Registered nurses' experience of care for adult patients with a temporary tracheostomy at general hospital wards. A phenomenological-hermeneutic explorative study.

BACKGROUND: Caring for adult patients with a temporary tracheostomy in general wards can be challenging and complex. Little research has explored registered nurses' experiences with caring for these groups of patients. OBJECTIVES: This study sought to interpret and describe registered nurses' lived experiences of caring for adult patients with a tracheostomy in general wards. RESEARCH DESIGN/METHODOLOGY: Six registered nurses were interviewed in this study. The interviews were analysed to gain comprehensive knowledge about caring for adult patients with a temporary tracheostomy. The interviews were transcribed, analysed, and interpreted by using Gadamers philosophical hermeneutics and Kvale and Brinkmann's three steps of understanding. SETTING: Three different wards medical, surgical, and neurological of a teaching hospital in Norway. FINDINGS: Three themes emerged from data analysis. These included experiencing clinically challenging patients, a lack of clinical support from the intensive care nurses, and a lack of professional confidence. CONCLUSION: This study highlighted the challenges surrounding the care of an adult patient with a tracheostomy in the general wards. Identifying these challenges would lead to further improvement in registered nurses' experiences and, in turn, in the quality of competent care for adult patients with a tracheostomy in the general ward. IMPLICATIONS FOR CLINICAL PRACTICE: Understanding the registered nurses' experiences will assist the head nurses in planning and providing relevant information and education to provide safe and holistic patient care. Adequate support from intensive care unit nurses and professional development are required to ensure high-quality care. This study recommends that healthcare managers focus on establishing step-down units to improve patient outcomes, especially for high-risk patients and to increase the competencies of registered nurses in caring for adult patients with a tracheostomy as a whole person.

Confronting one's vulnerability - patients with chest pain participating in a high-intensity exercise programme.

AIMS AND OBJECTIVES: To explain the transitional process that individuals with unexplained chest pain undergo while participating in an exercise training programme over time. BACKGROUND: Angina-like chest pain in patients with no obstructive coronary artery disease is a growing problem. Functional limitations, restricted daily activities and reduced quality of life are reported. In addition, physical activity is avoided in this population. DESIGN: The study follows a qualitative classic grounded theory (Glaser ). METHODS: Three times a week for 12 weeks, twelve patients with no obstructive coronary artery disease participated in a high-intensity aerobic exercise training programme supervised by physiotherapists and nurses. The data collection was based on diaries and interviews about the experience and analysed according to the principles of classic grounded theory. RESULTS: The core category was identified as 'confronting one's vulnerability' and included three subcategories: 'balancing existential uncertainty', 'transforming bodily perceptions' and 'becoming a more capable person'. CONCLUSION: The transition was described as a process of becoming more capable. Health professionals should be aware of the significance of high-intensity exercise training for people with unexplained chest pain and of the underlying dimension of vulnerability. RELEVANCE TO CLINICAL PRACTICE: Understanding the transition process that people with unexplained chest pain undergo while participating in a high-intensity exercise training programme promotes a person-centred approach. Taking this substantive theory into consideration will improve the prerequisites for establishing person-centred care.