Advance care planning experiences of patients with heart failure and their families: a qualitative systematic review protocol.

OBJECTIVE: This review aims to synthesize advance care planning experiences of patients with heart failure at stage C or D, and the experiences of their families. INTRODUCTION: The high incidence rates worldwide and the health burdens associated with heart failure indicate a need to implement end-of-life care for people with cardiovascular disease. Advance care planning is a core process in effective end-of-life cardiovascular care. Since the trajectory of heart failure is unique, it is necessary to establish patient-specific interventions focusing on their experiences, and develop effective advance care planning interventions. However, no previously published systematic reviews have integrated knowledge of the patient's or the family's experience. Therefore, more comprehensive analyses of the experiences of patients with heart failure and their families are required to conduct better interventions. INCLUSION CRITERIA: This review will consider qualitative studies on the experiences of adult patients with stage C or D heart failure who participated in advance care planning, and the experiences of their families. Studies conducted in all settings that accommodate patients with heart failure will be considered. METHODS: PubMed, CINAHL, Web of Science, Science Direct, Cochrane Central Register of Controlled Trials, PsycINFO, ProQuest Dissertations and Theses Global, Google Scholar, and gray literature will be searched for articles that meet the inclusion criteria. Studies published in English from the inception of the database to the present will be considered. Eligible studies will be critically appraised using standardized JBI tools for qualitative synthesis. The findings will be pooled using a meta-aggregation approach. The final synthesized findings will be assessed according to the ConQual approach to establish confidence in qualitative research synthesis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021229096.

Factors Associated with Japanese Nurses' Support on End-of-life Decision-making: A Cross-sectional Study.

PURPOSE: This study aimed to clarify the factors associated with Japanese nurses' end-of-life decision-making support. DESIGN: Cross-sectional study. METHODS: An online survey was conducted among 278 nurses. FINDINGS: Significantly associated factors included visiting nursing, nursing experience duration, female sex, workshop participation, and time spent on end-of-life care. CONCLUSION: Visiting nursing was the most significant factor associated with nurses' end-of-lifedecision-making support. CLINICAL EVIDENCE: Consideration should be given to the curriculum in basic nursing education related to visiting nursing. It shouldinclude end-of-life care as well as resources for end-of-life decision-making to increase the number of patients who die in their preferred setting.

Patient Perspectives of a Non-Invasive Telemonitoring Tool for Patients with Heart Failure.

AIM: Advancements in telemonitoring (TM) for patients with heart failure (HF) are incongruous because of the effect of TM intervention and various types of TM. This study aimed to clarify patients' experiences in using the TM tool. METHODS: This was a qualitative study. Data were evaluated using qualitative content analysis. Nine patients with heart failure → HF participated and completed the 1-month study period. RESULTS: The experience of this TM tool was determined using semi-structured interviews followed by qualitative content analysis. Finally, five themes emerged: habituation of self-care behaviour, no burden for use, a feeling of security, additional functions and advice rather than guidance. CONCLUSION: This TM tool is easy to use and has the potential to promote self-management in patients with HF. Based on the aforementioned findings, we revised this tool and added some functions and will perform additional tests.

Development of a Home-Based Nursing Intervention Model for Patients With Heart Failure: A Qualitative Feasibility Study.

AIM: To develop and verify the feasibility of a personalized home-based heart failure (HF) nursing intervention model to support HF patients, promote self-management, and avoid HF exacerbation and re-hospitalization. METHODS: Based on processes established in previous studies, literature reviews, and evidence-based guidelines and theories, we developed the nursing intervention model for patients with HF. The goal of this model is to harmonize symptom deterioration prevention behavior and individual lifestyle. After intervention, we conducted semi-structured interviews with participants, and data were transcribed verbatim, after which qualitative content analysis was employed. The contents of visiting nursing practice, opinions on this nursing model, and self-management in patients with HF were analyzed qualitatively and inductively from the viewpoint of practicality and acceptability. RESULTS: Five nurses who provided interventions, as well as five patients with HF, participated in this study. Accordingly, our findings showed that the framework, assessment, and nursing intervention contents of this model can be practical for everyday home nursing visitations. CONCLUSIONS: The content has been revised so that more visiting nurses can use them, including those who have less cardiovascular nursing experience.

Suffering and Attitudes Toward Death of Patients With Heart Failure in Japan: A Grounded Theory Approach.

Early palliative care is needed for patients with heart failure (HF). However, little is known about the suffering and attitudes toward death of these patients before they reach end-stage HF. This study aimed to identify the suffering and attitudes toward death of patients with early- and intermediate-stage HF. Our qualitative research process was guided with a grounded theory approach and consolidated criteria for reporting qualitative research. Participants were selected through theoretical sampling. Data were collected through semistructured interviews, participant observations, and medical records examination. The study included 10 patients. Analysis of the data revealed the core category of "evaluating whether HF hinders the current and future self." From this core category, 6 categories of causal conditions and 3 categories of consequences emerged. Participants with HF evaluated the causal conditions and suffering in the context of how they hindered the ideal state. After recognizing their own suffering, they expressed specific attitudes toward death. The 10 categories revealed in this study elucidate the process by which patients with HF form their attitudes toward death based on suffering. Health care professionals should consider these findings to help facilitate early palliative care interventions.

Study on the status of health-related hardiness and its influential factors among breast cancer patients undergoing radiotherapy / 中国实用护理杂志

Objective:To understand the current status of health-related hardiness among breast cancer patients undergoing radiotherapy and to analyze its influencing factors, and to provide evidence for the development of psychosocial care programs for breast cancer patients undergoing radiotherapy.Methods:A total of 126 postoperative breast cancer patients undergoing radiotherapy were selected from the First Affiliated Hospital of Dalian Medical University from January to September 2018. The self-designed general data questionnaire and Health-related Hardiness Scale (HRHS) were used to analyze the current status and the influencing factors of health-related hardiness among patients.Results:The overall score of health-related hardiness among breast cancer patients undergoing radiotherapy was 127.61±20.19, which was located at the low medium level. There were significant differences in the scores of patients of different ages, education background, marital status, fertility status, children status, family history, religion, family income, and medical insurance forms ( t value was -3.800-8.128, F value was 8.906-274.271 P<0.01). The regression analysis showed that the influencing factors of health-related hardiness were age, family income, marital status, education background, family history, and religion. The degree of the dependent variable was 89.4%. Conclusions:Breast cancer patients undergoing radiotherapy have a low medium level of health-related hardiness, and are affected by age, family income, marital status, education background, family history, and religion.

Experience of Japanese pregnant women with cancer in decision-making regarding cancer treatment and obstetric care.

AIM: Women who are diagnosed with cancer during pregnancy must make difficult, life-changing decisions that affect their own life and that of their fetus. The psychological impact of distress and anxiety resulting from facing often conflicting choices can greatly influence survival in these women. We conducted this study to clarify the experience of pregnant women with cancer in decision-making and to consider the role of nurses in providing care to pregnant women with cancer during their decision-making. METHODS: This qualitative study included post-partum Japanese women diagnosed with cancer who had made any treatment or pregnancy decisions. Data collection was conducted using semi-structured interviews and medical record review. Data were analyzed using qualitative content analysis and classified into subcategories, categories, themes, and phases. RESULTS: Participants comprised eight women with leukemia and cervical, breast, and digestive cancers. The decision-making experiences of these eight pregnant women with cancer were categorized into three phases: the interaction between the woman and her fetus, family members, and medical staff; confrontation with dilemma and uncertainty; and redefinition of the women's own decisions. CONCLUSIONS: The experience of Japanese pregnant women with cancer in decision-making has two aspects: verbal and nonverbal communication with their surroundings and reflection. The role of a nurse is to guarantee these women continuous communication channels and frank dialogue, to empower them in expressing their thoughts and informational needs to medical staff and family members.

Global Survey of the Roles, Satisfaction, and Barriers of Home Health Care Nurses on the Provision of Palliative Care.

Background: The World Health Assembly urges members to build palliative care (PC) capacity as an ethical imperative. Nurses provide PC services in a variety of settings, including the home and may be the only health care professional able to access some disparate populations. Identifying current nursing services, resources, and satisfaction and barriers to nursing practice are essential to build global PC capacity. Objective: To globally examine home health care nurses' practice, satisfaction, and barriers, regarding existing palliative home care provision. Design: Needs assessment survey. Setting/Subjects: Five hundred thirty-two home health care nurses in 29 countries. Measurements: A needs assessment, developed through literature review and cognitive interviewing. Results: Nurses from developing countries performed more duties compared with those from high-income countries, suggesting a lack of resources in developing countries. Significant barriers to providing home care exist: personnel shortages, lack of funding and policies, poor access to end-of-life or hospice services, and decreased community awareness of services provided. Respondents identified lack of time, funding, and coverages as primary educational barriers. In-person local meetings and online courses were suggested as strategies to promote learning. Conclusions: It is imperative that home health care nurses have adequate resources to build PC capacity globally, which is so desperately needed. Nurses must be up to date on current evidence and practice within an evidence-based PC framework. Health care policy to increase necessary resources and the development of a multifaceted intervention to facilitate education about PC is indicated to build global capacity.

Job satisfaction and related factors of nurses in university hospitals: Focusing on collaborative competency factors.

AIM: This study aimed to clarify the association between nurses' job satisfaction, interprofessional collaborative competency and other related factors in university hospitals in Japan. BACKGROUND: Enhancing a team's function in the university hospital setting requires strengthening each professional's competency: high-level professional competency leads to high job satisfaction. METHODS: In 2014, self-administered questionnaires were sent to all nurses working at two university hospitals in Japan. A multivariate analysis of variance was conducted to evaluate the relationship between job satisfaction as the response variable and interprofessional collaborative competency and other variables as the independent variables. RESULTS: Data from 913 nurses were used in the present analysis (response rate: 60.4%). Two factors from the Chiba Interprofessional Competency Scale 29 (factor 1: attitudes and beliefs as a professional; factor 5: attitudes and behaviours that improve team cohesion) and opportunities for information exchange with other professionals outside the hospital had significant relationships with job satisfaction. CONCLUSION: Strengthening interprofessional collaborative competency and increasing opportunities for information exchange with professionals outside the hospital would improve nurses' job satisfaction in university hospitals. IMPLICATIONS FOR NURSING MANAGEMENT: Interprofessional collaborative competency and opportunities for information exchange with other professionals are worth the attention of nursing administrators.

Self-management of congestive heart failure among elderly men in Japan.

The purpose of this study was to explore the process of self-management in elderly male patients with congestive heart failure among those who have had not needed re-hospitalization for more than 2 years. Semi-structured interviews were conducted with 10 male congestive heart failure patients. Interviews were audio-recorded and transcribed verbatim. Data were analysed using the modified grounded theory approach. As a result of the analysis, the core concept identified was a process of living life such that symptoms do not worsen, while balancing good choices and preferences. By trial and error, the men tried to find the limits of physical capacity and dietary choices that would lead to the worsening of symptoms, while also trying to maintain quality of life to the extent possible.