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1.
BMC Health Serv Res ; 24(1): 457, 2024 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-38609990

RESUMO

INTRODUCTION: Preventative spend is a global health and social care strategy. Improving Cancer Journeys (ICJ) is a proactive, holistic, multidisciplinary project consistent with this agenda, currently being rolled out across Scotland and parts of UK. ICJ helps people with cancer access whatever support they need to mitigate their most pressing concerns. This study hypothesised that ICJ service users should subsequently use less unscheduled care than matched cohorts not using ICJ. METHODS: Retrospective observational cohort study using linked national datasets. N = 1,214 ICJ users in Glasgow were matched for age, sex, deprivation, cancer type, stage, and diagnosis year to two control groups: 1. Cancer patients from Glasgow before ICJ (pre-2014), 2. Cancer patients from rest of Scotland during study period (2014-2018). Cancer registrations were linked for 12-month baseline and study periods to: NHS24 calls, A&E admissions, inpatient hospital admissions, unscheduled care, number & cost of psychotropic prescriptions. Per-person mean service uses were compared between groups. RESULTS: There was a significant increase in NHS24 calls in the ICJ group (0.36 per person vs. -0.03 or 0.35), more and longer A&E attendances in ICJ (0.37 per person vs. 0.19 or 0.26; 2.19 h per person vs. 0.81-0.92 h), more and longer hospital admissions in ICJ (4.25 vs. 2.59 or 2.53; 12.05 days vs. 8.37 or 8.64), more care pathways involving more steps in ICJ (0.77 spells vs. 0.39 or 0.57; 1.88 steps vs. 1.56 or 1.21), more psychotropic drug prescriptions and higher costs in ICJ (1.88 prescription vs. 1.56 or 1.21; £9.51 vs. £9.57 or £6.95) in comparison to both control groups. DISCUSSION: ICJ users sourced significantly more unscheduled care than matched cohorts. These findings were consistent with much of the comparable literature examining the impact of non-health interventions on subsequent health spend. They also add to the growing evidence showing that ICJ reached its intended target, those with the greatest need. Together these findings raise the possibility that those choosing to use ICJ may also be self-identifying as a cohort of people more likely to use unscheduled care in future. This needs to be tested prospectively, because this understanding would be very helpful for health and social care planners in all countries where proactive holistic services exist.


Assuntos
Neoplasias , Humanos , Estudos Retrospectivos , Neoplasias/terapia , Escócia , Prescrições de Medicamentos , Grupos Controle
2.
BMJ Open ; 13(5): e066829, 2023 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-37142317

RESUMO

DESIGN: Analyst blinded, parallel, multi-centre, randomised controlled trial (RCT). PARTICIPANTS: People with confirmed diagnoses of cancer (head and neck, skin or colorectal) attending follow-up consultation 3 months post-treatment between 2015 and 2020. INTERVENTION: Holistic needs assessment (HNA) or care as usual during consultation. OBJECTIVE: To establish whether incorporating HNA into consultations would increase patient participation, shared decision making and postconsultation self-efficacy. OUTCOME MEASURES: Patient participation in the consultations examined was measured using (a) dialogue ratio (DR) and (b) the proportion of consultation initiated by patient. Shared decision making was measured with CollaboRATE and self-efficacy with Lorig Scale. Consultations were audio recorded and timed. RANDOMISATION: Block randomisation. BLINDING: Audio recording analyst was blinded to study group. RESULTS: 147 patients were randomised: 74 control versus 73 intervention. OUTCOME: No statistically significant differences were found between groups for DR, patient initiative, self-efficacy or shared decision making. Consultations were on average 1 min 46 s longer in the HNA group (respectively, 17 m 25 s vs 15 min 39 s). CONCLUSION: HNA did not change the amount of conversation initiated by the patient or the level of dialogue within the consultation. HNA did not change patient sense of collaboration or feelings of self-efficacy afterwards. HNA group raised more concerns and proportionally more emotional concerns, although their consultations took longer than treatment as usual. IMPLICATIONS FOR PRACTICE: This is the first RCT to test HNA in medically led outpatient settings. Results showed no difference in the way the consultations were structured or received. There is wider evidence to support the roll out of HNA as part of a proactive, multidisciplinary process, but this study did not support medical colleagues facilitating it. TRIAL REGISTRATION NUMBER: NCT02274701.


Assuntos
Neoplasias , Pacientes Ambulatoriais , Humanos , Determinação de Necessidades de Cuidados de Saúde , Assistência Ambulatorial , Neoplasias/terapia , Participação do Paciente
3.
J Health Care Chaplain ; 29(2): 211-228, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-35695021

RESUMO

Health is holistic, but health services are often not. Primary care is the first point of contact for patients in the UK, and at least two in every three present with complex bio-psycho-socio-economic issues. In Scotland, the Community Chaplaincy Listening (CCL) service was created to see if chaplains could help. CCL involves specially trained chaplains listening to patients referred to them by general practitioners (GP) for spiritual support. Between 2018 and 2019, 143 people used CCL and completed baseline and post-discharge outcome measures. Mean Scottish PROM scores rose from 7.94 (± 3.4) at baseline to 12 (± 3.5) post discharge, a statistically and clinically significant rise of 4.06 (95% CI, 3-5.12), t(50) = 7.7, p < 0.0001, d = 1.08. The improvement was seen whether patients self-described as religious, spiritual, both, or neither. Health-related quality of life outcomes were mixed but patients referred to the service scored some of the lowest baseline EQ-5D-3L scores ever seen in the literature. Together these results suggest that CCL worked in primary care, especially for patients historically considered "difficult to treat." Limitations of the study are considered alongside implications for commissioners and service developers.


Assuntos
Serviço Religioso no Hospital , Assistência Religiosa , Humanos , Assistência ao Convalescente , Clero , Qualidade de Vida , Serviço Religioso no Hospital/métodos , Alta do Paciente , Assistência Religiosa/métodos
4.
Nurse Educ Pract ; 64: 103449, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36108457

RESUMO

BACKGROUND: Muslims constitute the largest, fastest growing religious minority in the UK. Globally, nurses are legally, morally and ethically obliged to provide non-discriminatory, person-centred, culturally sensitive care. This obligation includes supporting people with their religious needs where appropriate, but there is evidence this is not always happening, particularly for Muslims in mental health care. AIMS: This paper reviewed primary research to address the question: Can mental healthcare for Muslims be person-centred without consideration of religious identity? METHODS: Narrative synthesis and concurrent analysis. Searches were conducted post 2000 in MEDLINE, CINAHL, SAGE, PsychINFO and ASA with terms: 'Muslim', 'Islam* ', 'mental health', 'nurs* ', 'person-cent* ', 'religio* '. Narrative data were analysed for commonalities and themes. FINDINGS: Seven studies of sufficient quality were analysed. Unconscious religious bias was the overarching theme linking the findings that healthcare staff felt ill-prepared and lacked necessary knowledge and experience to work with diverse patient groups. Unconscious racial bias contributed to limited cultural/ religious competence in treatment and care. CONCLUSION: Religious identity is core for Muslim patients, so this group may not be receiving the person-centred care they deserve. Nurses need cultural and religious competence to deliver person-centred, holistic care to diverse patient populations, yet the importance of religious practice can be overlooked by staff, with harmful consequences for patient's mental and spiritual welfare. This paper introduces a welcome pack that could help staff support the religious observance of those Muslim patients/service-users wishing to practice their faith during their stay in health services.


Assuntos
Islamismo , Serviços de Saúde Mental , Competência Cultural , Assistência à Saúde Culturalmente Competente , Atenção à Saúde , Humanos , Islamismo/psicologia
5.
Health Soc Care Community ; 30(6): e5346-e5355, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35946441

RESUMO

Increasing evidence on men's involvement in informal, unpaid care has not transferred to the research literature around men's experiences. The aim was to explore the perspectives of men who are caring for a female partner with cancer over 1 year. Longitudinal narrative interviews (n = 22) were conducted with eight men in the UK from 2018 to 2019. Participants were aged from 32 to 76 years old, were all white British and in heterosexual relationships with women diagnosed with a range of cancer types. Interviews were transcribed and then analysed using a structural and performance approach to narrative analysis. We present, across four scenes, a process of change, transition and emotion management as the men were launched into a role that came with new responsibilities and expectations. Our study advances knowledge by highlighting the way that men perform and reflect on their negotiation with masculine discourses while supporting their partner, with implications for policy, research and practice.


Assuntos
Masculinidade , Neoplasias , Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Narração , Emoções , Negociação , Neoplasias/terapia
6.
J Health Care Chaplain ; 28(2): 147-161, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-32715984

RESUMO

In moving toward professionalising spiritual care in the healthcare system, as an equal partner in whole person care, it has become increasingly important to develop an evidence base for spiritual care interventions, their value and longer-term outcomes for those receiving this care. This study utilised hard copy questionnaires across five Australian general hospitals to investigate patient reported outcomes of in-patient spiritual care. The survey included the Scottish Patient Reported Outcomes Measure (PROM), measures of patient experience and an open-ended question about experience of care. Data indicated a positive correlation between positive experience of spiritual care and a high score on PROM. Qualitative data elaborated on if and how the spiritual care received met patients' needs, the qualities they valued in the provider of this care and impacts of the care they experienced. Further development of the PROM in a variety of situations is however recommended.


Assuntos
Terapias Espirituais , Espiritualidade , Austrália , Humanos , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários
7.
J Health Care Chaplain ; 28(3): 415-430, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34039228

RESUMO

Chaplains help people face some of the most complex, intractable and traumatic issues in their lives. Spiritual care works. Unfortunately, spiritual needs are rarely met in health and social care because a) spiritual distress is not recognised as such, and b) chaplain interventions are undervalued and misunderstood. The Scottish Patient Reported Outcome Measure (PROM) © was created to help provide evidence for the impact of chaplain interventions. The aim of this study was to establish whether the PROM could also be used to identify patients in need of chaplain interventions. To test this psychometrically, Rasch and Confirmatory Factor Analysis was conducted on an international dataset of post intervention PROMS from UK, Europe and Australia completed between 2018-2020 (n = 1117). The data fit the Rasch model, and the PROM demonstrated uni-dimensionality, construct validity and reliability, meaning PROM scores represent a coherent concept. Higher scores represented lower levels of spiritual distress, and the mean score was 12 out of 20. PROM score of 9 was one standard deviation below the norm, a metric routinely used to identify 'clinically important difference' in psychometric scales. A Scottish PROM© score of 9 and under could therefore identify people for whom chaplaincy may be beneficial. The clinical implications of this are considerable.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Análise Fatorial , Humanos , Psicometria , Reprodutibilidade dos Testes , Escócia
8.
Br J Nurs ; 30(14): S4-S13, 2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34288751

RESUMO

BACKGROUND: Vascular access devices (VADs) are essential for delivery of intravenous therapies. There are notable gaps in the literature regarding a focus on patient experience and meaning-making related to living with a VAD, specifically a central venous access device (CVAD). AIMS: To explore how patients make sense of living with a CVAD. METHODS: This study followed an interpretive phenomenological analysis (IPA) approach. Purposive sampling was used to identify 11 cancer patients who had a CVAD in situ. One-to-one semi-structured interviews were performed. Interviews were digitally recorded, transcribed and analysed by the lead author. FINDINGS: Four superordinate themes were identified: the self under attack; being rescued/being robbed; protection of others/protection of self; bewilderment and dismay at lack of staff competence. CONCLUSION: Having a CVAD affects the psychological, social, and personal self and impacts on self-esteem and self-image. Despite this, CVADs are accepted by patients and are eventually 'embodied' by them.


Assuntos
Cateterismo Venoso Central , Neoplasias , Adaptação Psicológica , Cateterismo Venoso Central/psicologia , Humanos , Neoplasias/terapia , Autoimagem
9.
J Clin Nurs ; 30(15-16): 2373-2385, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33949027

RESUMO

AIMS AND OBJECTIVES: To explore how newly qualified nurses' work experiences are constructed through the interplay between self, workplace and home-life influencing their retention. BACKGROUND: Nurses are critical to achieving the goal of universal health coverage. However, shortages of nursing staff are endemic. Of particular concern, newly qualified nurses are more likely to leave the nursing workforce. The point of transition to working as a newly qualified nurse is a time of vulnerability. Most studies attempt to discover why nurses leave. This study uses the concept of job embeddedness to examine the experience of this transition and first two years of practice to understand what might help newly qualified nurses stay. DESIGN: Qualitative approach using semi-structured telephone interviews. METHODS: Self-selecting sample of nurses (n = 23) who participated 1-year (n = 12) and 2 years (n = 11) post-qualification. Participants were part of a larger longitudinal cohort (n = 867) study which has followed them since September 2013 when they entered nurse education in two Scottish universities. Thematic analysis was used to understand the interplay between organisation/workplace and the individual. RESULTS: Three themes were developed: transition shock; workplace factors and work/life balance. Two further subthemes were developed: experience of support and belonging; and feeling unsupported and alienated. Eight participants had changed job or left, and two were looking to leave nursing. CONCLUSION: This study highlights how the experience of transition shock can be positively or negatively impacted by the workplace environment, and how in turn this impacts the home environment. Ultimately, this impacts retention of newly qualified nurses. RELEVANCE TO CLINICAL PRACTICE: Having adequate support resources, such as staffing, supportive team morale, professional development and family-friendly work environment, can create a work environment where they feel the purpose and meaningfulness of working as a nurse. This 'job embeddedness' can potentially enhance nurse retention. Reporting follows the COREQ checklist.


Assuntos
Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem , Humanos , Satisfação no Emprego , Pesquisa Qualitativa , Recursos Humanos , Local de Trabalho
10.
J Pastoral Care Counsel ; 75(1_suppl): 6-16, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33730915

RESUMO

Chaplains' unique contribution is to healthcare is to respond to the spiritual, religious and pastoral needs of patients and staff. This is their sole purpose, to provide a presence and space to meet individual need and promote healing, even when cure isn't possible. Their value is priceless to families in desperate times. However, despite growing evidence for their impact, chaplains are commonly undervalued and misunderstood by their organisations, and the global pandemic revealed the consequences of this confusion. Whilst some chaplains were applauded as heroes along with their fellow health colleagues, others were seen as little more than an infection risk. A survey was designed to capture and learn from the full range of chaplain experiences of the impact of the pandemic across the globe. In June 2020, 1657 chaplains responded from 36 countries. They all experienced considerable disruption to their usual practice, with enforced social distancing having the biggest impact. Out of necessity they embraced technology to maintain contact with patients and families, and shifted focus of their support to staff. Whilst some chaplains were viewed as essential employees by their organisations, most were not. Despite the majority thinking that their organisations understood what they did, chaplains themselves were neither clear or unclear about their role during and post pandemic. More surprisingly, they felt similarly unclear about their role before the pandemic. This paper concludes that in general chaplains lack leadership skills, and confusion about their role will persist until this changes.


Assuntos
COVID-19/psicologia , Clero/psicologia , Assistência Religiosa , Papel Profissional , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distanciamento Físico , Autocuidado , Inquéritos e Questionários , Teletrabalho
11.
Health Soc Care Community ; 28(6): 2060-2075, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32510179

RESUMO

Physical activity is beneficial for mental health, but people with mental health issues are less likely to be physically active than the general population. Socially prescribed programmes of activity are rarely adhered to, with high levels of drop out, and the proportion of people who continue after programmes have finished is even smaller. Lasting change therefore needs a fundamental change in behaviour, so an intervention grounded in behaviour change theory may be more likely to succeed. The aim of this original study was to understand the facilitators and barriers to participation and adherence to a supportive, personalised, physical activity programme for patients with mental health conditions. The intervention entailed a 16-week programme of activity, tailored to individual capability, supported by a dedicated 'behaviour change' practitioner trained in motivational interviewing. Fourteen people who had completed the intervention were interviewed in three focus groups in 2018. Data were transcribed verbatim then analysed for barriers and facilitators using Framework Analysis and the Theoretical Domains Framework. Twenty-five overarching themes were identified, which mapped onto 11 domains from the framework. Ten themes were barriers and 15 facilitators. Barriers included stigma, negative self-beliefs and difficulty trusting others. The facilitators reframed these negative attributes. For example, participants described feeling confident as a function of achieving personalised goals and learning something new. The intervention changed the way participants thought and acted. This original intervention has succeeded where many have failed, as it changed the way these participants with mental health conditions thought about physical activity. By reframing it as personally achievable and physically beneficial, participants' attitudes and behaviour changed as well, making it more likely they would sustain physical activity in future. These unique findings are likely to translate internationally due to the simplicity of the intervention, and the potential to improve lives of the most vulnerable.


Assuntos
Terapia por Exercício/psicologia , Transtornos Mentais/terapia , Exercício Físico/psicologia , Terapia por Exercício/métodos , Feminino , Grupos Focais , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Modelos Psicológicos , Cooperação do Paciente , Pesquisa Qualitativa , Estigma Social , Confiança
12.
Nurs Open ; 7(4): 1118-1128, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32587731

RESUMO

Aim: To explore levels of stigma in students of all fields of nursing and midwifery at different years and examine the impact of exposure to people with mental illness. Design: A cross-sectional survey was used. Methods: The Community Attitudes to Mental Illness questionnaire was administered to all branches of student nurses (adult health, mental health, child health and learning disability) and midwives in all three years in one Higher Education Institution (HEI) in Scotland. Results: Mental health nursing students scored significantly better on all stigma subscales. Stigma worsened with a little professional exposure to people with mental illness but then improved with increasing exposure. Both personal exposure and professional exposure to people with mental illness change perceptions. The professional results follow a J-curve. Current plans for cross-field experience involving short or virtual placements during student nurse training are likely to worsen stigma rather than improve it.


Assuntos
Bacharelado em Enfermagem , Transtornos Mentais , Tocologia , Estudantes de Enfermagem , Adulto , Atitude do Pessoal de Saúde , Criança , Estudos Transversais , Feminino , Humanos , Gravidez , Escócia
13.
BMC Cancer ; 20(1): 528, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503477

RESUMO

BACKGROUND: Cancer impacts on patients and their families across a range of different domains. For that reason, optimal cancer care has moved away from a disease-centric focus to a more holistic approach in order to proactively support people with their individual needs and concerns. While international policy clearly advocates this agenda, implementation into routine care is limited. Therefore, relevant interventions that measurably improve patient outcomes are essential to understand if this ideal is to become routine multidisciplinary practice. The aim of this study was to analyse the impact of a proactive, holistic, community-based intervention on health-related quality of life in a cohort of people diagnosed with cancer. Secondary aim was to explore the relationship between changes in health status and: cancer type, cancer stage, number of concerns expressed and change in severity of concerns pre and post intervention. METHOD: Prospective observational cohort study. A convenience sample of 437 individuals were referred to the service 'Improving the Cancer Journey (ICJ) in the UK. Each completed the Euroqol EQ-5D-3 L and visual analogue scale (VAS) and a Holistic Needs Assessment (HNA) during initial visit to the service and again at follow-up review, median 84 days later. Change between scores was tested with paired t-tests and relationships between variables with multiple regression models with heteroscedasticity-consistent standard errors. RESULTS: Participants were White British with median age between 50 and 64 years. Cancer type and stage were varied. EQ-5D utility scores improved at follow-up by 0.121 [0.0891-0.153], p < .001, and VAS scores improved by 7.81 [5.88-9.74], p < .001. The strongest predictor of change was a decrease in severity of concerns. Cancer stage 'palliative care' contributed to a reduction in health status. CONCLUSION: This study is the first to show that a holistic community intervention dedicated to supporting the individual concerns of participants had both a statistically significant and clinically meaningful impact on participants' health-related quality of life. The mean change in EQ-5D scores was more than the 'minimally important clinical difference' described in the literature. This is important because while quality of life has multiple determinants, this study has shown for the first time that it is possible to capture a clinically meaningful improvement as a function of reducing someone's personally identified concerns.


Assuntos
Nível de Saúde , Saúde Holística , Neoplasias/terapia , Reabilitação Psiquiátrica/organização & administração , Qualidade de Vida , Adulto , Idoso , Pesquisa Participativa Baseada na Comunidade , Feminino , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Neoplasias/psicologia , Estudos Prospectivos , Reabilitação Psiquiátrica/métodos , Inquéritos e Questionários/estatística & dados numéricos
14.
Nurse Res ; 28(2): 32-37, 2020 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-32351078

RESUMO

BACKGROUND: All studies need to integrate their findings back into the literature to explain how the new knowledge changes understanding. This process can be anxiety-provoking, especially when new literature appears to threaten the originality of the study. AIM: To reintroduce 'concurrent analysis' (CA) - a method of synthesising relevant literature with primary data. DISCUSSION: CA treats all data as primary data. To illustrate the technique, the authors synthesise relevant literature with findings from a doctoral study of patients' experiences of vascular access devices. CONCLUSION: CA raised new questions that would otherwise have remained unasked. For example, it revealed cultural differences in the way patients react to suboptimal treatment. IMPLICATIONS FOR PRACTICE: Nurse researchers are best placed to influence policy and practice when they can articulate the transferability of their findings. CA is a practical method of achieving this.


Assuntos
Teoria Fundamentada , Pesquisa Qualitativa , Literatura de Revisão como Assunto , Atitude Frente a Saúde , Humanos , Dispositivos de Acesso Vascular
15.
Br J Nurs ; 29(3): S10-S16, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32053440

RESUMO

BACKGROUND: Internationally, clinicians face increased demand, pressure on resources and unmet patient needs. A community social support service was co-located within cancer clinics in Glasgow, Scotland to help address some of these needs. AIM: To analyse the impact of the service on clinical staff and to propose an explanatory theory of change. METHOD: Qualitative exploratory design, using thematic analysis of semistructured interviews with 8 nurse specialists and 2 medical oncologists from lung, breast, head and neck, and gastrointestinal oncology teams in Glasgow in 2018-2019. FINDINGS: Four themes captured this process: 'The conversation', 'A better experience', 'Freedom to focus' and 'Working hand in hand'. CONCLUSION: Together, these four themes explained the process of effective interprofessional working. This process would have been predicted by the J-curve literature on diffusion of innovations. Linking J-curve theory to this successful process provides new understanding that could prove essential for clinical teams who are implementing change within their practice.


Assuntos
Unidades Hospitalares/organização & administração , Relações Interprofissionais , Humanos , Oncologia , Enfermeiras Especialistas/psicologia , Pesquisa Qualitativa , Escócia
16.
Br J Nurs ; 28(14): S4-S14, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31348702

RESUMO

BACKGROUND: the literature on the patient experience of living with a central venous access device (CVAD) is growing, but remains sparse. It suggests that patients accept having a CVAD as it should reduce episodes of repeated cannulations. However, a recent doctoral study found the reality did not live up to this hope. AIM: the study objective was to uncover the global, cross-disease experience of patients with CVADs. METHOD: an online survey was sent to an international sample of people living with CVADs. FINDINGS: 74 people from eight countries responded. Respondents corroborated the PhD findings: painful cannulation attempts continued after CVAD insertion because of a lack of clinical knowledge. Participants lost trust in clinicians and feared complications due to poor practice. CONCLUSION: clinicians often lack the necessary skills to care and maintain CVADs. This leads to a negative patient experience.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateteres Venosos Centrais , Competência Clínica/normas , Pessoal de Saúde/normas , Pacientes/psicologia , Adulto , Idoso , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Pacientes/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
17.
Eur J Cancer Care (Engl) ; 28(3): e13001, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30734383

RESUMO

OBJECTIVE: "Improving the Cancer Journey" (ICJ) is an original, community-based, multidisciplinary service offering holistic support to people diagnosed with cancer in Scotland. It is the first service of its kind in the UK. The aim of this qualitative study was to explore the experiences of people who have used this service. METHOD: Twenty service users were purposively sampled to capture a diverse range of age, sex, cancer types, and deprivation status. Semi-structured interviews explored their experiences of using ICJ. Interviews were transcribed verbatim and thematically analysed. RESULTS: Thirteen women and seven men (mean age 58 years) were interviewed. Three themes were identified: "one person, one place," "routes to unexpected support" and "safety net." CONCLUSION: Improving the Cancer Journey was perceived to be beneficial because it met the holistic needs of the ICJ service users. By helping people address concerns earlier rather than later, it prevented problems becoming unmanageable. Having an accessible expert to guide and support them through a range of services provided reassurance and created the space to self-manage at a time of distress. These original findings are internationally relevant because there is little evidence on the impact of holistic support services from the patient perspective.


Assuntos
Atitude Frente a Saúde , Saúde Holística , Neoplasias , Apoio Social , Seguridade Social , Adulto , Idoso , Instituições de Caridade , Feminino , Humanos , Governo Local , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Escócia , Medicina Estatal
18.
Cancer Med ; 7(9): 4836-4845, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30101561

RESUMO

BACKGROUND: It is increasingly internationally recognized that a cancer diagnosis impacts on people practically and financially as well as physically and psychologically. It is less clear what to do about this. This study introduces an original community service designed to mitigate this wider impact. Nonclinical "link officers" use holistic needs assessment (HNA) to help newly diagnosed people identify and quantify the severity of their physical, psychological, practical, financial, and social concerns. A care plan is then agreed, usually involving community interventions from partner agencies. Following intervention, assessment is repeated. The primary aim of this study was to establish whether there was a significant difference between initial assessment and follow-up, postintervention. Secondary aim was to identify potential predictors of increased levels of concern at baseline and follow-up. METHOD: Pre- and postintervention observational cohort study. Paired t test examined the difference in mean (SD) concern severity between baseline and follow-up. Multiple linear regression models were computed to hypothesize potential predictors of initial concern severity and severity change. RESULTS: The service saw 2413 people 2014-2017. Participants identified average 5.5 (4.7) concerns, financial concerns being most frequent. Mean severity at baseline was 7.12 (out of 10) (2.50), reducing to 3.83 (3.49) post-treatment, paired t(4454) = 64.68, P < 0.0001, reduction of 3.31 (95% CI 3.21-3.41). Factors associated with higher initial concern included unemployment and caring responsibilities. Unemployment was also associated with a smaller reduction of concern severity at follow-up. CONCLUSION: Patient level of concern went from a level associated with specialist referral to a much more manageable level. This original finding is internationally significant because it extends Khera et al's (2017) "provocative idea" that all patients should be screened for financial problems to show that they can be helped with all their concerns. This article describes a successful, transferable model of community care.


Assuntos
Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Neoplasias/epidemiologia , Neoplasias/psicologia , Apoio Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Adulto Jovem
19.
J Adv Nurs ; 74(7): 1639-1648, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29741782

RESUMO

AIM: Identification of risk factors predicting the development of death rattle. BACKGROUND: Respiratory tract secretions, often called death rattle, are among the most common symptoms in dying patients around the world. It is unknown whether death rattle causes distress in patients, but it has been globally reported that distress levels can be high in family members. Although there is a poor evidence base, treatment with antimuscarinic medication is standard practice worldwide and prompt intervention is recognized as crucial for effectiveness. The identification of risk factors for the development of death rattle would allow for targeted interventions. DESIGN: A case-control study was designed to retrospectively review two hundred consecutive medical records of mainly cancer patients who died in a hospice inpatient setting between 2009-2011. Fifteen potential risk factors including the original factors weight, smoking, final opioid dose and final midazolam dose were investigated. METHODS: Binary logistic regression to identify risk factors for death rattle development. RESULTS: Univariate analysis showed death rattle was significantly associated with final Midazolam doses and final opioid doses, length of dying phase and anticholinergic drug load in the pre-terminal phase. In the final logistic regression model only Midazolam was statistically significant and only at final doses of 20 mg/24 hrs or over (OR 3.81 CI 1.41-10.34). CONCLUSIONS: Dying patients with a requirement for a high dose of Midazolam have an increased likelihood of developing death rattle.


Assuntos
Sons Respiratórios/fisiologia , Doente Terminal/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Fumar Cigarros/efeitos adversos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Masculino , Registros Médicos , Midazolam/administração & dosagem , Midazolam/efeitos adversos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Assistência Terminal
20.
Nurse Educ Today ; 66: 33-38, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29655019

RESUMO

BACKGROUND: Emotional intelligence in nursing is of global interest. International studies identify that emotional intelligence influences nurses' work and relationships with patients. It is associated with compassion and care. Nursing students scored higher on measures of emotional intelligence compared to students of other study programmes. The level of emotional intelligence increases with age and tends to be higher in women. OBJECTIVES: This study aims to measure the differences in emotional intelligence between nursing students with previous caring experience and those without; to examine the effects of gender on emotional intelligence scores; and to test whether nursing students score higher than engineering colleagues on emotional intelligence measures. DESIGN: A cross-sectional descriptive study design was used. SETTINGS AND PARTICIPANTS: The study included 113 nursing and 104 engineering students at the beginning of their first year of study at a university in Slovenia. DATA: Emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire (TEIQue) and Schutte Self Report Emotional Intelligence Test (SSEIT). METHODS: Shapiro-Wilk's test of normality was used to test the sample distribution, while the differences in mean values were tested using Student t-test of independent samples. RESULTS: Emotional intelligence was higher in nursing students (n = 113) than engineering students (n = 104) in both measures [TEIQue t = 3.972; p < 0.001; SSEIT t = 8.288; p < 0.001]. Although nursing female students achieved higher emotional intelligence scores than male students on both measures, the difference was not statistically significant [TEIQue t = -0.839; p = 0.403; SSEIT t = -1.159; p = 0.249]. EI scores in nursing students with previous caring experience were not higher compared to students without such experience for any measure [TEIQue t = -1.633; p = 0.105; SSEIT t = -0.595; p = 0.553]. CONCLUSIONS: Emotional intelligence was higher in nursing than engineering students, and slightly higher in women than men. It was not associated with previous caring experience.


Assuntos
Inteligência Emocional , Empatia , Estudantes de Enfermagem/psicologia , Adulto , Fatores Etários , Estudos Transversais , Engenharia/educação , Feminino , Humanos , Masculino , Fatores Sexuais , Eslovênia , Inquéritos e Questionários
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