Patients' experiences of having chemotherapy in a day hospital setting

AIM: This paper is a report of a study to explore patients' experiences of having chemotherapy in a day hospital. BACKGROUND: The nature of cancer care has changed dramatically in recent years with most patients receiving chemotherapy in a day hospital. Despite recognition of the need to explore patients' experience of cancer treatment, little research has been undertaken in this specific area. METHOD: A qualitative approach was adopted with a convenience sample of 30 patients diagnosed with cancer and receiving chemotherapy in a day hospital. Data were collected from January 2002 to March 2003 using unstructured tape-recorded interviews and analysed using a narrative framework. FINDINGS: Participants viewed their experiences of chemotherapy treatment from the initial perspective of having to face their need to have chemotherapy. Their experiences in the day hospital had both positive and negative dimensions. Positive aspects related to maintaining a sense of normality and absence of the sick role, whilst negative aspects were related to the dehumanizing, factory-like system in the day hospital. Organizational issues also influenced experiences, including the sense of comradeship with other patients. Participants indicated the need to remain positive about the future and to learn to 'work around' the treatment. CONCLUSION: More effective methods are needed to develop patients' confidence and motivation to realize their self-care potential, together with increased awareness of organizational influences on patient experiences. Nurses need to focus on the 'here and now' concerns of patients as opposed to a biomedical perspective relating to treatment regimes, survival and prognosis.     

Patient subjective experience and satisfaction during the perioperative period in the day surgery setting: a systematic review

This systematic review used the Joanna Briggs Institute Qualitative Assessment and Review Instrument to manage, appraise, analyse and synthesize textual data in order to present the best available information in relation to how patients experience nursing interventions and care during the perioperative period in the day surgery setting. Some of the significant findings that emerged from the systematic review include the importance of pre-admission contact, provision of relevant, specific education and information, improving communication skills and maintaining patient privacy throughout their continuum of care.     

Palliative day care: a qualitative study of service users' experiences in the United Kingdom

In many countries, specialist palliative day care for patients with life-limiting conditions is provided by specific teams of professionals from a range of relevant disciplines. During 2006 to 2007, the day care services at a hospice in the U.K. were redesigned so that specialist palliative care sessions replaced the existing long-established, traditional day care model. The purpose of this study was to enhance the understanding of those aspects of the service that the users valued most (the "X-factor"). Qualitative data were collected via semistructured interviews with 29 patients and eight carers. These data were subjected to a framework analysis. The users of the service used poignant and powerful words to describe the special qualities that they valued, some phrasing it as the X-factor. The data are presented under three themes: the quality of the staff; the sense of community; and relationships. Of these, the relationships between and within the staff and patient groups held the greatest significance for the patients. Service providers need to recognize that opportunities for the formation of relationships between the patients, staff, and carers are of utmost importance when designing palliative day care services.     

军队医院非现役护理文职人员执业感受的质性研究

目的了解军队医院从事临床护理工作文职人员的执业感受,为完善文职人员管理提供理论依据。方法采用质性研究中的现象学研究方法,对9名军队医院护理文职人员进行非结构访谈,并用现象学分析法对获得的资料进行分析和整理,提炼出主题。结果文职人员执业感受的4个主题：自身地位重新确立、适当压力成为良性刺激、现实与期望存在差距、对职业前景感到迷茫。结论军队医院文职人员的职业感受以消极为主,应合理使用与管理文职人员,重视其地位转变后的身份确立、压力缓解、保障落实、职业规划,以稳定护理队伍,促进军队医院护理水平的整体提高。     

A geriatric day hospital in Hong Kong: An analysis of activities and costs

A survey of the activities of a geriatric day hospital in Hong Kong was carried out. It revealed that alternative modalities of hospital-based treatment were impractical and difficult to organize. Most patients and their carers were satisfied with the day hospital service, and the main area for improvement was in transportation. Costs of day hospital treatment were also calculated, and were found to be cheaper than an equivalent period of in-patient rehabilitation or out-patient therapy.     

Exploring the care experience of patients undergoing spinal surgery: a qualitative study

Purpose This exploratory study sought to explore the patient experience of the surgical journey from decision to operate, to hospitalization, discharge and subsequent recovery. Design Patients attended one of two focus group discussions. Patient sample Seven patients that had undergone surgery for spinal stenosis or disc prolapsed participated, aged between 48–75 years (mean age 59); five were male. Methods Patients’ attitudes towards the information and care they received from the point of the decision to operate through to post‐operative recovery were explored. Particular attention was paid to patients’ information needs, support provided, general understanding of the processes and ways in which care could have been improved. Results Patients identified nine main ‘needs’ they felt played an integral part in enhancing the patient experience including the need for reduced waiting times, for better information and preparation, to be proactive, to speak up and ask questions, to feel safe and to be treated with dignity and respect; and the need for ongoing support, human contact, and; continuity of care. Conclusion These findings suggest that there are several measures that could be taken to improve the patient's surgical experience. In particular, providing appropriate information to patients in a timely manner and ensuring that support and advice is easily accessible for those patients that need it are key areas for improvement.     

The experiences and perceived changes of Chinese ex-mental patients attending a holistic psychiatric rehabilitation programme: a qualitative study

The paper reports a study on the subjective experiences and perceived personal changes of Chinese ex-mental patients attending a psychiatric holistic rehabilitation programme. The programme adopted a self-help group approach in which holistic aspects of physical, psycho-social and spiritual needs are emphasized. There are different rehabilitation programmes for chronic mental patients. However, spiritual element is not consciously included in most of these programmes. Furthermore, few studies document the changes of participants attending psychiatric rehabilitation adopting self-help and holistic care principles. A qualitative approach using an in-depth interview was adopted. A total of 20 members from the programme, which was about one-sixth of all the regular group members were recruited. All interviews were audiotaped and transcribed. Data were coded, categorized and developed to different themes using content analysis. Totally, there were 52 themes developed from the data. However, only 13 themes on experiences in the group and nine themes on the perceived personal changes were reported. By attending the programme, participants had positive feelings and gained many positive learning opportunities when interacting with peers. Interacting with group counsellors was also very beneficial to them. Though there were only some improvements physically, there were clear perceived positive changes in the psychological, social and spiritual dimensions. These findings are consistent with those found in the quantitative measures reported previously. The subjective experiences of the participants were positive and they perceived positive personal changes after joining the group. The findings support the effectiveness of the long-term nature of self-help group. Furthermore, the holistic programme helps members rediscover meaning and purpose of life and the religious practices in the group can be regarded to be a protective factor to stress not only to those believers but also to the non-believers.     

Caring for dying patients outside special palliative care settings: experiences from a nursing perspective

The aim of the study was to describe nurses' experiences in caring for gravely ill and dying patients outside special palliative care settings. Tape-recorded qualitative interviews were conducted with a total of nine nurses in primary home care, community care and hospitals. The interviews were analysed according to phenomenological methodology, which resulted in the three common structures: ambition and dedication, everyday encounters, and satisfaction/dissatisfaction. In the 'everyday encounters' structure, the following key constituents emerged: responsibility, cooperation, experience and knowledge, feelings, and time and resources. The results describe the nurses' high ambitions to give dying patients and their relatives high-quality care. Despite this, they experienced greater or lesser degrees of dissatisfaction because of insufficient cooperation, support, time and resources. They experienced satisfaction through contact with patients and relatives, functioning collegial cooperation, and the knowledge, experience and personal growth the care had given them. The results indicate that nurses need the resources such as time, improved methods of communication and cooperation as well as more support in order to give quality palliative care and achieve satisfaction with the outcome. The need for discussion about the conditions for giving palliative care outside the hospices and other special palliative care settings is also elucidated.     

开放式管理和护理在住院精神病患者中的应用体会

目的探讨开放式管理和护理在住院精神病患者中的临床应用效果及存在的问题。方法将100例符合中国精神障碍分类与诊断标准第3版（CCMD-3）的住院精神病患者随机分成观察组（n=50）和对照组（n=50）。两组均为治疗12周以上,精神病症状消失,病情稳定,处于恢复期的患者。采用护士用住院患者观察量表（NOSIE）对两组患者进行观察后评定,并通过计算机处理后评分;采用自编的护士工作自评调查表,对患者进行观察、治疗护理后由护士自评。结果实施开放管理和护理的患者在社会能力、社会兴趣、个人卫生、配合治疗的程度、冲动或攻击行为以及私逃行为方面、护患沟通、改善服务态度和提高护理服务质量方面均比封闭式管理患者有明显的改善。结论对住院精神病患者实行开放式管理和护理适应了现代医学模式,体现了人文关怀和人性化服务理念。同时改善了服务态度,提高了护理服务及康复的质量,减少了病情复发。     

Patients' experiences of laparoscopic cholecystectomy in day surgery

Previous research has concentrated mainly on surgical aspects and postoperative complication rates after day surgery laparoscopic cholecystectomy (LC), and less on patients' experiences and nursing care aspects. A qualitative study was conducted aimed at investigating patients' experiences of LC in day surgery. Ten women and two men were interviewed. The material was coded, categorized and analysed using qualitative analysis. The findings demonstrate that individuals with gallstone disease experience limitations in their daily life and feelings of socially handicapped. Prior to surgery, the patients felt anxious and expressed a wish for tranquilizers, and to meet the surgeon responsible. At discharge after day surgery, amnesia was experienced and the respondents did not remember important information about the operation given by the surgeon. Experience of postoperative pain varied greatly. Several respondents had a relapse of pain on the third day lasting up to 1 week. The need for additional pain medication and a bloated feeling were reported. Some respondents reported nausea and vomiting, and most had questions about wound care. The need for additional telephone follow-up was mentioned, as was the fact that it was difficult to come home to small children. However, the great majority felt that returning home on the same day as the operation, was positive.     

PICC延续护理模式在基层医院的应用研究

目的探讨基层医院PICC延续护理模式对PICC带管出院肿瘤患者实行导管院外维护的应用效果。方法将202例PICC置管带管出院的肿瘤患者分为观察组102例和对照组100例,观察组以医院为中心建立乡镇卫生院维护点,培训维护点PICC维护人员,规范PICC导管维护流程及操作规程,医院PICC专业小组护士定期到乡镇卫生院维护点进行考核评估,以保证PICC维护质量;对照组返回医院进行PICC维护。结果观察组和对照组置管后导管相关并发症的发生率比较差异无统计学意义(P0.05);观察组患者对护理服务的满意度高于对照组(P0.05)。结论基层医院PICC延续护理,方便了肿瘤患者就近维护,降低维护成本,提高了患者的满意度。     

Factors affecting the quality of nursing care: the patient's perspective

The study described in this paper explored the adult patient's perspective of quality nursing care in acute-care hospital settings in Western Australia. Using grounded theory methodology, the author sought also to discover factors perceived by patients to influence the delivery of high quality nursing care. The findings revealed that patients perceived different levels, in terms of quality, of the care delivered. The level of quality of care was found to depend on certain contextual and intervening conditions pertaining to the broader environment, the organisation and personal factors of the nurse and patient. Variations in patient satisfaction and patients' feelings of vulnerability were related to the levels of care they received. The factors perceived by patients as either inhibiting or enhancing the quality of nursing care are the focus of this paper.