The experience of relatives asked for organ donation. The original project, obstacles, findings, and unexpected results.

In this article we describe the aims of a Swiss cohort study in bereaved relatives who were asked for organ donation. Their experience in the ICU was assessed six months after the donation request by questionnaire (quantitative approach) and, in a subgroup, by interviews (qualitative approach). The difficulties of running such a multitcentre study are reported in detail. A short overview of general findings is given. The unexpected results, namely the impact of our findings on communication skills training in ICU staffs, and the change engendered in the clinical practice of transplantation coordinators in the follow-up of donor families, are described in detail.

[Professional nursing--development and contents of a definition]. / Professionelle Pflege--Entwicklung und Inhalte einer Definition.

This definition of professional nursing was developed at the Institute of Nursing Science, University of Basel, in collaboration with the group of experts from the project "Future of Swiss Medicine" of the Swiss Academy of Medical Sciences. Starting points were existing definitions and a list of desirable contents. Using Grounded Theory approaches, potential contents were analysed and a first draft was written. Through several feedback rounds, this draft was refined to the definition that is presented here. Professional nursing is defined in two core sentences. As regards content, it relates to promoting and maintaining health, preventing health problems, and assisting people in treating illnesses and in dealing with consequences of illnesses and their therapies. The goal is to achieve the best possible results of treatments and care as well as the best possible quality of life in all phases of life until death for the people cared for. Eight additional paragraphs describe to whom professional nursing is directed, the tasks it includes, its essential basics, who delivers it, how it is put into practice, and its context. The definition has a scientific background and incorporates international perspectives and developments. An addendum outlines further thoughts regarding interprofessional collaboration in health care, focal points of nursing education, and future directions of professional nursing. It calls for an optimal collaboration among the different professional groups to reach the best possible outcomes for people with (potential) health problems. Trends in society and health care, especially the growing numbers of old and chronically ill people, will increase the need for professional care. It is necessary to develop new systems and models of care that meet population needs and have a lasting effect. Nursing education must take these future changes into consideration.

The Experiences of Professionals Regarding Involvement of Parents in Neonatal Pain Management.

OBJECTIVE: To explore the experiences of health care professionals related to parent involvement during painful procedures carried out on their infants and to describe contextual facilitators and barriers that influence parent involvement during evidence-based, nonpharmacologic pain relief. DESIGN: Qualitative study with focus group interviews. SETTING: Two Level III NICUs and one Level II NICU in the German-speaking part of Switzerland. PARTICIPANTS: Convenience sample of 17 NICU nurses and six neonatologists. METHODS: Three interprofessional focus group interviews were conducted. Data were analyzed by thematic analysis. RESULTS: Contextual factors among professionals, such as know-how and communication skills regarding neonatal pain management; reflective and collaborative practice; and an attitude of partnership with parents and organizational resources, such as time and staffing, promoted a working atmosphere in which it was possible to talk about neonatal pain with parents. Within this context, parents could be successfully involved in their infant's pain management. In contrast, lack of the aforementioned contextual factors, including an attitude of paternalism toward parents, resulted in a working atmosphere in which professionals "kept silent about pain" and hindered parent involvement during painful procedures. CONCLUSION: The work culture and organizational features of a NICU facilitate or hinder parent involvement in neonatal pain management. Facilitators and barriers should be identified from the individual, team, and system perspectives. Facilitation of parent-centered pain management in infants should be promoted by the organization.

Responses and experiences after radical prostatectomy: perceptions of married couples in Switzerland.

The purpose of this qualitative study was to explore the responses and experiences of a sample of Swiss men after radical prostatectomy and their intimate partners. Interviews were conducted with 10 couples and analyzed using constant comparative method. Getting a grip on it was the core process that was developed. Men focused on regaining control over their lives, urinary and erectile function while wives efforts focused on being there. The results revealed that current clinical practice of follow up at 3 months may not address the serious deficits in the patient's ability to "get a grip" on incontinence and other complications of surgery.

Responding to a crying infant - you do not learn it overnight: a phenomenological study.

OBJECTIVE: to examine the views and practices of first-time and experienced mothers in response to infant crying during the first 12 weeks post birth. DESIGN: longitudinal, qualitative study using an interpretive, phenomenological approach. SETTING: postnatal hospital and home settings in Switzerland. PARTICIPANTS: maximum variation sampling of 15 new mothers of diverse parity and educational background who had given birth to a full-term healthy neonate. METHODS: participant observations in the postnatal ward and two narrative interviews at participants' homes at 6-8 and 12-14 weeks post partum. Data analysis used interpretive approaches of case analysis, thematic analysis and exemplars. FINDINGS: first-time mothers showed some soothing skills from the beginning, but fine-tuned their practices of handling the crying infant and managing their own reactions. With growing experience mothers acquired a differentiated understanding of the crying's reason and urgency and used more successful soothing techniques. At the same time they learned to assess and mitigate their own stress reactions by self-soothing and adopting realistic expectations of normal infant behaviour. Experienced mothers knew the infant's frequent crying would diminish after a while whereas first-time mothers coped without this positive expectation. KEY CONCLUSIONS: with increasing child-care experience mothers' skills and attitudes towards crying changed, leading to a calmer and less escalating response to their crying infant. IMPLICATIONS FOR PRACTICE: inexperienced mothers need information on neonatal crying behaviour and on parents' stress response. They should be taught how to recognise and respond to the new-born's signals, and how to cope with their own stress. Postnatal care should provide novice mothers to learn from experienced role models.

Fatigue in patients undergoing chemotherapy, their self-care and the role of health professionals: a qualitative study.

PURPOSE: Fatigue affects most chemotherapy recipients, who commonly experience it as distressing. Previous publications showed that cancer patients frequently lacked information and education regarding fatigue; and while most engaged in self-care activities, it remained unclear why they chose specific activities or how effective those were. We explored cancer chemotherapy recipients' current perspectives regarding fatigue, with particular attention to related communication with health professionals, self-care activities, and perceived effectiveness of these measures. This study was part of a larger project that explored patients' symptom experiences during chemotherapy over three months. METHOD: In this qualitative study, 19 patients with lymphomas, breast, lung or colorectal cancer participated concurrently with treatment at a Swiss tertiary care hospital's oncology outpatient clinic. Data on patients' fatigue experiences were collected via individual interviews following their third cycle of chemotherapy. Grounded Theory methodology guided data analysis. RESULTS: At the start of their chemotherapy, health professionals informed patients that common side effects included fatigue. While all participants experienced different dimensions of fatigue, then, all were willing to endure it for the sake of an expected improvement in their conditions. Individuals' fatigue experiences depended largely on their particular life and illness circumstances. Most engaged in fatigue-related self-care activities and managed the symptom on their own. Communication with or input from health professionals was virtually absent during chemotherapy. CONCLUSIONS: Adequate and systematic information regarding fatigue and related self-care strategies need to be implemented at the beginning of chemotherapy, along with continuous assessment and individual guidance of patients throughout their treatment.

Do not attempt resuscitation: the importance of consensual decisions.

AIMS: To describe the involvement and input of physicians and nurses in cardiopulmonary resuscitation (CPR / do not attempt resuscitation (DNAR) decisions; to analyse decision patterns; and understand the practical implications. DESIGN: A Qualitative Grounded Theory study using one-time open-ended interviews with 40 volunteer physicians and 52 nurses drawn from acute care wards with mixes of heterogeneous cases in seven different hospitals in German-speaking Switzerland. RESULTS: Establishing DNAR orders in the best interests of patients was described as a challenging task requiring the leadership of senior physicians and nurses. Implicit decisions in favour of CPR predominated at the beginning of hospitalisation; depending on the context, they were relieved/superseded by explicit DNAR decisions. Explicit decisions were the result of hierarchical medical expertise, of multilateral interdisciplinary expertise, of patient autonomy and/or of negotiated patient autonomy. Each type of decision, implicit or explicit, potentially represented a team consensus. Non-consensual decisions were prone to precipitate personal or team conflicts, and, occasionally, led to non-compliance. CONCLUSION: Establishing DNAR orders is a demanding task. Reaching a consensus is of crucial importance in guaranteeing teamwork and good patient care. Communication and negotiation skills, professional and personal life experience and empathy for patients and colleagues are pivotal. Therefore, leadership by experienced senior physicians and nurses is needed and great efforts should be made with regard to multidisciplinary education.