Home care nursing practice for older persons with heart failure living at home.

AIMS AND OBJECTIVES: To enhance knowledge of how older people with heart failure, living at home, manage their illness with the support of their family caregivers and home care nursing services. BACKGROUND: Heart failure monitoring and self-care have been important means of reducing the serious impact of heart failure. Drawing on theories of practice as enacted and conceptualising service users and their family caregivers as active, the idea of attunement was used to explore how home care nurses work in supporting them. DESIGN: Ethnographic case study. METHOD: Data collection involved home visits and interviews (10 home care users, 10 caregivers, five home care team leaders). Data were field-notes and transcribed interviews. Themes were deductively developed from the findings, informed by the theoretical background, using content analysis. The COREQ checklist was used. FINDINGS: Three themes were developed from the data: (1) Practices of attunement in relations, (2) Becoming among difficulties and (3) Off track-difficult to attune around self-care. CONCLUSIONS: The findings reflect the complexity of heart failure monitoring at home, showing how, in addition to self-care measures, users are supported by an array of informal and formal care. The caregiving situation is shaped by relations among participants and involves making oneself available to the situation. We suggest a stance of attunement for home care nurses, which demands tact and calls for interest, engagement and openness. RELEVANCE TO CLINICAL PRACTICE: Study findings caution against limiting heart failure monitoring to circumscribed tasks, instead calling for a holistic understanding of what may be helpful for users. Home care nurses need time to attune with users living with heart failure and their caregivers to prevent exacerbations and promote well-being. NO PATIENT OR PUBLIC CONTRIBUTION: Although patients were not formally involved in study design ethnography favours their voice.

Community-based dementia care re-defined: Lessons from Iceland.

Studies of families caring for persons with dementia living at home often reflect feelings of being forgotten and abandoned by the authorities to shoulder the responsibility for care-giving. This has increased interest in how formal services can better support these families. This article analyses how health and social care professionals envision the needs of families of persons with dementia living in the community. It also describes the contributions of the formal care system to these families. The study design was qualitative. It involved interviews with professionals (N = 20), field observations from the settings where they worked, and public documents addressing care-giving for people with dementia. Data were analysed using the framework method. The findings reflected how those providing services to persons experiencing cognitive changes mainly understood the services as specialised. They focused on the diagnosis and treatment of the individual with dementia. They considered other aspects of care, such as attending to practical issues of daily life, to be a private matter, for which the family was responsible. In later stages of dementia, specialised day programs become available, offering rehabilitation to motivate positive daily living-for both the person experiencing dementia and family-centred supporters. Professionals in the field described primary care, community-based healthcare and home care services as poorly equipped to support these families. Participants acknowledged that families were often under a lot of stress and might need more support earlier in the illness. However, they saw themselves as powerless. Towards the end of the data collection, services were being re-designed to emphasise the role of primary care. In light of its holistic and family-centred approach, primary care may be well placed to integrate relational understanding of living with dementia and specialised knowledge of dementia treatment.

Facilitation of a Person-Centered Approach in Health Assessment of patients with chronic pain: An Ethnographic Study.

A phenomenologically derived assessment tool, Hermes, was developed in a rehabilitation setting for adopting the central ideals of person-centered care and patient participation into health-assessment practices in nursing. This focused ethnographic study aimed at exploring the feasibility of using Hermes for enabling the application of these ideals into assessment of patients with chronic pain upon admission to a rehabilitation center. Participants were patients with chronic pain, enrolled in rehabilitation, and their nurses. Data were collected by participant observation and interviews, and analyzed by thematic analysis. By the use of Hermes, the impact of illness was explored through supportive connection and dialogue with open, reflective, and interpretative features; understanding of the illness situation was enhanced; and possibilities provided in adjusting to health issues of concern. In sum, Hermes facilitated person-centered participation of patients with chronic pain in their health assessment and made a phenomenological philosophy usable in nursing-assessment practices.

'I try to make a net around each patient': home care nursing as relational practice.

BACKGROUND: As a result of restructuring, home care is increasingly defined in a narrow, task-based way, undermining the holistic nature of practice. Recent practice theories can aid us in articulating the nature of this important, yet often invisible practice. AIM: My aim in this article was to enhance our knowledge and understanding of the nature of home care nursing practice. METHOD: The approach was ethnographic, involving extensive fieldwork and formal interviews with members of five home care nursing teams and 15 older persons receiving care at home in a metropolitan area of Iceland. The study was approved by the National Bioethics Committee. FINDINGS: As a net of services, home care was enacted through relational, but often invisible care practices, relating different actors - patient, family and health-care and social-care workers - in doing the work needed for the older persons to live comfortably at home. The work was collective in that it was shared by different actors and motivated by a common understanding that had developed and was preserved in conversations in the teams. LIMITATIONS: Although the findings are limited in that they only reflect home care as practiced in one neighbourhood, they can be seen as providing important insights into what is needed for home care services to work. CONCLUSION: Home care practice can be understood as relational, aimed at creating a net of needed assistance. This work is a collective accomplishment of the teams and shaped by ideals and values shared among team members.

'This is just what you do when you are pregnant': a qualitative study of prospective parents in Iceland who accept nuchal translucency screening.

BACKGROUND: nuchal translucency (NT) screening, mainly for Down's syndrome, in the first trimester of pregnancy is becoming an established practice in many countries. However, very little is known about parents' knowledge and beliefs prior to undergoing screening. Such information is essential to form guidelines regarding informed decision-making. OBJECTIVES: to explore the influences on prospective parents' decision-making in relation to NT screening in early pregnancy, and to gain insight into how the views of prospective mothers and fathers towards the benefits and implications of screening may differ. DESIGN: a qualitative study using framework analysis based on a grounded theory approach. PARTICIPANTS: 10 couples, who had decided to have NT screening, were recruited from four community health centres in Iceland. All pregnancies were defined as 'low risk' for fetal anomaly. DATA COLLECTION: semi-structured interviews were conducted separately with each prospective mother and father at 7-11 weeks and again at 20-24 weeks of gestation. In total, 40 interviews were conducted. FINDINGS: the majority of prospective mothers in this study had already decided to accept NT screening before they entered the public antenatal care system. The decision to accept screening seemed to lie with the prospective mother and had hardly been discussed by the couple. Differences between prospective mothers and fathers were observed in relation to the expression of expectations towards the benefits of screening and the perception of disability, which is of interest in the context of information provided to prospective parents. CONCLUSIONS AND IMPLICATIONS: the findings from this study are of interest to clinicians and policy makers forming future guidelines for antenatal care both in Iceland and further afield. It highlights the need for information for prospective parents to be in the public domain prior to their contact with maternity services. Additionally, findings add to knowledge of prospective fathers in early pregnancy regarding how their perceptions of disability may contribute to the couple's decision to accept screening.