The role of next of kin of patients with cancer: learning to navigate unpredictable caregiving situations.

AIMS AND OBJECTIVES: The aims of this study are to develop knowledge about (1) the experiences of next of kin in caring for seriously ill patients with cancer and (2) the effects of strain and support on the next of kin's ability to cope. BACKGROUND: Better treatment has resulted in patients with cancer normally living longer. Because this treatment is typically administered in a polyclinic or at home, next of kin inherit the largely unknown and demanding role of caregiver. DESIGN: A qualitative, descriptive and interpretive design. METHODS: Focus group interviews were used. The sample comprised 16 adults who were the next of kin of patients with cancer. A thematic content analysis was performed, the text coded for meaning units, condensed and interpreted based on the understanding of the next of kin's role and ability to handle the situation. RESULTS: The role of next of kin is multifaceted and challenging. It is important for next of kin to be near and to take care of the sick. Next of kin's acceptance of the situation plays a crucial role in their ability to cope and to look forward. The unpredictability of the situation adds stress and affects the daily routines. CONCLUSIONS: Providing next of kin with knowledge, support and guidance is important in helping them to understand and cope with the situation and to reduce the amount of strain that they experience in the caregiving role. RELEVANCE TO CLINICAL PRACTICE: This study emphasises the importance of health workers in possessing the knowledge and competence required to educate, guide and support the next of kin of those with cancer. Health workers should provide care to next of kin, and a support system for next of kin must also be available.

Cancer nurses narrating after conversations with cancer outpatients: how do nurses' roles and patients' perspectives appear in the nurses' narratives?

AIM: The aim of this study was to contribute to knowledge of nursing practice in the cancer care field by exploring cancer nurses' perceptions of conversations with cancer outpatients. BACKGROUND: Current practice at cancer outpatient clinics in Norway is that nurses have planned conversations with patients and relatives as a follow-up after patient-physician conversations about assessment and medical treatment. Little is known about nurses' experiences of conversations in the ambulatory context. This study reports the experiences of initial patient-nurse consultations. Data were collected in 2006-2007. DESIGN: A qualitative phenomenological hermeneutic study was performed. A purposive sample of 12 cancer nurses was selected for qualitative interviews where nurses were narrating about conversation experiences. Significance and meaning of conversation experiences were analysed within a hermeneutic perspective, inspired by Ricoeur. Anonymity and voluntary participation procedures were followed. Ethical approval for the study was obtained from the Regional Committee for Medical Research Ethics of the region. FINDINGS: There were plots of nurses experiencing conversations as hard work, routine work or artistry. The nurses' conceptualizations of their roles as an information provider, or patient-centred caring role were rooted in rules of the nursing community or in humanistic caring ethics. Differences of nurses' perceptions and experiences of conversations are explained by different attitudes and role appreciations. CONCLUSION: Cancer nurses' role appreciation and meaning horizons are guiding their perceptions of patient-nurse communication. Feeling free to act in interplay with patients' voices, the patients' perspectives become foreground. There is an educational challenge here in terms of developing methods to help nurses to discover how their mental work and meaning horizons guide conversational practice.