A new perspective on threatened autonomy in elderly persons: the disempowering process.

This study explored factors other than medical condition and treatments which contributed to the discharge experiences of 12 rural and 9 urban patients. Interpretive research methodology included document review, observation and in-depth interviews of all key participants. The purposefully selected sample consisted of a total of 21 patients, 22 informal caregivers, and 117 professionals involved in the hospital and/or home setting. Findings document a new perspective on how patients and professionals together contribute to the patient's threatened autonomy. Lack of clarity about goals, aspirations, and purpose in life and a generally negative frame of mind in the elderly combine with professional practice approaches to create a disempowering process. Faced with the biomedical orientation and paternalism of professionals, patients with a positive mindset and sense of direction and purpose in life did not experience threat to their autonomy. The researchers conclude that empowerment strategies must encompass a patient-centred approach, which includes an understanding of the patient's mindset, goals, aspirations, and sense of purpose within a larger life context. This consideration is essential to enable elderly patients to maintain autonomy despite continued health care requirements.

Breast cancer patients' experiences of patient-doctor communication: a working relationship.

The traumas of diagnosis and treatment for breast cancer are well researched and generally addressed in care. While women with breast cancer continue to identify the need for better communication with physicians, studies to date have not investigated how the process of communication between physicians and women with breast cancer actually unfolds. This phenomenological study therefore explored how women with breast cancer experience patient-physician communication to gain a greater understanding of effective approaches. Interviews of a purposeful sample of 11 women within 6 months of initial diagnosis or recurrence of breast cancer were audiotaped, transcribed verbatim and analyzed using inductive interpretation. Themes and patterns of positive and negative experiences emerged. All experiences began with the woman's feeling of vulnerability. In positive experiences, information sharing and relationship building were inextricably linked components of a working relationship which was at the same time affective, behavioural and instrumental. This experience, in turn, influenced the woman's experience of control and mastery of the illness experience, and their experience of learning to live with breast cancer. Findings illuminate the importance of comprehensively patient-centred, working relationships. Several specific techniques to enhance effective communication are identified.

Using the patient-centered method to achieve excellence in care for women with breast cancer.

The diagnosis of breast cancer remains one of the most threatening and emotionally debilitating diagnoses given to patients. Breast cancer elicits fears of loss of ability, control, hope, and at worst--loss of life. Patients and their families, devastated by the diagnosis of cancer, often feel unsupported or dismissed by their health care providers. Using the example of breast cancer, this paper describes how the application of the patient-centred clinical method can assist physicians in caring for patients diagnosed with breast cancer. Composite cases and quotes drawn from qualitative research studies with breast cancer patients are used to illustrate the application of the patient-centred clinical method.

The challenging experience of palliative care support-team nursing.

The purpose of this study was to document the experience of palliative care nursing as a part of a multidisciplinary support team. Data were obtained from two palliative care support-team nurses. Each nurse privately recorded on audiotape any reflections about particularly meaningful aspects of her daily work experience; in-depth interviews with the two nurses together also were used for data collection. Inductive analysis elicited previously identified dimensions of palliative care nursing, including the support and coordination functions provided to other health professionals. The palliative care support-team experience included many challenges associated with the ultimate outcome of death; restricted and unpredictable time frames; and greater demands for human resources, psychosocial-care skills, and interdisciplinary, family-oriented care. These factors appeared to interact with the nurses' commitment by escalating their drive to serve others and creating both internal and external conflicts. The nurses expended considerable energy in role adaptation and in intrapersonal and interprofessional conflict management. This effort emerged as being vital to the nurses preserving their own integrity, both personally and professionally. The findings of this study may help all professionals who provide palliative care to better understand the nature of their work, themselves, and each other. Strategies to promote understanding may help to reduce the amount of time and energy that professionals must dedicate to preservation of integrity.

From hospital to home: elderly patients' discharge experiences.

BACKGROUND: Little is known about the effect on elderly patients of the transition that occurs upon discharge from the hospital to the patients' homes. This report describes hospital discharge as experienced by a group of elderly patients. METHODS: Qualitative research techniques were used to study the effect of hospital discharge on 12 patients, 12 caregivers, and 62 health professionals involved in the process. Research methods included interviews, observation of participants, and review of pertinent documents. RESULTS: Findings indicate that the patients' mindsets and family relationships contribute to the discharge experience. Problems with communication among members of the health care team created problems in the discharge process. The opinions of health professionals and patients' family members sometimes differed regarding appropriateness of various facets of the discharge process. CONCLUSIONS: The findings suggest that there is a need to better facilitate communication and coordination of the hospital discharge process for elderly patients.

Evolving an empowering approach to continuous quality improvement in home care.

Theory suggests that in an "empowering" organization all individuals assume genuine decision-making roles and control over their work. Unfortunately, many organizations actually stifle empowerment through creating new bureaucratic barriers as they implement structures to deploy quality management principles. The Oxford County Home Care Program describes how it redesigned its organizational structure to facilitate empowerment.

Creating health with chronic illness.

Within the current context of health care, health promotion for individuals with chronic illness often reflects the priorities of disease-specific preventive care needs and related physical, social, emotional, and spiritual well-being. This article reports a phenomenological study of how older people with chronic illness experience health and health promotion and illuminates a different perspective of health resources and strategies. The findings have profound implications for nursing practice and theory, suggesting the need for restructuring work assignments and refocusing nursing care more clearly away from the medical model.

Mother-loss: recreating relationship and meaning.

The purpose of this investigation was to describe adult women's experiences in losing their mother. Using an interpretive phenomenological frame of inquiry, 5 women were purposively selected to share their loss experience. Memories of the mother-daughter relationship were explored, and the meanings the daughters attached to their loss described, in written narratives, 2 in-depth interviews, and 1 group session. Seven themes emerged: Recalling, Holding On, Saying Goodbye, Longings of the Heart, Shifting Patterns of Relationship, Recreating the Dialogue, and Honouring Our Mothers/Ourselves. The loss of one's mother represents the loss of one's first intimate relationship, a relationship that has a unique meaning for daughters because their personal development is profoundly and uniquely shaped by it. This potentially pervasive and transforming life experience is best understood from an in-depth exploration and understanding of the nature of the mother-daughter relationship. Nurses who come to understand the dynamic interaction of grief and development through women's experience of mother-loss can more successfully offer their presence, their understanding of the complexity of the mother-daughter relationship, and their skills in bereavement care to facilitate healing and to promote health and personal growth.

The effects of family nursing and family medicine clinical rotations on nursing and medical students' self-efficacy for health promotion counseling.

The effects of community-based family nursing and medicine clinical rotations on students' confidence in their knowledge and ability to counsel clients in selected health promotion areas were examined from the perspective of Bandura's (1986) self-efficacy theory. Nursing students (n=66) enrolled in a community family nursing course and medical students (n=71) enrolled in a 6-week family practice clerkship rotation completed questionnaires at three points: prior to, at completion of, and 3 months following their clinical rotations. Nursing and medical students' self-efficacy levels at pretest were similar. At-posttest, nursing students' self-efficacy was significantly higher than that of the medical students. This difference was sustained at 3 months follow up. Students' conception of health (clinical vs. nonclinical) did not have an effect on posttest self-efficacy levels. Self-efficacy scores accounted for 63% of the variance in the nursing students' self-reported use of health promotion principles in their daily practice; but only 11% of the variance in medical students' daily practice. The results of this exploratory study provide information to guide theory-informed curricular decisions to design clinical learning activities that foster the development of health promotion counseling skills in both nursing and medical students.

Bridging town and gown: building research partnerships between community-based professional providers and academia.

Strategic research partnerships between community-based professionals and academic researchers are increasingly recognized as a means of evolving evidence-based practice and policy directions in health services delivery. Many barriers impede collaboration, however, and information on how to successfully implement collaborative partnerships is scattered, leaving much to trial and error. This article describes the process of achieving a successful research partnership among community-based home care professionals and academic researchers during a 6-year period of collaboration. The case illustration portrays how to identify and motivate the right research partners, how to mobilize resources, how to sustain an effective partnership process during the lengthy time commitments required to complete research, and how to ensure the experience of return on investment of time, energy, and resources in the partnership process. As measured by the outcomes of their collaborative research experience, the authors conclude that the benefits of bridging town and gown greatly outweigh the challenges of research partnerships.