Patient experiences of uncertainty - a synthesis to guide nursing practice and research.

AIM: The aim of this study was to provide a synthesis of patients' experiences of uncertainty in illness and the interventions outlined, based on qualitative research. BACKGROUND: There is a need to explore various patient experiences from a nursing perspective in order to achieve evidence-based practice and improve the quality of care. Uncertainty in illness is a dynamic experience - a stressor with a major impact on patients' illnesses. METHODS: A literature search performed on PubMed and Cinahl yielded 15 qualitative studies that met the inclusion criteria and which were analysed and interpreted. RESULTS: Experienced uncertainty was one of two main areas comprising three themes: explaining, feeling and facing uncertainty. The second main area was suggested intervention strategies consisting of three themes: organizing the patient trajectory throughout the health-care system, supporting patients through relationships and providing knowledge through clear and accurate communication. CONCLUSION: Providing insight, confidence and supporting the patients' feeling of control are of importance for health-care professionals. IMPLICATIONS FOR NURSING MANAGEMENT: Structured organization of the trajectory system should be followed up, while outcome measures (patient satisfaction), education and training programmes for patients and families after discharge to improve coping strategies and reduce uncertainty should be developed. Nurse leaders should work towards the establishment of clinical academic nursing positions to integrate knowledge, skills, experiences and research into everyday routines.

Caregiver distress associated with neuropsychiatric problems in patients with early Parkinson's disease: the Norwegian ParkWest study.

OBJECTIVES: We investigated caregiver distress associated with neuropsychiatric problems in patients with newly diagnosed Parkinson's disease (PD). MATERIALS AND METHODS: Persons who were next of kins of 198 patients and 168 healthy individuals completed the Neuropsychiatric Inventory Caregiver Distress Scale. RESULTS: Even at the time of diagnosis PD has a considerable impact on the next of kins' experience of distress. Nearly 50% reported distress, significantly more than in the control group, and more than one-quarter reported moderate severe distress. Except the more rarely reported neuropsychiatric symptoms, apathy was the symptom that most frequently caused caregiver distress in PD patient's next of kin (94.5%), followed by depression (88.2%), anxiety (86.2%) and irritability (83.3%). CONCLUSIONS: The study underlines the importance of focusing on neuropsychiatric aspects in patients and associated caregiver distress even in early PD management.