Psychosocial and emotional management of work experience in palliative care nurses: A qualitative exploration.

BACKGROUND: Palliative care, a crucial aspect of healthcare, faces challenges in psychosocial and emotional management among nurses. With an increasing need for palliative services globally, addressing the emotional well-being of nurses becomes pivotal. AIM: To explore nurses' psychosocial and emotional work experiences in a palliative care department. The focus is on understanding the challenges, identifying coping strategies, and assessing the impact on professional and private life when facing those experiences. METHODS: A phenomenologic-hermeneutical study involving semi-structured interviews was conducted to comprehend the lived experiences of ten nurses working in a hospital's palliative care department in Spain. Hermeneutic analysis was employed to extract patterns and insights from their experiences. The COREQ checklist was used to report this study. FINDINGS: Palliative care nurses perceived insufficient preparation in emotional management, grappling with complex family interactions and unique work dynamics. They highlighted the significance of self-protection strategies, experience, clinical sessions, and external resources. Limited training in emotional resilience and challenges posed by the COVID-19 pandemic emerged as organisational barriers. Nurses expressed a desire for enhanced training and resources. CONCLUSION: The study uncovered a deficiency in the emotional preparedness of palliative care nurses, impacting their professional and personal lives. Despite positive aspects, the emotional toll necessitates attention and intervention. IMPLICATIONS FOR NURSING POLICY: Comprehensive emotional training for palliative care nurses, addressing barriers, providing resources, and acknowledging emotional labour is necessary. Reinstating paused training sessions and considering specific challenges like those posed by the pandemic are vital. Supporting nurses in their professional and private lives is crucial for sustaining quality care in palliative care departments.

Active listening, shared decision-making and participation in care among older women and primary care nurses: a critical discourse analysis approach from a gender perspective.

BACKGROUND: Nursing care for older women represent a challenge worldwide due to its characteristics. When communication is impaired between primary care nurses and older women living alone, an imbalance in power relations occurs. The main objective of this study is to analyse the power relations between older women and primary care nurses in situations of active listening, shared decision-making and participation in care. METHODS: We developed a qualitative study in southern Spain using a discursive and gender approach. We used purposeful sampling to interview older women who lived alone and received home nursing care. Simultaneously, we conducted focus groups with primary care nurses who provided home care to older women. A linguistic analysis of the transcripts was carried out. RESULTS: Nine semi-structured face-to-face interviews were conducted with older women who lived alone and two face-to-face focus groups with four primary care nurses in each. The discourse of the participants demonstrated an imbalance in power relations. Influenced by work overload, active listening was considered a privilege in primary care nurses´ discourse. Regarding shared decision-making, older women´s discourses revealed "mirages" of real situations where they thought they were deciding. Participation in care was difficult since older women saw themselves as a nuisance in nurses´ presence, and primary care nurses did not facilitate older women's engagement. Older women weren´t considered when organising home visits and had interiorised a subordinated feeling. Similarly, a strict sense of identity made primary care nurses feel powerful in their relationships with older women. CONCLUSIONS: The discourse of older women represented them as victims of a hostile panorama whilst they were sometimes satisfied with the deficient care received. The discourse of primary care nurses used more discursive strategies to represent themselves as professionals committed to caring. However, it also revealed deficiencies in care, discriminatory elements, and feelings of being limited by their working conditions. Active listening to older women and engagement in decision-making readjust empower the older women. Attending to the needs and concerns of primary care nurses could recalibrate the power imbalance between them and healthcare organisations.

Health communication and shared decision-making between nurses and older adults in community setting: An integrative review.

AIM: To explore the role of health communication in Shared Decision-Making (SDM) between nursing staff and older people in the community setting. BACKGROUND: Society and healthcare services are marked by an exponentially ageing population, leading to a significant proportion of patients being older adults with highly demanding care needs. Scientific literature supports shared decision-making as a process that engages patients in their care. However, the increasing use of technology and the consequences of the COVID-19 pandemic have influenced how nurses communicate with older patients. Therefore, it is crucial to understand how to develop health communication to reach effective, shared decision-making processes. METHODS: Whittemore and Knafl's integrative review method, the literature search comprised five databases: PubMed, CINALH, Web of Science, Scopus and PsycINFO. RESULTS: The 12 included studies were synthesised into three study patterns: (1) nurse-older patient health communication relationship, (2) older patients' perspectives and (3) nontherapeutic communication in end-of-life care. CONCLUSION: This review underscored the crucial role of effective health communication in shaping SDM dynamics between nursing staff and older people in the community setting. Key elements included transparent information exchange, establishing trust and maintaining communication channels with informal caregiving networks. SDM actions were aligned with preserving older people's autonomy, but communication challenges persisted, particularly in end-of-life situations. Advanced care planning was recommended to address these shortcomings and improve communication among older people, healthcare professionals and families. IMPLICATIONS: Implementing educational measures based on verbal and nonverbal health communication in nursing training could be beneficial. Nursing research could continue to develop and refine specific communication strategies adapted to the social determinants of health for diverse clinical situations regarding older adults in the community setting. REPORTING METHOD: The authors have adhered to relevant EQUATOR guidelines through the PRISMA 2020 checklist. No Patient or Public Contribution.

Integrating shared decision-making, expressing preferences and active participation of older adults in primary care nursing: a systematic review of qualitative studies and qualitative meta-synthesis.

OBJECTIVES: To systematically synthesise the results of primary qualitative studies on how community-dwelling older adults experience shared decision-making processes, express preferences and actively participate in care. DESIGN: Systematic review of qualitative studies and qualitative meta-synthesis. METHODS: We focused on studies about community-dwelling participants aged ≥65 undergoing a health-disease process circumscribed to a primary healthcare setting, and the central theme should focus on either shared decision-making, expressing preferences or patient participation. We searched the following databases: MEDLINE, CINAHL, Web of Science, Scopus and PsycINFO (time publication frame 2012-2022). We excluded studies in those cases where the qualitative results were not analysed or unrelated to the phenomenon addressed, phenomena were not clear enough to be included or the setting did not occur in the community. RESULTS: A total of 12 studies were included in this meta-synthesis. We appraised the quality of the selected studies through Critical Appraisal Skills Programme (CASP) Checklist. The metasummary comprised the frequency and intensity of qualitative patterns across the included studies. The meta-synthesis revealed four influential elements in their interaction: recognising personal qualities, facing professional characteristics, experiences of discrimination and a double-edged context. CONCLUSIONS: The phenomena studied were influenced by how older people approached their role in their binomial relationship with healthcare professionals. Those with a reinforced self-concept were better aware of health-disease-related situations regarding shared decision-making and the importance of being communicatively assertive. Professional characteristics were also crucial in how older people modulated their acting ability through their personality, communication skills and the approach healthcare professionals used towards older adults. Situations of discrimination generated through an imbalance of power inhibited the expression of preferences and hindered the active participation of older people. The context surrounding the participants influenced all these situations, key in tipping the balance between a therapeutic and a harmful side. PROSPERO REGISTRATION NUMBER: CRD42022363515.

Analysing Power Relations among Older Norwegian Patients and Spanish Migrant Nurses in Home Nursing Care: A Critical Discourse Analysis Approach from a Transcultural Perspective.

Power relations in care are the link between patients and nurses regarding communication and the ability to act in this context. It can be affected when there is cultural interference between members, putting mutual understanding at risk in healthcare situations. This study analyses power relations in healthcare situations between older Norwegian patients and Spanish migrant nurses regarding active listening, shared decision-making, and patient participation. We performed a hermeneutical study endorsed in critical discourse studies framework from a transcultural perspective. A purposive sampling included older Norwegian patients living alone and Spanish migrant nurses working in Norway. Eleven face-to-face semi-structured interviews were conducted with older patients and four via videoconference with migrant nurses. The analysis followed hermeneutic considerations by Crist and Tanner, and linguistic analysis was performed. Shared decision-making and active listening situations sometimes showed a power imbalance that negatively influenced older Norwegian patients. However, Spanish migrant nurses were also conditioned by care organising institutions. This power triangle negatively affected the relationship between the older patients and migrant nurses, resulting in a lack of communication, personnel, time and trust. The migratory experience influenced the care provided by Spanish migrant nurses, shaping a series of cultural competencies acquired through the migratory process.

"With your age, what do you expect?": Ageism and healthcare of older adults in Spain.

INTRODUCTION: Ageism could influence the relationship between older patients' meeting needs and healthcare professionals' answers. AIMS: To highlight the experience of older adults with healthcare systems, how they perceive ageism from their healthcare providers, and to explore the relationship between perceived ageism and self-perception of aging (SPA). METHODS: We conducted an exploratory qualitative study. The participants were 14 women over 65 who lived alone in their homes. RESULTS: Professional responses ignored the expression of preferences of the older patients and excluded them from decision-making processes. These answers influenced older patients' use of health services. Moreover, the negative aspects predominated in a SPA influenced by the internalization of stereotypes and a relationship weighed down by ageist behaviors on the part of health professionals. CONCLUSION: Explicit situations of ageism influence an imbalance in power relations between older patients and healthcare professionals, a misuse of health services, and a negative SPA.

Emotional Universe of Nurse Case Managers Regarding Care for Elderly at Risk in Spain: A Hermeneutical Study.

The role of nurse case managers (NCM) involves a rarely visible emotional labor, even more when their role focuses on the care of elders at risk (EAR). Motivated by the lack of qualitative research on the emotional universe of NCM, this study explores the emotional universe (EU) of NCM regarding the care they provide to EAR in primary health care as well as the reasons that generate these emotions. An interpretative-phenomenological approach was implemented in southern Spain, with a purposive sampling that included nurses playing the NCM role for at least three years. Data collection was conducted in two periods (between September 2019 and July 2022). The primary collection tool was the semi-structured individual interview, with starting categories based on Bisquerra's EU taxonomy. The analysis followed Ricoeur's considerations, using the Nvivo software. In the NCM's EU, the recognition of the social phenomena stands out, with an open feeling of empathy regarding the desire of the EAR to continue living at home. However, there was also helplessness, resignation, disappointment, and frustration when EAR rejected their proposals. Furthermore, the system's limitations aroused compassion in the NCM and made them go beyond the limits of their role. This EU requires that their role be valued more, and higher responsiveness must be enforced to improve EAR care.

Care and Rearing of Institutionalized Girls in Arequipa, Peru: An Ethnographic Approach.

INTRODUCTION: Institutional care for children is a global phenomenon. Despite its advantages, common threats have been described. In Peru, more than 70% of institutionalized children/adolescents have living parents who cannot take care of them. The study aims to understand the care/rearing of institutionalized girls in Arequipa, Peru. METHODOLOGY: Ethnographic design, with a sample integrated by 27 institutionalized girls. Data collected based on participant observation and semi-structured interviews. The analysis followed the Method of Constant Comparisons. RESULTS: Five main themes were found: (a) The little house (foster home) is better than my house; (b) They take care of me-even when I am sick-; (c) But . . .; (d) What I have lived is what I am; (e) Happiness fits in this little house. DISCUSSION: An ethnography of care/rearing practices could be helpful for a better understanding of the dimensions of the life of institutionalized girls living in developing countries.