Human Caring Perspectives of Care Meanings and Expressions in a Nigerian Cancer Care Setting.

BACKGROUND: Caring in Africa is often viewed from sociopolitical and humanity perspectives. OBJECTIVE: The aim of this study was to investigate the meanings and expressions of caring from the narratives of persons living with cancer and their nurses. METHODS: This study adopted a qualitative ethnonursing methodology. A purposive sampling technique was used to select the key participants, who were grouped into 7 nurses and 6 patients. General participants included 4 physicians, 3 ward assistants, and 6 patients' relatives. Interviews of participants were digitally audio-taped and then transcribed verbatim. Data analysis in this study followed the phases of ethnonursing data analysis enabler and was conducted using NVivo 14 software. Data categories were reviewed and sorted to discover recurrent patterns within the data. RESULTS: Caring was seen as a social practice that is both transactional and transformational. Six thematic patterns emerged: restoring hope, reaching out to the inner lifeworlds of the patients, mutual empathy, going the extra mile, compassionate presence, and being human/having a sense of human connection. The study revealed that there are discernible patterns in care needs and expectations, even though each cancer patient is unique in his or her specific care needs and expectations. CONCLUSION: Caring in this study constituted a variety of meanings, and human caring was demonstrated and practiced interpersonally. Hence, there is evidence of living caring in everyday life, in observable ways. IMPLICATIONS FOR PRACTICE: Nurses should enhance both their own and the patient's sense of personal meaning in the caring partnership to enable them to be present in concrete unique nursing situations with the suffering human being.

Bringing Delirium to Light: Impact of CAM-ICU Tool to Improve Care Coordination.

BACKGROUND: Delirium is a serious complication in patients in the critical care unit (CCU) that may lead to prolonged hospitalization if left undetected. The CCU at our hospital does not have a framework for determining delirium that could affect patient outcomes and discharge planning. PRIMARY PRACTICE SETTING: CCU in a community hospital. METHOD: A posttest-only design was used for this study. We established a framework for the early assessment of delirium, educated and trained nurses to detect delirium, collaborated with the informatics department, intensivist, nursing, respiratory therapy and worked with case management to deploy the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We used a one-tailed independent t test to determine the impact of CAM-ICU on length of stay (LOS). Cross-tabulation and chi-square tests were used to examine the impact of CAM-ICU tool on home care utilization between the intervention and comparison groups. RESULTS: There was a 3.12% reduction in LOS after implementing the CAM-ICU tool. Also, a reduction in home care service utilization demonstrated statistical significance ( p = .001) between the intervention group (62.5%; n = 177) and the comparison group (37.5%; n = 106). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Case managers are essential in improving care transitions. Case managers need to become competent in understanding the implications of the CAM-ICU tool because of their relevant role in the multidisciplinary rounds as advocates to improve care transitions across the continuum of care. Case managers need to have an understanding on how to escalate when changes in the Richmond Agitation-Sedation Scale scores occur during the multidisciplinary rounds because it can affect care coordination throughout the hospital. CONCLUSIONS: Implementing the CAM-ICU decreased LOS, and reduced health care utilization. The early identification of patients with delirium can affect the outcomes of critically ill patients and entails multidisciplinary collaboration.

Dominant Worldviews, Institutional, and Contextual Factors Affecting Cancer Care: Evidence From an Institutional Ethnonursing Study in Nigeria.

INTRODUCTION: Cancer remains a significant health burden in Nigeria and requires the efforts of all stakeholders to address it. Little is known about how the worldviews of Nigerian patients with cancer and other institutional factors affect cancer management in Nigeria. This paper draws evidence from an ethnonursing study conducted in a Nigerian cancer care setting. METHOD: This study adopted a qualitative design using an ethnonursing approach. The study was conducted in one of the primary cancer treatment centers owned by the federal government of Nigeria. Data collection was conducted using participant observation, interviews, and field notes. Data collected were analyzed using NVivo 12 and presented as categories and sub-categories. RESULTS: Analysis yielded two themes and seven sub-themes. The major themes included (1) dominant worldview and (2) institutional/contextual factors. Participants attributed life, living, and death as being controlled by a supreme being. Cancer care was constrained by unfavorable institutional factors such as lack of equipment, staffing, and intensified workload. DISCUSSION: Cancer institutions should provide more cancer care infrastructure that will facilitate the work of nurses and other health care workers. There should be an enabling environment that would attract and retain nurses in the cancer wards. The hospital environment should be made conducive for the cancer care providers, patients with cancer, and their relatives.

Designing dementia care activation program for Filipino American caregivers.

OBJECTIVE: This research study aims to identify the fundamental components of community adaptation for a culturally tailored care partner activation program for Filipino American family caregivers of patients with Alzheimer's Disease and related dementia (ADRD). DESIGN: The study utilized focus group interviews with community nurse leaders, stakeholders, and family caregivers of patients with ADRD. RESULTS: The research revealed that education and knowledge about the disease, community-based services and facilities, support groups and resources, spiritual and cultural values, and access to transportation are all critical components for community adaptation. CONCLUSION: The findings suggest that a culturally tailored care partner activation program that incorporates these components can enhance the quality of life for Filipino American caregivers and their loved ones with ADRD. The nursing implications of the study underscore the importance of nurses being culturally competent and sensitive to the unique challenges faced by Filipino American caregivers. Nurses can provide valuable support to caregivers by educating them, connecting them with community resources, and advocating for culturally responsive care practices.

Navigating the Complexities of Dementia Care: The Lived Experiences of Black American Family Caregivers.

Black American individuals have a higher rate of Alzheimer's disease and related dementias (ADRD) diagnoses compared to other racial/ethnic groups, and their family caregiver population is expected to increase rapidly over the next 2 decades. The current study aimed to explore Black American women's experiences caring for family members with ADRD. An interpretative phenomenology approach was used to gain a deeper understanding of the caregiving experiences of Black American women. Participants in the study were all Black American married women aged 63 to 81 years (mean = 71.3 years, SD = 6.6 years). Key themes that emerged from the study included: (a) Family Care Obligation, (b) Caregiving Journey, (c) Prioritizing Health Concerns, (d) Coping Behaviors, and (e) Support Needs and Challenges. Family caregivers require ongoing support, education, and guidance. Implications for nursing practice include focusing on family assessments, increased education and awareness, and collaboration with interdisciplinary teams to provide the best resources. [Journal of Gerontological Nursing, 49(6), 19-26.].

Exploring the relationship between planned behavior and self-determination theory on health-seeking behavior among older adults with hearing impairment.

This study aimed to examine the relationship between planned behavior and self-determination theory in predicting health-seeking behavior among older adults with hearing impairment. A total of 103 participants aged 60 years and above completed a self-administered questionnaire that measured variables related to health-seeking intention, knowledge competence, relatedness, attitudes, stigma, and perceived competence and autonomy. The results of the study indicated that both the planned behavior and self-determination theory models significantly predicted health-seeking intention and behavior among older adults with hearing impairment. Higher knowledge competence, relatedness, positive attitudes, and perceived competence and autonomy were found to be significant predictors of health-seeking intention and behavior. The findings of this study suggest that interventions aimed at increasing knowledge competence, relatedness, positive attitudes, and perceived competence and autonomy may be effective in promoting hearing health-seeking behavior among older adults with hearing impairment. Future research may further explore the role of these variables in predicting health-seeking behavior and the effectiveness of interventions in promoting hearing health in this population. Clinical practitioners and healthcare professionals may benefit from these findings in designing targeted interventions for this population.

Risk for post-operative delirium related to comorbidities in older adult cardiac patients: An integrative review.

BACKGROUND: Delirium is defined as a sudden onset of confusion due to disruption in normal brain functioning. Although it is highly prevalent in post-operative patients, most significantly the older adult population, limited information exists explaining why its onset occurs. PURPOSE: This integrative review aimed to synthesise specific comorbidities that can contribute to the development of post-operative delirium in older adult cardiac surgical patients. METHODS: PRISMA statement was used to report the identification, selection, appraisal and synthesis of articles and the PRISMA diagram reports the selection process. The Johns Hopkins Evidence-Based Practice Tools were used as guide in literature review, critical analysis, levelling of evidence and quality rating. PubMed, ProQuest, CINAHL plus, EMBASE, MEDLINE, Ovid Nursing Collection and Cochrane databases were searched from 2015 to 2020. RESULTS: The initial search yielded 1529 articles. Following the removal of duplicates and screening, 14 articles were included for this review. The following comorbidities were identified in the studies: Diabetes mellitus, atrial fibrillation, depression, impaired olfaction, pre-existing cerebrovascular disease, pre-existing cardiovascular disease, insomnia and frailty. CONCLUSION: There was a strong indication of the development of post-operative delirium among older adult cardiac surgical patients with comorbidities. RELEVANCE TO CLINICAL PRACTICE: Awareness of the impact of comorbidities in developing post-operative delirium may help healthcare providers to plan and implement proper care management among older adult cardiac surgical patients with comorbidities.

The Role of Social Engagement in Older Adults' Health.

The purpose of the current study was to explore the association between social engagement and the health status, cognition, and perceived well-being of older adults using data from the National Health and Aging Trends Study. Descriptive statistics, clustering, and regression modeling were performed to analyze the data. We used the regression model to identify statistically significant relationships between the representative variables and the extent to which participants participated in social activities. The most representative variable for each of the three clusters was selected and fitted to the regression model, which consists of (1) acute health problems and events, (2) cognitive and communication barriers, and (3) chronic conditions contributing to long-term health status. A regression model found that two factors-cognitive and communication barriers and chronic conditions contributing to long-term health status-were statistically significant in determining social engagement in older adults. Health care providers should consider various factors in planning and implementing social programs that can positively engage older adults. [Research in Gerontological Nursing, 15(3), 152-160.].