Abstract: There is sound evidence to support the notion that the provision of effective psychosocial care improves the o
Posted: Thu Mar 31, 2022 7:55 am
Abstract: There is sound evidence
to support the notion that the provision
of effective psychosocial care improves
the outcomes
of patients with cancer.
Central to the implementation of this care is that health
professionals have the necessary communication and assessment
skills. This study aimed to identify key issues related
to providing effective psychosocial care
for adult patients admitted with
hematological cancer, as perceived by
registered nurses with 3 or more years of clinical experience. An
exploratory qualitative design was used for this study. Two focus
group interviews were conducted with 15
experienced cancer nurses. The provision
of psychosocial care
for patients with cancer is
a dynamic process that has a professional and personal impact on
the nurse. The 5 analytic themes to emerge from the data were as
follows: When is it a good time to talk? Building relationships;
Being drawn into the emotional
world; Providing support throughout
the patient's journey; and Breakdown in
communication processes. The findings from this study indicate an
urgent need to develop a framework to provide nurses with both
skill development and ongoing support in
order to improve nurses' ability to
integrate psychosocial aspects of care
and optimize patient outcomes.
There is growing evidence that the provision of effective
psychosocial care improves the outcomes of patients with
cancer.1,2 However, providing psychosocial care for patients
with cancer can place specific burdens on health professionals. The
effectiveness of the care provided is dependent on the training,
skills, attitudes, and beliefs of staff. The Clinical
practice guidelines for the psychosocial care of adults with
cancer have been developed by the National Breast
Cancer Centre and the National Cancer Control Initiative in
Australia as a benchmark for the psychosocial needs of patients
with cancer. These evidence-based guidelines are designed for use
by all health professionals who care for people during the course
of cancer diagnosis and treatment. Central to the successful
implementation of these guidelines is the ability for health
professionals to exercise the necessary assessment and
communication skills, for example, discuss prognosis and treatment
options available with the patient or the move from curative to
palliative treatments. We know that health professionals can have
low confidence in exercising these skills that can result in a
failure by health professionals to provide effective psychosocial
care to patients with cancer.The purpose of this paper is to elicit
the key issues perceived by registered nurses that arise when
caring for adults with hematological cancer to enable the
development of a framework to assist nurses to provide optimal
evidence-based psychosocial care. In addition, such a framework
will assist nurses to recognize the point at which psychosocial and
emotional responses to patients' needs require specialist
intervention.
The Study
Aim
This study aimed to identify key issues related to providing
effective psychosocial care for adult patients admitted with
hematological cancer, as perceived by registered nurses with 3 or
more years of clinical experience.
Methods
Design
A descriptive qualitative design was used for this study. A
qualitative approach was selected because rich descriptive data,
not available through quantitative methods, were desired to
document the nurses' experiences. Focus groups were chosen because
of their added benefits above individual interviews, in particular
the synergy generated between group members,19 their
naturalistic approach in tapping into everyday social processes of
communication,20 and their "permissive" and peer support
function in encouraging participants to divulge opinions and
beliefs that might not emerge through an individual
interview.21 Approval for this study was granted by the Deakin
University Ethics Committee and the ethics committee of the
participating tertiary referral hospital.
Participants
Participants were purposively selected based on their role in
providing psychosocial care. Although it is recognized that
psychosocial care is a multiprofessional process, this study aimed
to uncover psychosocial care in the context of the 24-hour
management of the patient. The rationale for selecting experienced
registered nurses was that there was an expectation they would
carry the burden of providing complex psychosocial care in the ward
environment. In Australia, registered nurses usually have a degree
qualification. It was considered that these nurses would be role
models and coaches for inexperienced nurses. Hence, the study
sample was limited to experienced registered nurses. Nurses who had
been working on the cancer ward at a major Melbourne tertiary level
hospital, a key center in the provision of oncology services in
Victoria and Australia, for 3 years or more were approached to
participate in the study. A total of 15 experienced nurses
participated.
The participants work on a busy hematology/oncology/radiotherapy
and bone marrow transplant ward that has a complex patient acuity
and associated significant morbidity. The nurses face a range of
complex psychosocial issues related to patients' diagnosis and
associated treatment and their personal circumstances. The 30-bed
ward admits approximately 640 oncology patients, 50 bone marrow
transplant patients, and more than 100 radiotherapy patients each
year. At the time of the study, the ward had just commenced a
Nursing Care Delivery system pilot project that was a modification
of the previous Primary Nursing model utilized by the ward.
Procedure
Two focus groups, 8 participants and 7 participants,
respectively, in each group, were conducted in October 2003. One
member of the research team who had experience in facilitating
focus group interviews conducted the sessions. At both sessions, an
observer was present to take notes pertinent to each session.
Before commencing each interview, introductions were made between
the participants and the researchers present. The facilitator
[R.E.] gave an overview of the purpose of the interview, followed
by outlining the ground rules that apply to the conduct of focus
group interviews, and consent was then requested to audiotape the
session. A statement was made relating to maintaining
confidentiality of individual group members' perceptions at the
conclusion of the session. Participants were also reminded of their
right to withdraw from the study should they wish to do so. The
facilitator circulated written details to participants of who to
contact should they require any emotional support after the
interview.
A brief biographical form was circulated to capture data such as
the qualifications, experience, and role configuration of the
individual participants. Before commencing the interview, the
facilitator encouraged the participants to use "real life" examples
to identify situations in which psychosocial support for patients
and families was considered effective or could have been
enhanced.
During both sessions, the facilitator used a guide consisting of
open-ended questions and probes drawn from the relevant literature
and existing clinical guidelines regarding the psychosocial needs
of patients with life-threatening diseases. The guide was designed
to allow participants to talk freely about their experiences of
caring for patients with hematological cancer and their family
members. The focus group sessions lasted 1 hour; both were
tape-recorded and transcribed verbatim.
Ethical Considerations
Participants were invited to participate in the study based on
their experience; they were informed that they did not have to take
part in the study and that nonparticipation would not affect their
position within the ward. Once the nurses agreed to participate in
the study, they were asked to sign a consent form. Although there
was no perceived inherent risk to participants, before commencing
the sessions, the facilitator circulated written details of a
psychologist available to them should they require emotional
support at the conclusion of the session. Individual participant
data have not been reported.
Data Analysis
The data were coded and analytic themes developed using content
analysis. The transcripts were initially read by one member of the
research team. This took some time and required the text to be
understood as a whole. Notes taken by the observer during each of
the focus group interviews were also read at this time to provide a
context for the interview transcript. Common themes within the
context of each interview were identified resulting in the
identification of 5 major themes. Validation of themes occurred in
2 ways. The coding of the themes was reviewed between the project
research fellow who had initially coded the data and 2 other
members of the research team: one academic and one clinician. All
members were in agreement with the themes. A presentation of the
study findings was given to participants further validating the
findings.
Results
Demographic Characteristics
All participants were female and were registered Division 1
nurses; 20% (n = 3) had hospital registration with 80% (n=13)
having completed a Diploma of Nursing. One participant had
completed an Honors degree, 2 had completed a Postgraduate Diploma
in Nursing. Most participants (53%, n= 8) had had greater than
9-year experience in nursing; however, the majority (53%, n = 8)
had been in their current position for between 1 and 3 years. Five
themes were identified: when is it a good time to talk? Building
relationships, being drawn into the emotional world, providing
support throughout the patient's journey, and breakdown in
communication processes.
1.Is the model used theoretical or conceptual in this study? why
is it important to have theoretical or conceptual in a
research study ?
2.Is there a literature review in the study? was is the purpose
of a literature review?
3. what is the problem statement in the study?why is problem
statement necessary in a research study?
4. what was done to protect the participant in this study? why
is it important to protect them?
to support the notion that the provision
of effective psychosocial care improves
the outcomes
of patients with cancer.
Central to the implementation of this care is that health
professionals have the necessary communication and assessment
skills. This study aimed to identify key issues related
to providing effective psychosocial care
for adult patients admitted with
hematological cancer, as perceived by
registered nurses with 3 or more years of clinical experience. An
exploratory qualitative design was used for this study. Two focus
group interviews were conducted with 15
experienced cancer nurses. The provision
of psychosocial care
for patients with cancer is
a dynamic process that has a professional and personal impact on
the nurse. The 5 analytic themes to emerge from the data were as
follows: When is it a good time to talk? Building relationships;
Being drawn into the emotional
world; Providing support throughout
the patient's journey; and Breakdown in
communication processes. The findings from this study indicate an
urgent need to develop a framework to provide nurses with both
skill development and ongoing support in
order to improve nurses' ability to
integrate psychosocial aspects of care
and optimize patient outcomes.
There is growing evidence that the provision of effective
psychosocial care improves the outcomes of patients with
cancer.1,2 However, providing psychosocial care for patients
with cancer can place specific burdens on health professionals. The
effectiveness of the care provided is dependent on the training,
skills, attitudes, and beliefs of staff. The Clinical
practice guidelines for the psychosocial care of adults with
cancer have been developed by the National Breast
Cancer Centre and the National Cancer Control Initiative in
Australia as a benchmark for the psychosocial needs of patients
with cancer. These evidence-based guidelines are designed for use
by all health professionals who care for people during the course
of cancer diagnosis and treatment. Central to the successful
implementation of these guidelines is the ability for health
professionals to exercise the necessary assessment and
communication skills, for example, discuss prognosis and treatment
options available with the patient or the move from curative to
palliative treatments. We know that health professionals can have
low confidence in exercising these skills that can result in a
failure by health professionals to provide effective psychosocial
care to patients with cancer.The purpose of this paper is to elicit
the key issues perceived by registered nurses that arise when
caring for adults with hematological cancer to enable the
development of a framework to assist nurses to provide optimal
evidence-based psychosocial care. In addition, such a framework
will assist nurses to recognize the point at which psychosocial and
emotional responses to patients' needs require specialist
intervention.
The Study
Aim
This study aimed to identify key issues related to providing
effective psychosocial care for adult patients admitted with
hematological cancer, as perceived by registered nurses with 3 or
more years of clinical experience.
Methods
Design
A descriptive qualitative design was used for this study. A
qualitative approach was selected because rich descriptive data,
not available through quantitative methods, were desired to
document the nurses' experiences. Focus groups were chosen because
of their added benefits above individual interviews, in particular
the synergy generated between group members,19 their
naturalistic approach in tapping into everyday social processes of
communication,20 and their "permissive" and peer support
function in encouraging participants to divulge opinions and
beliefs that might not emerge through an individual
interview.21 Approval for this study was granted by the Deakin
University Ethics Committee and the ethics committee of the
participating tertiary referral hospital.
Participants
Participants were purposively selected based on their role in
providing psychosocial care. Although it is recognized that
psychosocial care is a multiprofessional process, this study aimed
to uncover psychosocial care in the context of the 24-hour
management of the patient. The rationale for selecting experienced
registered nurses was that there was an expectation they would
carry the burden of providing complex psychosocial care in the ward
environment. In Australia, registered nurses usually have a degree
qualification. It was considered that these nurses would be role
models and coaches for inexperienced nurses. Hence, the study
sample was limited to experienced registered nurses. Nurses who had
been working on the cancer ward at a major Melbourne tertiary level
hospital, a key center in the provision of oncology services in
Victoria and Australia, for 3 years or more were approached to
participate in the study. A total of 15 experienced nurses
participated.
The participants work on a busy hematology/oncology/radiotherapy
and bone marrow transplant ward that has a complex patient acuity
and associated significant morbidity. The nurses face a range of
complex psychosocial issues related to patients' diagnosis and
associated treatment and their personal circumstances. The 30-bed
ward admits approximately 640 oncology patients, 50 bone marrow
transplant patients, and more than 100 radiotherapy patients each
year. At the time of the study, the ward had just commenced a
Nursing Care Delivery system pilot project that was a modification
of the previous Primary Nursing model utilized by the ward.
Procedure
Two focus groups, 8 participants and 7 participants,
respectively, in each group, were conducted in October 2003. One
member of the research team who had experience in facilitating
focus group interviews conducted the sessions. At both sessions, an
observer was present to take notes pertinent to each session.
Before commencing each interview, introductions were made between
the participants and the researchers present. The facilitator
[R.E.] gave an overview of the purpose of the interview, followed
by outlining the ground rules that apply to the conduct of focus
group interviews, and consent was then requested to audiotape the
session. A statement was made relating to maintaining
confidentiality of individual group members' perceptions at the
conclusion of the session. Participants were also reminded of their
right to withdraw from the study should they wish to do so. The
facilitator circulated written details to participants of who to
contact should they require any emotional support after the
interview.
A brief biographical form was circulated to capture data such as
the qualifications, experience, and role configuration of the
individual participants. Before commencing the interview, the
facilitator encouraged the participants to use "real life" examples
to identify situations in which psychosocial support for patients
and families was considered effective or could have been
enhanced.
During both sessions, the facilitator used a guide consisting of
open-ended questions and probes drawn from the relevant literature
and existing clinical guidelines regarding the psychosocial needs
of patients with life-threatening diseases. The guide was designed
to allow participants to talk freely about their experiences of
caring for patients with hematological cancer and their family
members. The focus group sessions lasted 1 hour; both were
tape-recorded and transcribed verbatim.
Ethical Considerations
Participants were invited to participate in the study based on
their experience; they were informed that they did not have to take
part in the study and that nonparticipation would not affect their
position within the ward. Once the nurses agreed to participate in
the study, they were asked to sign a consent form. Although there
was no perceived inherent risk to participants, before commencing
the sessions, the facilitator circulated written details of a
psychologist available to them should they require emotional
support at the conclusion of the session. Individual participant
data have not been reported.
Data Analysis
The data were coded and analytic themes developed using content
analysis. The transcripts were initially read by one member of the
research team. This took some time and required the text to be
understood as a whole. Notes taken by the observer during each of
the focus group interviews were also read at this time to provide a
context for the interview transcript. Common themes within the
context of each interview were identified resulting in the
identification of 5 major themes. Validation of themes occurred in
2 ways. The coding of the themes was reviewed between the project
research fellow who had initially coded the data and 2 other
members of the research team: one academic and one clinician. All
members were in agreement with the themes. A presentation of the
study findings was given to participants further validating the
findings.
Results
Demographic Characteristics
All participants were female and were registered Division 1
nurses; 20% (n = 3) had hospital registration with 80% (n=13)
having completed a Diploma of Nursing. One participant had
completed an Honors degree, 2 had completed a Postgraduate Diploma
in Nursing. Most participants (53%, n= 8) had had greater than
9-year experience in nursing; however, the majority (53%, n = 8)
had been in their current position for between 1 and 3 years. Five
themes were identified: when is it a good time to talk? Building
relationships, being drawn into the emotional world, providing
support throughout the patient's journey, and breakdown in
communication processes.
1.Is the model used theoretical or conceptual in this study? why
is it important to have theoretical or conceptual in a
research study ?
2.Is there a literature review in the study? was is the purpose
of a literature review?
3. what is the problem statement in the study?why is problem
statement necessary in a research study?
4. what was done to protect the participant in this study? why
is it important to protect them?