Qualitative health research
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Comparative Study
Home care nurses' provision of support to families of the elderly at the end of life.
In this article we describe our study of assistance for family decisions and caregiving by Japanese home care nurses to families of elderly relatives at the end of life. The participants were 31 nurses who had been evaluated as providing good end-of-life care. ⋯ Home care nurses are responsible for (a) estimating the possibility of dying at home, (b) visualizing what is coming and what can be done, (c) proposing where and how the family can say goodbye, (d) building family consensus, (e) coordinating resources, and (f) offering psychological support for end-of-life care. End-of-life family care by home care nurses is a process in which multiple components of care are provided with changing content as death approaches.
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In this article, we draw on data collected from two samples of home care nurses to examine how relationships between nurses and family caregivers intersected with access to palliative home care nursing services. Participants referred to relationships as important for their practical benefits and for access to care: good relationships enhanced the nurse's ability to assess clients and families and fostered the family's trust in the nurse's care. Although emphasizing the need to build and maintain relationships (often requiring time), participants simultaneously referred to beliefs about the need to control the personal emotions invoked in relationships so as to ensure appropriate access for clients and families. Future research should further explore how the organizational and resource context, and the culture of palliative care, shape nurses' beliefs about relationships in their practice, the nature and types of relationships that can develop, and both client and family caregivers' access to care.
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There are three main conceptualizations of nurses' stress: occupational stress, moral distress, and traumatization (compassion fatigue, secondary traumatic stress, vicarious trauma). Although we have learned a great deal from these fields, some of them lack important contextual aspects of nurses' practice, such as the gendered nature of the workforce and the nature of the work, including bodily caring. The purpose of this study was to reformulate the nature of stress in nursing, with attention to important contextual aspects of nurses' practice. ⋯ Data collection methods included in-depth interviews, participant observation, and focus groups with pediatric intensive care nurses. Data analysis focused on the social organization of nurses' stress, including negotiating power-based hierarchies and articulating the patient to the system. The article concludes with recommendations for addressing nurses' stress through a more critical and contextual analysis.
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Involvement of parents in their children's pain management is universally accepted as best practice, yet there is little understanding of their needs. Twelve parents of children with chronic pain were recruited to this study in which the impact of caring for a child with chronic pain was explored. ⋯ A minority remained in distress, finding an adaptive response to the child's pain challenging. Catastrophic thinking, fear of pain, and the desire to fulfill a nurturing parental role led parents to place themselves continually "on call." Findings indicate that parents might require support to care effectively for their children, and that many of the actions necessitated by children's pain require complex and counterintuitive decisions.
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A growing number of patients search for medical information on the Internet. Understanding how they use the Internet is important, as this might impact their health, patient-practitioner roles, and general health care provision. In this article, we illustrate the motives of online health information seeking in the context of the doctor-patient relationship in Switzerland. ⋯ The initial motivations for online health information seeking are identified in the needs for acknowledgment, reduction of uncertainty, and perspective. Searching health information online was also encouraged by personal and contextual factors, that is, a person's sense of self-responsibility and the opportunity to use the Internet. Based on these results, we argue that online health information seeking is less concerned with what happens during the consultation than with what happens before or after it, in the sociocultural context.