Caring Interventions Research Articles

Development and validation of the Fall Risk Assessment Scale for patients in rehabilitation hospitals: A methodological study.

Falling is a serious threat for patient safety in hospitals. This study aimed to identify the risk factors of fall amongst rehabilitation patients and to use them for developing and validating the Persian version of Fall Risk Assessment Scale (FRAS). The current methodological study was conducted in two phases. In the first phase, based on the review of the literature and investigation of the medical records of 251 patients selected via purposive sampling, the risk factors of fall were extracted and the FRAS was developed accordingly. In the second phase, the face and content validities of the designed scale were determined by cognitive interview and Content Validity Index (CVI) and to evaluate the construct validity, known-groups comparison was performed. Its inter-rater reliability was analyzed using the weighted Kappa Coefficient (κ*). The study adhered to COSMIN guidelines. Fall was significantly associated with disease diagnosis, used medications, history of fall, cognitive impairments, and three items of the Functional Independence Measure (toilet transfer, bed transfer, and shoer transfer). The CVI of the scale was 0.94. The risk for falls group had a significantly higher perceived fall risk than the no risk for falls group, thus establishing known-group validity. Its weighted kappa coefficient was >0.85, its sensitivity was 73%, and its specificity was 82%. The valid and reliable FRAS may accurately assess the level of Fall Risk patients in Rehabilitation wards, helping to predict fall during hospitalization. So, enabling the planning and implementation of effective caring interventions.

Psychometric Evaluation of the Complexity of Care in the Home Care Setting Instrument (COMID) in Italian Language.

To test the psychometric properties of the complexity assessment instrument for home nursing practice (COMID) Italian version. Cross-sectional study. Internal consistency was determined using Cronbach's alpha, whilst the two-way mixed effects, absolute agreement, single measure intraclass correlation coefficient (ICC 3.1) was calculated to evaluate the inter-rater reliability both on individual factors and the overall score. Registered Nurses enrolled at the MSc in Nursing at the University of Applied Sciences and Arts of Southern Switzerland and homecare nurses working for several home care institutions were involved in the data collection process following ad hoc training on the use of the COMID assessment instrument. A total of 220 questionnaires were completed by 36 nurses. Cronbach's alpha was 0.764, in line with the original study. The inter-rater reliability ranged from good (factor 6 ICC = 0.85) to excellent (factors 1-5 ICC > 91), with the ICC assessed on the total score of the COMID also excellent (ICC = 0.95). The COMID Italian version is a valid and reliable instrument for homecare nurses to assess complex situations according to the tests performed on a sample of older people receiving home care in Southern Switzerland. The use of such an instrument will enable the identification of the most relevant areas of complexity to be discussed by the nursing and multidisciplinary team to plan and deliver personalised caring interventions.

Abrupt Terminations In The Treatment of Suicidal and Self‐Harming Young People: The Negativel in the Therapeutic Relationship

Psychotherapy with suicidal and self‐harming young people is complex, as this population group is difficult to engage in treatment and their internal reactions may remain concealed, leading to impulsive suicide attempts or abandonment of treatment. The resulting countertransference reactions of confusion, guilt and shame are most distressing and often cause psychotherapists to avoid treating this population group. Safety concerns increase when self‐destructive patients abandon therapy, or their condition worsens despite the therapist's best efforts. The vicissitudes of the adolescent developmental process suggest that, in some cases, withholding information, rejection of the therapist's caring interventions, and abrupt termination of treatment arise from the need for separation and independence and are ego syntonic and therefore suicide protecting. In other cases, the risk for suicide may be increased because of the transference experience of hostile abandonment. A negative therapeutic reaction (NTR) is a disturbing development in the course of psychotherapy that has not been adequately explained in the treatment of suicidal young people. This article is a consideration of whether these negative reactions associated with abrupt, unplanned terminations, in the treatment of self‐destructive young people, should appropriately be thought of as an NTR or as a developmental stage in separation.

Phenomenological characteristics of autobiographical future thinking in nurses with burnout: a case-control study.

Nurses constitute the largest group of healthcare workers worldwide, and job burnout is very common among them. This study aims to explore abnormal future thinking in nurses with burnout. Additionally, the study investigates whether these manifestations worsen as burnout progresses. The study was conducted in inpatient ward nurses at a tertiary hospital in Hangzhou, China. In the first phase, two group of nurses were recruited: nurses with burnout (N = 70) and nurses without burnout (N = 70). In the second phase, three groups were recruited according to the burnout levels: mild burnout (N = 43), moderate burnout (N = 42) and severe burnout (N = 43). Data on job burnout were obtained using the Chinese Maslach Burnout Inventory. The Sentence Completion for Events in the Future Test (SCEFT) was employed to measure the content of future thinking, which was evaluated by two raters in terms of the specificity, emotional valence, and concrete content of the imagined future events. The proportions of specific types of events among all the produced events were calculated. The results revealed that nurses with burnout, compared to nurses without burnout, imagined fewer specific future events, positive events, and events related to relationships and achievement. They also had more omissions. As the level of burnout increased, their impairment in future thinking worsened. Furthermore, the results also revealed that the scores of emotional exhaustion, depersonalization, and personal accomplishment had significant correlations with the proportions of positive events and events related to relationships and achievement/mastery in nurses' future thinking content. The future thinking ability of nurses with burnout was impaired, and this impairment worsened as the symptoms of burnout progressed. The findings of the present study have important implications for nurse caring and advocate effective interventions targeting positive future thinking to mitigate nurses' burnout.

Nutritional Care for Institutionalized Persons with Dementia: An Integrative Review.

Older people are at risk of malnutrition, especially when they suffer from cognitive impairment. Guidelines that orient nursing care in this regard need to be updated. The aim of this review is to address the best available evidence on interventions that can benefit nutritional nursing care for institutionalized older adults with dementia. Integrative review using the Dimensions and Eureka search engines, and the PubMed, Embase, Scielo, CINAHL, and ScienceDirect databases. We searched from the year 2015 through to 2021. We employed the MMAT guidelines for mixed, qualitative, and quantitative studies, and the PRISMA, CASP, and JBI guidelines to value the reviews. A total of 55 studies met the inclusion criteria. The best available evidence to support nutritional nursing care for institutionalized older adults with dementia highlights several aspects related to the assessment and caring interventions that are focused on people with dementia, their caregivers, and their context. Both the assessment and nutritional care interventions for older people with dementia should consider the patient-caregiver dyad as the subject of care and understand the context as a fundamental part of it. The analysis of the context should look further than the immediate environment.

Lessons Learned From Implementing a Caring Contacts Clinical Practice Guideline Recommendation.

The U.S. Department of Veterans Affairs (VA) and Department of Defense clinical practice guideline on the treatment of veterans at risk for suicide recommends considering caring contacts interventions after a psychiatric hospitalization for suicidal ideation or suicide attempt. This quality improvement project examined the implementation of the recommendation at a large VA health care system. The project enrolled 29% of hospitalized veterans (N=135 of 462). Enrollment barriers included lack of staff availability and veteran ineligibility due to homelessness or housing instability. Opportunities to improve the reach of the intervention in future quality improvement processes are discussed, especially because acceptability of the intervention was high among veterans.

Effect of a Nurse-Led, Patient-Centered, Gratitude Intervention on Patient Hospitalization Experience.

Objectives were to evaluate patient perceptions of a nurse-led, patient-centered gratitude intervention and if nurses identified actionable items to improve patient's hospitalization experience. Research demonstrates positive effects of gratitude and caring interventions on patient health and well-being. Evidence is sparse regarding nurse-led gratitude interventions improving hospitalized patient's experiences. In this pilot study, 91 adult medical patients completed gratitude forms twice daily for up to 6 shifts and a study discharge form documenting intervention perceptions. In response to the patients' gratitude-related feedback, RNs recorded patient experience-related actions they and interprofessional teams could implement. On average, patients perceived the nurse-led gratitude intervention as helpful (4.2) (1 = very unhelpful, 5 = very helpful) and improved hospitalization experiences (4.3) (1 = seldom, 5 = never). Most of the time actions were required or to be taken, based on patient gratitude intervention responses. Patient perceptions of nurse-led gratitude intervention demonstrated helpfulness and improved hospitalization experience.

Spotting good ageing: using welfare theory of health to frame the agency of older adults with immigrant backgrounds to attain good ageing

ABSTRACT Care providers for older immigrants in Sweden find themselves in a paradox. Individuals and associations call for culturally sensitive elderly care. However, implementing this comes at the risk of over-culturizing needs and behaviours, drawing a negative picture of ‘the problem of immigrants’ that needs to be solved with special interventions. To find a balance in this paradox, we applied the welfare theory of health to grasp a new understanding of the phenomena and draw a holistic picture of a person’s needs and resources available to achieve good ageing, reaching beyond the cultural paradox. Semi-structured qualitative interviews were conducted with older adults with immigrant backgrounds in Sweden. The interviews were analysed using content analysis. Combining welfare theory of health with immaterial capital theories offered a holistic theoretical approach to good ageing. This took its departure from the agency of older adults, mitigating the gap between their vital life goals and available resources to reach these goals. Although informants wanted caring interventions from close family, we identified distinct responses to mitigate the diminished trust older adults had in the capability of welfare institutions to provide adequate elderly care.

Ethnographic Methods, Music, and Aging

Qualitative methods are proving to be important tools for studying the multi-faceted experience of living with aging, with a focus on the arts. Ethnographic methods are productive ways to discover and examine music in everyday life. Systematically studying the normal and often taken-for-granted ways aging adults experience music, in the full range of settings where they can be found, can abide by the first rule of translational science research: to design and conduct research in order to facilitate the efficient and timely development and application of clinical and caring interventions. This presentation will review a series of ethnographic studies of music experiences in residential facilities, dementia respite groups, family, and hospice. We will suggest ways to apply findings from these studies to enlighten volunteer hospice workers’ protocols for care.

A grounded theory study on work related stress in professionals who provide health & social care for people who exhibit behaviours that challenge.

Providing direct health and social care services for people who exhibit behaviours that challenge can be a highly stressful occupation. Existing literature has suggested that there is a need to develop further theoretical understanding of how work related stress can be reduced in professions that consist of providing care for people who exhibit behaviours that challenge. The aim for this study was to use a Classic Grounded Theory approach to develop a theoretical framework to illustrate a common issue that could influence work related stress levels experienced when managing behaviours that challenge in health and social care settings. A series of focus groups and 1:1 semi-structured interviews were conducted to explore the articulated experiences of 47 health/social care professionals who provide care for people who exhibit behaviours that challenge. This led to the development of Therapeutic Engagement Stress Theory (TEST), which illustrates that the perceived capacity to therapeutically engage with people who exhibit behaviours that challenge is an issue that can influence the levels of stress experienced by health/social care professionals. TEST provides a framework that could be applied to identify specific factors that inhibit staff to successfully deliver caring interventions for people who exhibit behaviours that challenge, and also inform bespoke support mechanisms to reduce stress in health/social care professionals.

Guiding Principles for Transforming Curriculum Through Integration of Technology as Expression of Caring

Challenged by a Summer Academy on humanoid caring robots, members of the Anne Boykin Institute for the Advancement of Caring in Nursing created guiding principles for transforming curricula by integrating technology into nursing education. The guidelines were oriented in academy dialogue on nursing as caring and robotic caring. Articles written for a special topics issue for the International Journal for Human Caring addressed robots in healthcare systems and perspectives on robots as providers of caring interventions. Themes in the articles informed the guidelines. The guidelines might incentivize faculty to integrate humanoid caring robots, a technology exemplar, into nursing curricula.

Where is the Care in Caring: A Polemic on Medicalisation of Health and Humanitarianism

Currently in the caring professions, the human condition of facing uncertainty and danger is often overlooked in the quest for measurable outcomes that prove efficiency, taking agency out of the hands of the individuals being cared for. Traits that make an ‘ideal’ practitioner include compassion, advocacy skills, and the ability to engage with people in vulnerable situations, and to establish trusting, respectful relationships. Within a system of models, quotas, and specialties, these traits are easily hindered within health care and humanitarianism. The critical examination in this article in no way rejects the valuable elements in the fields of humanitarianism and health care. Rather, it discusses how care can be re-introduced. Uncertainty and danger are part of the human experience, and caring interventions need to take that into account. This article highlights the benefits of a collaborative relationship between the person in crisis and the practitioner, instead of a paternalistic relationship in which the practitioner is viewed as the ‘expert.’ With a caring perspective, the individual who is experiencing the crisis will retain ownership of and responsibility for their life, and not rely solely on external sources of wellbeing and comfort.

Investigating the Relevance of Nursing Caring Interventions Delivered to Patients with Coronary Artery Disease at a Teaching Hospital in China: A Retrospective Study.

Objective: Coronary artery disease (CAD) remains the leading cause of morbidity and mortality worldwide. Previous systematic reviews and meta-analysis of randomized controlled trials concluded that nursing caring interventions (NCIs) are beneficial for coronary artery patients. However, most of those interventions were conducted in outpatient or home-based settings or through the telephone. Due to its multiple benefits, the authors recommended the application of such interventions to hospitalized coronary artery patients. Currently, little is known on the status of application of such evidence-based interventions in the actual clinical setting for hospitalized coronary artery patients. Similar studies conducted in China were also inadequate. Therefore, this study aimed to investigate the kinds of NCIs delivered to hospitalized coronary artery patients and their consistent relationship with risk factors of CAD found in the clinical records of patients. Results of this study were expected to alert nurses to consider such risk factors when caring for coronary artery patients as well as appraising their caring efforts in improving the patient’s wellbeing for the reduction of morbidity and mortality from a CAD sequel. This report also disseminates some cardiovascular knowledge and health tips to the readers.Methods: A descriptive, cross-sectional, retrospective design using clinical case notes was employed; the study was undertaken in coronary care wards at the teaching hospital in China from November 2017 to September 2018. A total of 300 coronary artery case notes were randomly selected from 700 eligible cardiovascular patients files by using a simple random technique of simple random numbers through Microsoft office excel sheet. Chi-square (χ2) test and multivariate logistic regression analysis for adjusted odds ratio with 95% confidence interval (CI) within its range were used to compare the relationship among independent (patient's demographic and clinical risk factors of CAD) and dependent variables (NCIs implemented to such patients).Results: A total of 300 coronary artery patients’ case notes were audited with a mean age of 63±11.2 years. Of these 175 (58.3%) were males, 126 (42%) were smokers and 224 (74.7%) were hypertensive. NCIs such as “administer coronary artery medication and their instructions” was mostly delivered to 291 (97%) patients. The delivery of three out of eight gathered NCIs were significantly influenced by three or all of these CAD risk factors (age, smoking, hypertension, and diabetes) (p < 0.05 and/or < 0.01) with an adjusted odds ratio (95% CI) within their significant ranges. Patients with diabetes mellitus were five times more likely to influence the delivery of “administer medication and their instructions” than the rest of patients with coronary artery risk factors (p < 0.01; AOR (95% CI) 5.02(2.059-7.207).Conclusion: This study reveals that nurses delivered beneficial evidence-based interventions to patients with CAD. The interventions were significantly consistent with age as an unmodifiable risk factor and smoking, hypertension, and diabetes as modifiable risk factors of CAD. However, the management of stress in these patients was low; and since stress may trigger CAD, it should be assessed and managed appropriately.

Lee Geropalliative Caring Model: A Situation-Specific Theory for Older Adults.

This article describes the Lee Geropalliative Caring Model (GCM), a situation-specific theory that guides geropalliative care, defined as the care of older adults in the last 2 years of life. Underpinned by the theory of human caring, the GCM offers a framework for achieving the person/family outcome of well-being by suggesting caring interventions within 4 priority domains: aligning care, keeping safe, comforting body/mind/spirit, and facilitating transitions to persons with late-stage illness, including frailty and dementia. The GCM can be used to inform practice, policy, education, and research.

The Core of Sibling Stem Cell Donation - A Grounded Theory Study.

Background:There is a lack of theoretical framework supporting stem cell transplant nurses in their assessment, judgment and caring interventions of sibling stem cell donors.Objective:The purpose of this study was to explore sibling stem cell donors’ main concerns and how they deal with them before and after donation.Method:Ten healthy sibling donors, 5 men and 5 women, with a median age of 54 years were included in this study when they were due to donate stem cells to a brother or sister. Data were collected prospectively on three occasions (before the donation and three and twelve months after it) through in-depth interviews, which were recorded and transcribed verbatim for analysis by the Grounded Theory method according to Charmaz.Results:This study describes the efforts of the ten donors to fulfil their duty as a sibling by doing what they considered necessary in order to help. Their efforts were summarised in a process wherein the grounded theory generated three main categories; Prepare, Promote and Preserve. A clear path of transition leading to fulfilment is evident, starting before the donation and continuing for one year afterwards.Conclusions:Being a sibling stem cell donor means doing what you have to do to fulfil your duty and if possible, saving the life of a seriously ill brother or sister. The relationship between the siblings is strengthened by the donation process. Sibling stem cell donation appears to be about fulfilment and the theoretical framework may support clinicians in their evaluation and support of donors.

Palliative care nurses' spiritual caring interventions: a conceptual understanding.

To investigate spiritual caring by palliative care nurses and to describe their interventions. Spirituality and spiritual caring are recognised as integral components of holistic nursing. Qualitative data captured on a questionnaire were analysed thematically ( Braun and Clarke, 2006 ). The study involved forty-two palliative care registered nurses working across seven palliative care services in Sydney, Australia. The research question was: 'What spiritual caring interventions do palliative care nurses use in their practice?' Nurses completed an open-ended questionnaire to identify and interpret their spiritual caring. Three sub-theme categories and four major concepts of spiritual caring. Categories identified are: humanistic, pragmatic and religious interventions; while concepts of spiritual caring are: 'being with', 'listening to', 'facilitation of' and 'engaging in'. A conceptual understanding of spiritual caring was identified.

The association between conscience understanding and clinical performance among nurses working at education hospital of Arak

Background: Patient care with strict professional and ethical standards is an important element in maintaining health-care standards. In this regard, moral behavior of nurses toward patients has an important role in the recovery and return of their health. Conscience acting is suggested to have a positive impact on patients and their relatives. Acting in accordance with the guidance of good values is an incentive to provide good quality care and restricts low-quality performance. In this study, the aim is to determine the clinical relevance between conscience understanding of nurses and their clinical performance. Materials and Methods: In this cross, 194 nurses working in hospitals of Arak Medical Sciences University in 1395 were recruited by random sampling. Demographic and clinical data were collected through questionnaires and were analyzed in terms of descriptive statistics using SPSS 16 software (Chi-square test). Results: The results showed that the perceptions, conscience, and clinical performance based on Chi-square test is not statistically relevant (P ≥ 0.05). However, there was a significant correlation between the areas of health-care interventions and understanding of conscience (P = 0.02) so that 83% (6/50) of the nurses whose caring interventions were at best were also having a higher score on moral conscience. Among the different dimensions of conscience understand, only the moral (ethical) conscience showed a significant relationship with nursing care interventions is (P = 0.03), so that 75 (9.46%) of nurses who scored good in terms of moral (ethical) conscience, also showed a desirable health-care interventions. Conclusion: Nurses, have the main role in improving the quality of health-care services. According to our results, moral conscience considerations have a positive impact on nurses' approach toward patients in terms of health-care interventions. Hence, the moral approach of nurses toward patients and health-care issues can be very fruitful in fulfillment of health-care organization's mission to provide a healthy society. Based on these results, more intention is recommended regarding the nursery education and training in terms of moral and ethical practice.

Nursing Students' Perceptions of Their Own Caring Behaviors: A Multicountry Study

The aim of this study was to identify perceptions of caring behaviors in student nurses from four countries. This study employed a descriptive, comparative survey design. Four hundred sixty-seven students were recruited from four countries (Nigeria, India, Greece, and the Philippines) to participate in the study during the months of September 2013 to January 2014. Data were collected using the Caring Behavior Inventory. The highest ranked subscale was "assurance of human presence" (4.827 ± 0.927), while "positive connectedness" (4.610 ± 0.949) was the lowest ranked subscale. There were no statistically significant correlations between the Caring Behavior Inventory scale and gender (F = 0.215, p = .643), educational level (F = 0.396, p = .529), and family structure of students (F = 0.680, p = .410), except for age (F = 9.380, p = .002, η2 = 0.141) and the country of origin (F = 5.772, p = .001, η2 = 0.036). Students from four countries possess positive caring behaviors, specifically on physically based caring interventions, while there is a need to emphasize expressive caring behaviors during nursing education and training. Caring interventions should be carried out in order to help students build or enhance their caring behaviors that can be adapted to clinical situations.

Innovando en la toma de decisiones compartida con pacientes hospitalizados: descripción y evaluación de una herramienta de registro de nivel de intensidad terapéutica

Background and aimShared decision-making between patients and healthcare professionals is crucial to guarantee adequate coherence between patient values and preferences, caring aims and treatment intensity, which is key for the provision of patient-centred healthcare. The assessment of such interventions are essential for caring continuity purposes. To do this, reliable and easy-to-use assessment systems are required. This study describes the results of the implementation of a hospital treatment intensity assessment tool. Material and methodsThe pre-implementation and post-implementation results were compared between two cohorts of patients assessed for one month. ResultsSome record of care was registered in 6.1% of patients in the pre-implementation group (n=673) compared to 31.6% of patients in the post-implementation group (n=832) (P<.01), with differences between services. Hospital mortality in both cohorts is 1.9%; in the pre-implementation group, 93.75% of deceased patients had treatment intensity assessment. ConclusionsIn hospital settings, the availability of a specific tool seems to encourage very significantly shared decision-making processes between patients and healthcare professionals —multiplying by more than 5 times the treatment intensity assessment. Moreover, such tools help in the caring continuity processes between different teams and the personalisation of caring interventions to be monitored. More research is needed to continue improving shared decision-making for hospital patients

How Later Adolescents With Adult Responsibilities Experience HIV Bereavement in Nigeria: Application of a Bereavement Model

Conceptual models assist in the better understanding of phenomena and also in the planning ofeffective responses. We applied the Dual Process Model (DPM) to examine how six later adolescents (ages 18-24 years) experienced the multiple stressors of bereavement, maturational tasks, and caregiving roles. Using a semi-structured interviewing approach, participants who were purposively recruited narrated how parental loss to HIV impacted their lives. In relation to the proposition of the DPM model, the study revealed that participants (a) anticipated grief before the death of their parents, (b) engaged in activities to return to normalcy after parental loss, and (c) neglected grief emotions in order to cope with the demands of caregiving. The application of a model to examine responses to bereavement can assist health care practitioners to appreciate and have a deeper understanding of how best to approach caring interventions for late adolescents with multiple stressors.