Nurses respond to patients' psychosocial needs by dealing, ducking, diverting and deferring: an observational study of a hospice ward.

BACKGROUND: Psychosocial support is considered a central component of nursing care but it remains unclear as to exactly how this is implemented in practice. The aim of this study was to provide a descriptive exploration of how psychosocial needs (PNs) of patients in a hospice ward are expressed and met, in order to develop an understanding of the provision of psychosocial support in practice. METHODS: An embedded mixed-methods study was conducted in one hospice ward. Data collection included observations of patients' expressions of PNs and nurses' responses to those expressed PNs, shift hand-overs and multi-disciplinary meetings. Interviews about the observed care were conducted with the patients and nurses and nursing documentation pertaining to psychosocial care was collated. Descriptive statistical techniques were applied to quantitative data in order to explore and support the qualitative observational, interview and documentary data. RESULTS: During the 8-month period of observation, 227 encounters within 38 episodes of care were observed among 38 nurses and 47 patients. Within these encounters, 330 PNs were expressed. Nurses were observed immediately responding to expressed PNs in one of four ways: dealing (44.2 %), deferring (14.8 %), diverting (10.3 %) and ducking (30.7 %). However, it is rare that one type of PN was clearly expressed on its own: many were expressed at the same time and usually while the patient was interacting with the nurse for another reason, thus making the provision of psychosocial support challenging. The nurses' response patterns varied little according to type of need. CONCLUSIONS: The provision of psychosocial support is very complex and PNs are not always easily recognised. This study has allowed an exploration of the actual PNs of patients in a hospice setting, the way in which they were expressed, and how nurses responded to them. The nurses faced the challenge of responding to PNs whilst carrying out the other duties of their shift, and the fact that nurses can provide psychosocial support as an inherent component of practice was verified. The data included in this paper, and the discussions around the observed care, provides nurses everywhere with an example against which to compare their own practice.

Observations of professional-patient relationships: a mixed-methods study exploring whether familiarity is a condition for nurses' provision of psychosocial support.

BACKGROUND: There is a popular belief that the professional-patient relationship is a prerequisite in the provision of psychosocial support. Studies suggest that professionals must know, or be familiar with, a patient in order to effectively provide psychosocial support. AIM: To examine the association between familiarity and the provision of psychosocial care by professionals. DESIGN: A mixed-methods study involving participant observation, interviews and organisational and documentary analysis was conducted over 8 months in an inpatient hospice setting. PARTICIPANTS: In total, 38 nurses (registered and auxiliary) and 47 patients were included in a maximum variation sampling strategy. Data were analysed using both qualitative and quantitative techniques. RESULTS: The data disconfirm the belief that familiarity is either a necessary or sufficient condition for the provision of psychosocial support. Nurses familiar with patients did not necessarily respond to patients' psychosocial needs, and nurses with no prior contact with the patient immediately dealt with psychosocial needs. CONCLUSION: Psychosocial support can be provided on a patient's first contact with a clinician and does not rely on building a professional-patient relationship. This suggests that high-quality psychosocial care can be provided in the short time frame available to palliative care clinicians.

A women-centred exploration of postpartum perineal pain when the perineum is diagnosed as intact: A French Gadamerian research study.

BACKGROUND: Postpartum perineal pain is a frequent symptom (90%) with consequences on postnatal health regardless of whether the perineum remains intact. The impact of that pain on both short and long-term health has been studied and literature suggests midwives have a role to play in addressing this issue. However, the determinants of perineal pain when no lesions are identified are under researched and there is little understanding of women's views on this topic. AIM AND OBJECTIVES: The aim of the study was to gain an understanding of postpartum perineal pain when the perineum is considered to be intact. The objectives were •To gain an understanding of postpartum pain and its consequences on health and well-being •To explore women's views and understanding of perineal pain postpartum •To gain an understanding of the determinants of postpartum perineal pain when no anatomic lesion is diagnosed. METHODS: A Gadamerian hermeneutic approach was used to achieve a shared understanding of the issue. Participants were recruited from two maternity hospitals in the French area of Vaucluse. All women aged 18 to 45 years old, having given birth vaginally to a single live child and diagnosed with an intact perineum, were invited to participate in face-to-face interviews. Eleven participants were interviewed once, six of whom agreed to a second interview which took place over the telephone due to Covid lockdown. FINDINGS: The findings identified three major themes 1. Can't honestly call it pain, 2. Reassurance in normality, 3. Managing the unexpected. The use of the word pain to describe perineal sensations in postpartum was questioned by the participants, who used inner resources to deal with these sensations. Fostering self-confidence, having the possibility to explain the sensations and qualifying them as normal were some approaches women usedto manage their postpartum perineal sensations in a positive manner.

Altered progesterone receptor isoform expression remodels progestin responsiveness of breast cancer cells.

The ovarian hormone progesterone is essential for normal breast development and function. However, it is also implicated in breast cancer development. Progesterone signals through two nuclear receptors [progesterone receptor A (PRA) and progesterone receptor B (PRB)], which display striking differences in transcriptional activity when analyzed separately. The two species are coexpressed equally in normal breast, but expression becomes markedly disrupted in breast cancer, where a predominance of PRA is common. To determine the impact on PR transcriptional activity of the shift from coexpression of PRA and PRB, observed in normal cells, to predominance of PRA, common in cancers, we modeled these changes in PR expression patterns using an inducible model of PRA predominance. At short treatment times progestin regulation was directed toward transcriptional modulators, whereas longer exposure more frequently targeted genes associated with regulation of cell shape, adhesion, and metabolism, and a number of these targets acquired responsiveness only when PRA predominance was achieved. Consistent with this, overexpression of PRA altered progestin effects on cell-substrate attachment and focal adhesion signaling. Our data suggest that disrupted balance of PRA and PRB remodels progestin responsiveness and that altered regulation of morphology and adhesion are important components of altered progestin response in breast cancer.