualitative study was employed with the formation of six focus groups. Data was analyzed via a thematic content of the discussions. Participants and research context: Thirty-one students attending a University College in Oslo participated. Findings: Five major themes and thirty subthemes were identified. Major themes included labor constraints, organizational contraints, professional constraints, communication constaints and emotional strain. Discussion: Findings of this study resonate with other research as well as with studies on missed nursing care. Findings also lend support to the definition of missed nursing care actions as required care that is omitted, either in part or whole, or delayed. Conclusion: The findings from this study extend understanding of what barriers health professionals perceive as inhibiting them from offering quality care. The focus groups provided a valuable flora for discussion regarding what participants perceived as missed.展开更多
Background: Many studies have focused on exploring the concept of care from patient and nurse perspectives, but knowledge is limited regarding student perceptions. Objective: To explore the meanings given to the conce...Background: Many studies have focused on exploring the concept of care from patient and nurse perspectives, but knowledge is limited regarding student perceptions. Objective: To explore the meanings given to the concept of professional care from the perspective of graduate students in nursing and pastoral care. Research design: A qualitative study was employed with the formation of six focus groups. Data were analyzed via a thematic content analysis of the discussions. Participants and research context: Thirty-one students attending a University College in Oslo participated. Findings: Seven main themes and forty-four subthemes were identified. Major themes included reverence and respect for the dignity and value of human life, bonding, sensitive to self and other, communication, competence, willfulness and deep caring. Discussion: Different levels of intentionality, professional comportment and caring consciousness were revealed in the discussions. Findings also lend support to major beliefs and values in Watson’s Human Caring Theory. Conclusion: The focus groups generated valuable detail of complex experiences behind student’s perceptions, attitudes, beliefs and actions. Focus group methodology can enhance holistic nursing practice by providing opportunities to explore and clarify holistic care values, create opportunities for self-awareness and transformative learning in education, clinical practice, administration and research.展开更多
Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient respo...Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.展开更多
The concepts of patient and public involvement (PPI) have been recognized and linked with quality in health services internationally and in Europe. In England, for more than a decade, NHS policies have increasingly qu...The concepts of patient and public involvement (PPI) have been recognized and linked with quality in health services internationally and in Europe. In England, for more than a decade, NHS policies have increasingly quoted patient-centred services. Limited evidence exists about the implementation of PPI policies and strategies within organisations;three studies only have explored health professionals’ perceptions of PPI. Although nurses’ positive support for patient and public involvement has been noted, comparatively little is known about senior nurses’ experiences of embedding PPI. A national consultation utilising three focus groups aimed to explore senior nurses’ perceptions of challenges and facilitators for PPI implementation. Four Strategic Health Authorities (SHAs) and eleven Primary Care Trusts (PCTs) in England, with fifteen senior nurses with leadership roles and direct PPI experience, participated. Nurses’ perceptions on patient and public involvement, challenges and facilitators for its implementation were discussed. Focus groups were digitally recorded and transcribed verbatim;anonymised transcripts were validated by participants and analysed with thematic analysis. Limited resources, patient representation and recruitment, complexities of implementing PPI and national policy changes were challenging. Commissioning limitations, lack of feedback on patient experience, limited staff awareness, negative attitudes, management of patients and public expectations constituted further challenges. Nursing role characteristics and informal involvement activities, PPI policy and cultural change, commissioning PPI competencies, related service frameworks, providing feedback on patient experiences to staff and recognition of involvement benefits were recognised as facilitators. Findings provided new insights into senior nurses’ experiences and evidence that progress towards meaningful, effective PPI remains slow. However, recognition of existing nursing role characteristics and potential delivery problems created by expanded nursing roles, informal PPI practice and internal organisational sharing of patient feedback may bring an “emerging productive partnership” with nurses enabling and contributing to effective PPI.展开更多
The aim of this study was to gain increased knowledge about nurses’ experiences of care transition of older patients from hospital to municipal health care, based on two research questions: How is nurses’ experience...The aim of this study was to gain increased knowledge about nurses’ experiences of care transition of older patients from hospital to municipal health care, based on two research questions: How is nurses’ experience continuity during care transition of older patients from hospital to municipal health care? How would nurses describe an optimal care transition? Nurses have a pivotal role during care transitions of older patients. More knowledge about their experiences is necessary to develop favorable improvements for this important period in the older patient’s treatment and care. The study has a qualitative explorative design with follow-up focus group interviews. Nurses (N = 30) working in hospital (n = 16) and municipal (n = 14) health care were organized in five mixed focus groups during the period October-January 2014/2015. The focus groups met twice, answering the research questions following a previously circulated semi-structured interview guide. The interview analysis was inspired by content analysis. The analysis resulted in the themes “Administrative demands challenge terms for collaboration” and “Essentials for nursing determine optimal care transitions for older patients”. Administrative demands may prevent nurses’ professional dialogue and collaboration across health care levels. Older patients’ best interests should be ensured through a collaborative relationship between hospital and municipal nurses, to form continuous care across health care levels. Clinical practice should be aware of essentials for nursing, which could influence and facilitate a more individualized and continuous transition for older patients.展开更多
Introduction: Previous studies have shown that a light sedation level is beneficial for intubated patients in the Intensive care unit (ICU). Aim: This study aimed to describe intensive care nurses’ experiences of car...Introduction: Previous studies have shown that a light sedation level is beneficial for intubated patients in the Intensive care unit (ICU). Aim: This study aimed to describe intensive care nurses’ experiences of caring for intubated patients under light sedation. Methods: This study was an explorative descriptive qualitative study. Data were collected from 12 intensive care nurses by three focus group interviews and analyzed using qualitative content analysis. Findings: Five categories emerged from the data: 1) the importance of verbal communication and the nurses’ presence, 2) feelings of frustration and heavy workload, 3) assessment of patients’ pain and anxiety, 4) the nurses’ desire for the development of guidelines, and 5) being inspired by the care. Conclusion: The study found that intensive care nurses were positive towards light sedation care but the organization of care did not support them as the patients cared for with light sedation treatments demanded their physical presence at patients’ bed site.展开更多
Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these...Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants;average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident’s home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents’ hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff’s work routines, capacities and resources.展开更多
Urinary incontinence is a common medical condition among nursing home residents. Urinary incontinence in older people has a multifactorial etiology and is therefore more difficult to assess and treat than urinary inco...Urinary incontinence is a common medical condition among nursing home residents. Urinary incontinence in older people has a multifactorial etiology and is therefore more difficult to assess and treat than urinary incontinence in younger people. Previous research has shown that incontinence care in nursing home residents often is inadequate and little systematized. The aim of this study was to identify perceptions and barriers that influence the ability of the nursing staff to provide appropriate incontinence care. This was a qualitative study using focus-group methodology. Data were collected from three focus-group interviews with 15 members of the nursing staff from six different units in a nursing home. The focus-group interviews were recorded on tape, transcribed verbatim and analyzed according to qualitative content analysis. Three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: “physical and cognitive problems”. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: “lack of knowledge”, “attitudes and beliefs” and “lack of accessibility”. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: “rigid routines”, “lack of resource”, “lack of documentation” and “lack of leadership”. The findings from this study show that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about UI, are the most important barriers to provide appropriate incontinence care.展开更多
文摘Objective: To ascertain that standard antenatal care (Focused antenatal care) is being received at the Primary Health Care level in urban and rural areas of Ekiti State and to determine the facilitating factors and challenges to the practice of FANC in urban and rural areas. Design: Cross sectional. Setting: Primary Health Centers Participants: Pregnant women and Heads of health facilities. Methods: Two hundred respondents each from urban and rural areas primary health centres were proportionately selected from 18 primary health centers using simple random sampling. Exit interviews were conducted using the antenatal care exit interview form of the Safe Motherhood Needs Assessment package. In-depth Interviews were conducted with the heads of selected facilities. Data was analysed using descriptive statistics and Chi square test and content analysis for indepth interview. Results: More respondents 58 (29.3%) from the urban areas had the minimum contents compared to 41 (20.7%) of the rural respondents (p < 0.05) and 178 (90.8%) of the urban were taught a range of health education topics compared to 177 (88.5%) (p = 0.45). Urban respondents were about 1.6 times more likely to receive the minimum contents than rural respondents. In-depth interview results explicated the facilitating factors and challenges to focused antenatal care in the study areas. Conclusion: The findings of this study is consistent with other studies establishing the fact that better health service is available to urban residents than rural residents;however, this study has succeeded in comparing the documented standard of antenatal care with what was being practiced in the selected PHCs of the state. The basic contents of focused antenatal care in Ekiti state were received by a small proportion of the respondents, suggesting that focused antenatal care had not fully translated into quality service;one major challenge to the delivery of standard antenatal care was inadequate number of skilled health workers especially in the rural areas. The gap between quality and utilisation of antenatal in urban and rural areas is gradually being closed up;this success should be improved upon and maintained.
文摘Background: With the inflation of economic constraints on health care and demand to increase care quality, there is an increasing need to develop a clear understanding of what actions by health professionals are perceived as threatening quality care. Objective: To explore graduate nursing and pastoral care student’s perceptions of missed care in Norway. Research design: A qualitative study was employed with the formation of six focus groups. Data was analyzed via a thematic content of the discussions. Participants and research context: Thirty-one students attending a University College in Oslo participated. Findings: Five major themes and thirty subthemes were identified. Major themes included labor constraints, organizational contraints, professional constraints, communication constaints and emotional strain. Discussion: Findings of this study resonate with other research as well as with studies on missed nursing care. Findings also lend support to the definition of missed nursing care actions as required care that is omitted, either in part or whole, or delayed. Conclusion: The findings from this study extend understanding of what barriers health professionals perceive as inhibiting them from offering quality care. The focus groups provided a valuable flora for discussion regarding what participants perceived as missed.
文摘Background: Many studies have focused on exploring the concept of care from patient and nurse perspectives, but knowledge is limited regarding student perceptions. Objective: To explore the meanings given to the concept of professional care from the perspective of graduate students in nursing and pastoral care. Research design: A qualitative study was employed with the formation of six focus groups. Data were analyzed via a thematic content analysis of the discussions. Participants and research context: Thirty-one students attending a University College in Oslo participated. Findings: Seven main themes and forty-four subthemes were identified. Major themes included reverence and respect for the dignity and value of human life, bonding, sensitive to self and other, communication, competence, willfulness and deep caring. Discussion: Different levels of intentionality, professional comportment and caring consciousness were revealed in the discussions. Findings also lend support to major beliefs and values in Watson’s Human Caring Theory. Conclusion: The focus groups generated valuable detail of complex experiences behind student’s perceptions, attitudes, beliefs and actions. Focus group methodology can enhance holistic nursing practice by providing opportunities to explore and clarify holistic care values, create opportunities for self-awareness and transformative learning in education, clinical practice, administration and research.
文摘目的探讨焦点解决短期治疗(Solution-focused brief therapy,SFBT)联合叙事护理对实施安宁疗护晚期癌症患者焦虑抑郁及生活质量的影响。方法选取2022年8月至2023年5月晚期癌症安宁疗护患者作为研究对象,入院时采用医院焦虑抑郁量表(Hospital anxiety and de-pression scale,HADS)进行调查,筛选评分≥8分的患者纳入本研究(n=110),按照随机数字表法分为对照组(n=55)和试验组(n=55)。对照组采用安宁疗护常规护理,试验组在对照组的基础上采用焦点解决短期治疗联合叙事护理进行干预。比较两组干预前后焦虑自评量表(Self-rating anxiety scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)和癌症治疗功能评价量表(Functional assessment of cancer therapy,FACT-G)评分的差异,评价干预效果。结果因病情变化或死亡,试验组完成52例,对照组完成53例。干预前,试验组和对照组SAS、SDS、FACT-G评分比较差异均无统计学意义(P>0.05);干预后,试验组SAS、SDS、FACT-G评分分别为(42.52±2.30)分、(57.63±3.80)分、(67.54±2.52)分,对照组SAS、SDS、FACT-G评分分别为(47.29±2.73)分、(62.25±2.87)分、(64.39±3.08)分,两组比较差异均有统计学意义(P<0.05)。结论SFBT联合叙事护理干预,可降低晚期癌症患者的负面情绪,缓解抑郁焦虑,提高其生活质量。
文摘Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.
文摘The concepts of patient and public involvement (PPI) have been recognized and linked with quality in health services internationally and in Europe. In England, for more than a decade, NHS policies have increasingly quoted patient-centred services. Limited evidence exists about the implementation of PPI policies and strategies within organisations;three studies only have explored health professionals’ perceptions of PPI. Although nurses’ positive support for patient and public involvement has been noted, comparatively little is known about senior nurses’ experiences of embedding PPI. A national consultation utilising three focus groups aimed to explore senior nurses’ perceptions of challenges and facilitators for PPI implementation. Four Strategic Health Authorities (SHAs) and eleven Primary Care Trusts (PCTs) in England, with fifteen senior nurses with leadership roles and direct PPI experience, participated. Nurses’ perceptions on patient and public involvement, challenges and facilitators for its implementation were discussed. Focus groups were digitally recorded and transcribed verbatim;anonymised transcripts were validated by participants and analysed with thematic analysis. Limited resources, patient representation and recruitment, complexities of implementing PPI and national policy changes were challenging. Commissioning limitations, lack of feedback on patient experience, limited staff awareness, negative attitudes, management of patients and public expectations constituted further challenges. Nursing role characteristics and informal involvement activities, PPI policy and cultural change, commissioning PPI competencies, related service frameworks, providing feedback on patient experiences to staff and recognition of involvement benefits were recognised as facilitators. Findings provided new insights into senior nurses’ experiences and evidence that progress towards meaningful, effective PPI remains slow. However, recognition of existing nursing role characteristics and potential delivery problems created by expanded nursing roles, informal PPI practice and internal organisational sharing of patient feedback may bring an “emerging productive partnership” with nurses enabling and contributing to effective PPI.
文摘The aim of this study was to gain increased knowledge about nurses’ experiences of care transition of older patients from hospital to municipal health care, based on two research questions: How is nurses’ experience continuity during care transition of older patients from hospital to municipal health care? How would nurses describe an optimal care transition? Nurses have a pivotal role during care transitions of older patients. More knowledge about their experiences is necessary to develop favorable improvements for this important period in the older patient’s treatment and care. The study has a qualitative explorative design with follow-up focus group interviews. Nurses (N = 30) working in hospital (n = 16) and municipal (n = 14) health care were organized in five mixed focus groups during the period October-January 2014/2015. The focus groups met twice, answering the research questions following a previously circulated semi-structured interview guide. The interview analysis was inspired by content analysis. The analysis resulted in the themes “Administrative demands challenge terms for collaboration” and “Essentials for nursing determine optimal care transitions for older patients”. Administrative demands may prevent nurses’ professional dialogue and collaboration across health care levels. Older patients’ best interests should be ensured through a collaborative relationship between hospital and municipal nurses, to form continuous care across health care levels. Clinical practice should be aware of essentials for nursing, which could influence and facilitate a more individualized and continuous transition for older patients.
文摘Introduction: Previous studies have shown that a light sedation level is beneficial for intubated patients in the Intensive care unit (ICU). Aim: This study aimed to describe intensive care nurses’ experiences of caring for intubated patients under light sedation. Methods: This study was an explorative descriptive qualitative study. Data were collected from 12 intensive care nurses by three focus group interviews and analyzed using qualitative content analysis. Findings: Five categories emerged from the data: 1) the importance of verbal communication and the nurses’ presence, 2) feelings of frustration and heavy workload, 3) assessment of patients’ pain and anxiety, 4) the nurses’ desire for the development of guidelines, and 5) being inspired by the care. Conclusion: The study found that intensive care nurses were positive towards light sedation care but the organization of care did not support them as the patients cared for with light sedation treatments demanded their physical presence at patients’ bed site.
文摘Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants;average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident’s home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents’ hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff’s work routines, capacities and resources.
文摘Urinary incontinence is a common medical condition among nursing home residents. Urinary incontinence in older people has a multifactorial etiology and is therefore more difficult to assess and treat than urinary incontinence in younger people. Previous research has shown that incontinence care in nursing home residents often is inadequate and little systematized. The aim of this study was to identify perceptions and barriers that influence the ability of the nursing staff to provide appropriate incontinence care. This was a qualitative study using focus-group methodology. Data were collected from three focus-group interviews with 15 members of the nursing staff from six different units in a nursing home. The focus-group interviews were recorded on tape, transcribed verbatim and analyzed according to qualitative content analysis. Three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: “physical and cognitive problems”. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: “lack of knowledge”, “attitudes and beliefs” and “lack of accessibility”. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: “rigid routines”, “lack of resource”, “lack of documentation” and “lack of leadership”. The findings from this study show that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about UI, are the most important barriers to provide appropriate incontinence care.
