Phenomenological Study Explored The Perceptions Nursing Essay
Phenomenological Study Explored The Perceptions Nursing Essay
This study looked at patients’ perceptions of reverse isolation while undergoing autologous bone marrow transplant (ABMT). Persons in reverse isolation experience both obvious and less evident stressors. To understand patients’ perceptions of these stressors, semi-structured audiotaped interviews were held periodically during isolation (21-25 days) with six subjects receiving ABMT. This identified recurrent themes, which were then validated in a final interview. Most subjects understood the rationale of reverse isolation, and many prepared by bringing objects of personal value with them. Phenomenological Study Explored The Perceptions Nursing Essay. Few mentioned feeling restricted by the room after the initial days. Some patients used the TV, VCR, radio, and telephone as “extensions to the world,” as well as for entertainment. Subjects found visits from their main supports very important in coping with feelings of isolation. Phenomenological Study Explored The Perceptions Nursing Essay.The patients’ emphasis on a variety of ways to pass time was particularly interesting. The overall finding, however, was that the physical side effects of the treatment brought more distress than the isolation
The authors questioned the directors of 13 protected-environment installations on the psychological effects of protected environment treatment. Psychological problems reported included anxiety, depression, sleep disturbance, withdrawal, regression, and hallucinations. Children seemed to adapt better than adults to protected environments. Respondents recommended the use of preentry orientation, structured recreation programs, steps to prevent time disorientation, and psychological support for both patients and staff to minimize the psychological effects of treatment in protected environments
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A variety of infection prevention and control precautions are used to minimise the risk of infection spread from person to person, both patients and staff. Standard Precautions (SPs), including hand hygiene and use of personal protective equipment (PPE), are applied routinely to all patients, whereas transmission-based precautions (TBPs) are used when a patient is known or suspected to have an epidemiologically important infectious disease or condition, in order to further reduce the risk of spread of infection.
The use of single room isolation is part of TBPs and is a cornerstone of hospital infection prevention and control practice. However, successfully implementing TBPs, including single room isolation, continues to be a challenge in the UK for a number of reasons. Phenomenological Study Explored The Perceptions Nursing Essay.
Effective approaches to increasing the quality and safety of patient care are increasingly based on utilising simple tools that increase the likelihood that care will be provided in a reliable way. The tool presented is intended to facilitate both learning and practice in relation to TBPs and to promote the delivery of safe patient care in relation to single room isolation. It is designed for use in those situations when a single room is available for patient isolation. It also highlights the other important TBPs to be taken to prevent the spread of infection, whether or not a single room is available. It can be adapted for use with any organism or disease for which TBPs are recommended. Phenomenological Study Explored The Perceptions Nursing Essay. At a time when healthcare associated infections (HCAI) such as Clostridium difficile and meticillin resistant Staphylococcus aureus (MRSA) continue to have an impact on both acute and community care settings, and their reduction is embedded within national targets for NHS healthcare providers, tools that make it easy for healthcare workers to apply safe practices within their daily routines are essential.
Initial testing suggests that this tool is acceptable to healthcare workers and further study will identify its potential contribution to healthcare workers’ knowledge and practice in this area.
Bone marrow transplantation (BMT) is being increasingly used to treat children and adults with a variety of life-threatening diseases. Although BMT is a life-saving intervention in many instances, it is a high-technology procedure–both aggressive and life-threatening–associated with an array of physical and psychological stressors. Therefore, psychiatric and psychosocial research and intervention can greatly contribute to the understanding and management of BMT recipients, donors, and their families. Seven major areas of psychiatric and psychosocial concern in BMT are identified and the literature relevant to each area is reviewed.
Since October 1988 there has been an isolation ward at Basle Cantonal Hospital. Its purpose is to treat patients with high dose chemotherapy and bone marrow transplantation under protective isolation and by standardized criteria. The isolation ward has two sub-units, viz. the reverse isolation for neutropenic patients (8 single room units) and the LAF unit (5 laminar airflow units) for allogeneic bone marrow transplantation (BMT). Up to July 1992, 287 patients (152 males and 133 females) required 527 hospitalizations. Phenomenological Study Explored The Perceptions Nursing Essay.The median age was 41 (5-82) years in the reverse isolation unit and 28 (4-61) years in the LAF unit. Bed occupation was 90% and 82% throughout the period. 71% of patients were from the Basle area and the rest from elsewhere in Switzerland or from other countries. Diagnosis: acute leukemias (112); myelodysplastic or myeloproliferative syndromes (52); severe aplastic anemia or agranulocytosis (46); lymphoproliferative syndromes (50); solid tumors (28). Indications for hospitalisation: BMT (107); complications after BMT (infections, GvHD) (63); chemotherapy on protocols of SAKK (105); other chemotherapies (64); antilymphocyte globulin or growth factor treatment (27); splenectomies (18); neutropenic fever (62); patient work-up (59); terminal care (20). Patients in reverse isolation were hospitalized for a median 17 (1-142) days; in the LAF unit for 52 (1-121) days.(ABSTRACT TRUNCATED AT 250 WORDS) Phenomenological Study Explored The Perceptions Nursing Essay.
There has been a remarkable growth in the use of bone marrow transplantation (BMT) in the past 30 years. The rapid expansion of BMT reflects its increasingly important role in the treatment of several life-threatening diseases of the hemopoietic system. The first BMT in human patients was performed after conditioning with total body irradiation (TBI). As an important part of BMT protocols, TBI has an established role in many preparative regimens used before BMT in the treatment of hematological diseases. Historically, TBI schedules varied during the last 30-year period with regard to different radiation source used, treatment technique, beam modifiers, actually delivered total dose, dose rate, and fractionation schedule. The aim of this review article is to discuss the 50- year experience in the field of TBI, as well as radiobiological, technical and dosimetric requirements and especially effects of total dose, dose rate and fractionation schedules on the prognosis of transplanted patients. The radiobiological and radio-oncological requirements demand special TBI treatment techniques quite different from usual radiotherapy. The technique needed depends extremely on the prescribed values of treatment parameters and on the local technical possibilities. TBI dosimetry has to account for the physical situation of treatment with very large field sizes at extended distances and should be performed under TBI conditions close to the real treatment situation. The effects of total dose, dose rate, fractionation schedule on the leukemia cell killing, immunosuppression, and sparing of normal tissues are considered in detail. Phenomenological Study Explored The Perceptions Nursing Essay. Their effects on overall survival, leukemia recurrence, acute and chronic graft versus host disease (GvHD), late radiation-induced injuries to normal tissues or organs as well as incidence of interstitial pneumonitis, renal dysfunction and cataract development are analyzed. The definition of currently used TBI procedures is so different in different centers that retrospective analyses remain futile, under better definition and normalization of dose, fraction size, and endpoints occur. There are a lot of difficulties to evaluate, compare or understand clinical RESULTS from so different treatment regimens, often with an irregular set of parameters. In order to establish clinical trials and to evaluate clinical RESULTS, we need comparable schedules, uniform specification, and complete reporting of all relevant parameters. After 50-year experience in the field of TBI, we are beginning to understand the relationship of TBI dose, dose rate and fractionation. However, 20 years after Glasgow we will repeat his persuasion that, however, many questions remain unanswered.
Patients’ need for comfort at the end of their lives is rarely fulfilled. The comfort of patients at the end of their lives, especially children, is affected by nurses’ understanding of what comfort means.
Aims:
This research aims to explore and to understand the meaning of children’s comfort at the end of their life for nurses.
Setting and Design:
The research applied descriptive qualitative phenomenology design.
Subject and Methods:
The study was conducted at Jakarta. Nurses who have experience in caring the child at the end of their life were in-depth interview with an open-ended question. Data were then analyzed using the Colaizzi method.
Results:
This research identified six themes: striving to reduce children’s suffering, realizing what children wanted, observing the children felt comfortable in their family’s acceptance of their condition, facing internal and external conflict, experiencing mixed feelings knowing the children’s condition, and requiring support from all parties.
Conclusion:
Nurses should provide information regarding children’s end of life conditions to the family, to achieve family acceptances. Eventhough it was hard situation and rose internal conflict to nurses. It was found that children also felt comfortable at the end-of-life when they did not experience any suffering, and their wishes were granted. Subsequently, the nurses did not have mixed feelings when the children died. Therefore, evaluation of the training effectiveness that has been given to the nurses should be done to fulfill the need of the child’s comfort at the end-of-life. Phenomenological Study Explored The Perceptions Nursing Essay.
Introduction
Cancer is the uncontrolled growth and spread of abnormal cells inside the body with the potential to cause death.[1] In America, it is the main cause of death in children aged 14 years or less.[2] In Indonesia, the 2013 Basic Health Research data state that 0.5% of total cancer patients are children aged 14 years or less.[3]
Children suffering from cancer at the end of their lives need comfort, but it is rarely fulfilled.[4] The uncomfortable conditions experienced by children are related to pain, dyspnea, digestive problems, and neurological changes.[5] Nurses’ management of pain or other symptoms is part of the multidisciplinary model of providing comfort.[6]
Nurses’ understanding of what comfort means to children at the end of their lives affects the intervention of comfort provided to increase the children’s quality of life.[7] Therefore, exploring the nurses’ understanding on the essence and meaning of children’s comfort at the end of their life is a study necessarily conducted.
Subject and Methods
This descriptive qualitative phenomenological study gathered data through in-depth interviews with semi-structured open-ended questions addressed to the participants, and they were recorded using the Sony Voice Recorder ICD-PX440. Data analysis was conducted by using the Colaizzi method and occurred simultaneously with data collection.[8] The research took place over the course of 3 months in a Jakarta home care facility.
Key informants proposed candidates for participation and subsequently, the researchers contacted the participants through the WhatsApp Messenger. The researchers were then explained to the candidates. Phenomenological Study Explored The Perceptions Nursing Essay. After obtaining the candidates’ agreement to participate, we began the data collection process. Ten participants participated in this research. Characteristics for participant were nurses who had attended palliative care training, nurses who had certificates of palliative care training, nurses who had given pediatric nursing care to children at the end-of-life, nurses who had good Indonesian speaking skills, and nurses who were willing to be participants and to share their experiences.
This study obtained ethical approval by the Ethical Committee of Nursing Faculty of Universitas, Indonesia. Ethical principles were applied to the whole research process including data collection, data processing, and research outcome publication.
Data collection was conducted through semi-structured in-depth interviews with open-ended questions. The interview length among 10 participants was approximately 40 min to 1 h and 50 min. There were no obstacles, either physically or emotionally, in collecting the data among the ten participants.
Each recorded result of the interview was transcribed verbatim. The Colaizzi method was used to analyze the data.[9] The transcripts were read repeatedly to determine significant statements and meaningful formulation so that they could be grouped into categories, subcategories, and themes.[10]
Results
The six themes found in this research: striving to reduce children’s suffering, realizing what the children wanted, observing the children felt comfortable in their family’s acceptance of their condition, facing internal and external conflict, experiencing mixed feelings knowing the children’s condition, and requiring support from all parties. Phenomenological Study Explored The Perceptions Nursing Essay.
Striving to reduce children’s suffering
This theme illustrates the various efforts undertaken by nurses to reduce and even eliminate the pain experienced by children at the end-of-life. Those efforts begin with conducting a physical examination of pain and other symptoms that appear such as shortness of breath, fever, and digestive problems. The followings are participants’ statements:
… pain, how pain it is, frequency, the length, and then its location, its intensity, until its pain scale…(Participant 5)
… they felt shortness of breath and weak, these are usually associated with pain…(Participant 4)
… when the kid was fussy and has got fever. we measure the temperature…(Participant 2)
Nursing interventions to overcome the children’s pain implemented by pharmacology and nonpharmacology. This I mentioned in the statements of the participants below:
…like in cancer that usually has used morphine… by listening to music, by coloring, pain distraction is by watching TV, compressing the pain on the permitted location…(Participant 5)
Realizing what children wanted
Psychological counseling in children shows the nurses that the greatest hope and desire of the children at the end-of-life is by doing activities favored by the children. The nurses prepare for the psychosocial and spiritual conditions of the children before they can realize what the children really want before they die. This is as stated in the participants’ expression:
… pray as many as possible, for Muslims, for Christians pray as many as possible to Jesus…(Participant 1)
In identifying the children’s psychological comfort the nurse will clarify it directly by asking questions about comfort to them. Here are their statements:
…asking the kid’s preferences, their hobbies, then their wants such as reading novel, are you bored? What do you want?…(Participant 2) Phenomenological Study Explored The Perceptions Nursing Essay.
… the comfort of the child to die… do not assume yourself… we assume what the kid likes– in fact it is not, so just ask as long as we still can communicate, ask, because the kid having the body and feeling the pain, who can say comfortable or not, ask …we as nurses do not ever assume something…(Participant 4)
Finally, the nurses embody the children’s true wants to provide comfort to them at the end-of-life. This is revealed from the statement:
… comfortable if their wants have already been realized…(Participant 3)
Observing the children felt comfortable in their family’s acceptance of their condition
Sincerity of the family when the child will die is something that will reassure the children’s soul. The nurses also attempt to prepare the family for the child to die as stated in the following statements:
…we ask to read Yasin, mother to hug or hold, mother to say love to the kid, and mother to say if she has been relief, if mother is sincere the death process will not be long…(Participant 6)
The assistance of nurses to parents to be sincere their child who will die includes identifying their feelings, exploring their feelings, and showing care to them.
… I am mostly worried if talking about…(Participant 5)
… by asking like that I care with the emotion they feel right now…(Participant 2)
Facing internal and external conflict
The children’s comfort at the end-of-life is not something that the nurses can easily get but must be striven to achieve. Internal conflicts of the nurses and external conflicts involving families as care providers must be dealt with by the nurses. This is like the following participants’ statements:
… not easy to say, but it must be (eyes staring blankly)…(Participant 3)
… sometimes there is something to do (the speech such as being sarcastic, eyes slightly glanced). so this kid does not feel the pain and the cough gets better…(Participant 2)
In addition, nurses also have to accept when the family feels more comfortable if bringing the child to the hospital when the condition of the child shows signs of death even though it is not in accordance with the expectations and wishes of the nurses or the child itself.
… it is fine if the family wants to take the kid to the hospital…(Participant 4) Phenomenological Study Explored The Perceptions Nursing Essay.
Experiencing mixed feelings knowing the children’s condition
All the nurses’ feelings will occur in line with the increase and decrease of the children’s conditions at the end-of-life. Various expressions of nurses’ happiness during giving life care to the children and families are depicted from one of the participant’s expression that is:
… by (chuckled) realizing the kid’s wants, I feel happy…(Participant 3)
The feelings of guilt, sadness, disappointment, and regret are also shown by all participants through some quotes below:
… there is feeling of regret if it has not been realized because we want to elevate the life quality at the end of the children…(Participant 1)
… it’s difficult to accept, very difficult (bowing the head), feeling such as never enough always false, difficult…(Participant 3)
In addition, the participants also express feelings of pleasure and sadness that are felt at the same time knowing their child’s condition, namely:
…when the child died, I felt such a success (while clenched hands as a sign of success) even though I was sad, meaning that all of the child wants had been granted at the end … (Participant 6)
Requiring the support from all parties
The identification of the need for providing the capacity of palliative care must be done earlier, so the cares given can achieve the best possible objective. This is expressed from the statements of the participants:
… we involve social workers pekerja sosial, usually friends from the other foundations are involved such as Yellow Ribbon, friends from the Social Department, psychologists, or nutritionists…(Participant 5)
While the support provided by psychologists and doctors revealed in several participants’ statements that include:
… we cannot solve the psychology of the patient or the patient gets angry or we invite a psychologist for the family…(Participant 3)
… we must coordinate with the primary physician, the what the progress are and what the decreases are at home…(Participant 1) Phenomenological Study Explored The Perceptions Nursing Essay.
Discussion
Nurses in this study faced internal and external conflicts related to the challenges of providing palliative care. Internal conflict arose when nurses tried to deliver news about the end-of-life to children and their families.[11]
Furthermore, nurses mentioned that the internal conflict was caused by an uncertain disease prognosis. This cannot be avoided and ought to be faced by pediatric palliative nurses.[12] Further complicating things, the word “die” is considered taboo in Indonesian society. However, most families want to be informed of the disease prognosis so that they can contribute meaningfully to the decision-making process.[13]
Nurses can learn to manage internal conflict by increasing their communication skills. Good communication is an important factor in preparing parents and children to face a potentially terminal diagnosis.[14] Efforts to increase that skill could be accomplished by creating a nursing communication standard, conducting consultations, and increasing colleague support.[15] Good communication is key to providing comfort when facing a difficult situation.[16]
External conflict faced by nurses was related to uncooperative caregivers and children. Caregivers, in this case, were parents or other relatives of the children, such as an uncle, aunt, or grandmother. Nurses can provide support for these families by providing complete information about the children’s condition, suggesting ways the family can spend more time together and can take care of the children’s needs, involving family members outside of the nuclear family unit, and asking for help from the neighborhood.[17]
One of the nurses’ primary duties is to conduct management of the patient’s pain and other physical symptoms.[18] In this way, children feel more comfortable, relieved, and calm. In assessing pain, it is important that other symptoms experienced by the children be considered.[19] Phenomenological Study Explored The Perceptions Nursing Essay.
These factors are further supported by the nurses’ ability to consider the children’s age, the children’s level of cognitive development, the children’s communication skills, the children’s past experience of handling pain, and the children’s conviction about the pain, so that it can be determined which pain measurement will be used.[20]
Nonpharmacological intervention is an important part of pain management with children at the end-of-life.[19] In this study, nurses conducted an independent intervention to decrease the children’s pain by distracting their attention from the pain and making them happy such as playing such a game, drawing, or walking around. The importance of family involvement in pediatric nursing is extensively present in research. Parents are involved in planning the pediatric nurse’s efforts at the end-of-life.[21]
In this study, nurses also provided care for the psychological spiritual aspect of children and their families. Addressed to fulfillment the aspect spiritual of children or families is the one of active total care of patients in palliative care.[22] The psychological assistance provided to children and their families aims to prepare them for the child to die in comfort condition. Ultimately, the goal is for their families not to feel regret once their children die.
Nurses provide psychological support by being a partner to family members who want to talk about their children’s condition.[23] Therefore, it is important that the nurses’ attitudes during the assistance process be suitable and individualized to the needs and conditions of the children and their families, and that they show respect and appreciation for the children’s autonomy.[24] Listening to children is another important component to nurses providing attentive care.[25] Moreover, be someone who can be trusted, kindness, warmth, honesty, and affection are essential to building the nurse and patient relationship.[23]
The psychological welfare of the family during the children’s end-of-life proceedings is critical and can affect the children’s psychological condition.[23] At the end of the children’s lives, the nurses felt that the children would be comfortable if their family were sincere with the children’s condition. Family members can help children who are dying feel more comfortable by saying supportive words and convincing them of their acceptance.[26] Phenomenological Study Explored The Perceptions Nursing Essay.
Nurses providing palliative care to children also have mixed feelings about the children’s conditions. The feelings of hopelessness and disappointment stated by the nurses are in line with the statement that nurses sometimes feel hopeless when they cannot do anything to relieve the torment experienced by the patients and their families. The loss and hopelessness when facing the death of a child are not only felt by the family alone but also by the health-care professionals who provide care at the end-of-life.[16]
The feelings experienced by nurses providing care to dying children, such as hopelessness, anger, sadness, and anxiety, can cause fatigue quickly for the nurses to impact on the increased number of palliative nurses who resign,[27] it is imperative that nurses receive support and motivation from all parties involved in providing palliative care for children.
Nurses need time to learn coping strategies that can be used to face the condition of death.[12] This is in accordance with findings which state that a safe environment is important to overcoming challenges in providing care to dying children.[28]
Some activities that can help nurses overcome feelings of sadness, anger, and hopelessness are the creation of a support group and the provision of training to assist with handling traumatic situations.[27] Some other activities are identifying distressing conditions experienced by nurses, giving a lecture on techniques to help overcome those conditions, and identifying nurses who need a personal consultation. Phenomenological Study Explored The Perceptions Nursing Essay. Palliative care in a multidisciplinary setting encourages optimal care.[29] Therefore, palliative care must be supported by health-care professional teams that are proficient in symptom management, psychosocial nursing, spiritual support, nursing care planning, communication, and the ability to be supportive during the decision-making process.[30]
Nurses, as part of the multidisciplinary team, need to consider several things, such as appreciating other professions and supporting each individual’s contributions, to provide the highest quality of care to patients and their families.[31]
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Limitation
The limitation of the study is in the population. The pediatric nurse corresponding to the participant characteristics that can be included in this study is only obtained from the Rachel Home Foundation who is engaged in pediatric palliative care.
Conclusion
Nurses interpret children’s comfort at the end-of-life as a condition where children feel relieved, where the children’s wishes are fulfilled, and when the family is accepting of the condition of their children. To foster this feeling of comfort in children, nurses need many supports, and they must work to overcome the internal and external conflicts that produce mixed feelings which can affect their provision of care. In the future, the nurse should evaluate training effectiveness and discuss supportive factors and obstacles in applying theories gathered from this training, especially to resolve communication barriers to provide the comfort of children at the end-of-life. Phenomenological Study Explored The Perceptions Nursing Essay.
