Mental health nurses’ support to caregivers of older adults with severe mental illness : a qualitative study

Background: Literature has shown the serious impact of severe mental illness on the daily life of caregivers. We studied reported caregiver support practices by mental health nurses for use in the development of a nursing intervention. We aimed to explore current caregiver support practices by mental health nurses. Methods: Twenty-one participants completed semi-structured interviews, and 17 participants attended two focus groups. All interviews were audio-taped, transcribed and coded for qualitative analysis. Results: The diversity in caregiver support could best be described by three prototypes: the tolerator, the preventer and the concerner, representing three approaches of involvement with caregivers. At one end of the spectrum are mental health nurses (MHN) who are essentially only concerned with the wellbeing of the care recipient and see the caregiver as a potential impediment in reaching the client’s goals. We call these the tolerators. At the other end of the spectrum are the MHNs who see the caregiver and the care recipient as inextricably connected with each other. In these cases the MHN directs her/his intervention towards both the informal caregiver and the care recipient. We call these the concerners. In the middle position are MHNs who realize that caregivers are important agents in the achievement of the client’s goals, and therefore consider preventing them from becoming overburdened as an important goal. We call these the preventers. Conclusions: Based on the extent to which the MHNs believe that the informal caregiver plays a necessary role in the client’s support system, and the degree to which they feel responsible for the caregiver’s wellbeing, three MHN prototypes can be distinguished. These prototypes determine how the nurses’ vision directs their understanding of their role and responsibilities and the content of their behaviour. This implies that a change in behaviour needs to be preceded by a change in vision. Therefore, promoting family support cannot be achieved by one-size-fits-all-programmes

Associated factors of hope in cancer patients during treatment : a systematic literature review

Aim: To identify the associated factors of hope during treatment in cancer patients. Background: Hope is very important to cancer patients at all stages of the disease process. Hope is seen as an important coping mechanism. Most research about hope in cancer patients considered the end of life or in palliative care. Several and different factors are associated with hope. It is not yet sufficiently clear which factors are associated with hope during the treatment. Design: A systematic literature review of quantitative empirical studies on hope in cancer patients during treatment. Data Sources: Search in MEDLINE (PubMed interface), CINAHL (EBSCO interface), Psychinfo and Cochrane (January 2009-December 2018). Review Methods: Empirical quantitative studies were included regardless of the disease stage, written in English or Dutch, measuring hope from the perspective of cancer patients. Two authors independently screened all the studies and assessed their quality. Results: Thirty-three studies were included. Positive relationship has been established between hope and quality of life, social support, spiritual and existential well-being. Hope appears to be negatively associated with symptom burden, psychological distress and depression. There appears to be no relationship between hope and demographic and clinical variables. The relationship between anxiety and hope remains unclear. Conclusions: Hope primarily seems to be a process that takes place in a person's inner being rather than being determined from outside. Impact: Health professionals may want to focus on the meaning of hope for cancer patients in relation to the associated factors. A better understanding of the meaning of hope during treatment can be of great value in supporting cancer patients with regard to treatment decisions, psychosocial support, the experienced quality of life and symptom burden and any wishes they may have with regard to advanced care planning

Vertrouwen in de relatie tussen zorgverleners en patiënten met een chronische ziekte : een exploratieve kwalitatieve studie

DOEL: Exploreren van het concept vertrouwen zoals het zich manifesteert in de relatie tussen patiënten met chronische aandoeningen en hun zorgverleners. METHODE: Veertien semigestructureerde interviews met patiënten die bevraagd werden over hun relatie met hun zorgverleners. Een grounded-theory-benadering werd gebruikt. Datacollectie en data-analyse gebeurden iteratief. Er vond onderzoekerstriangulatie plaats. RESULTAAT: Het uit de data gereconstrueerde concept ’vertrouwen’ is de uitkomst van de interactie tussen de patiënt en de zorgverlener. Vertrouwen kan verschillende dimensies aannemen: 1. vertrouwen in de professional, 2. vertrouwen in de relatie, 3. vertrouwen in de onvoorwaardelijkheid van de relatie en 4. wantrouwen. Vertrouwen is de uitkomst van een proces waarbij er facilitatoren en barrières zijn voor het opbouwen of afbreken van vertrouwen in de zorgrelatie. DISCUSSIE: Een breed palet van factoren die het ontstaan en evolueren van vertrouwen bij patiënten met een chronische aandoening beïnvloeden werd verkregen. Vervolgonderzoek met een grotere steekproef in diverse settings is wenselijk om de ervaringen van patiënten en de bestaande concepten verder uit te diepen. CONCLUSIE: Het belang van vertrouwen in de zorgrelatie bij patiënten met een chronische aandoening wordt in deze studie beklemtoond. Interpersoonlijke competenties blijken belangrijk. De resultaten kunnen zorgverleners helpen te reflecteren over hun gedrag ten aanzien van patiënten met een chronische aandoening

Perspectives of family members on planning end-of-life care in the older palliative patient

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How interdisciplinary teamwork contributes to psychosocial cancer support

Background: The organization of psychosocial care is rather complex, and its provision diverse. Access is affected by the acceptance and attitude of patients and professional caregivers toward psychosocial care. Objectives: The aims of this study were to examine when patients with cancer experience quality psychosocial care and to identify circumstances in collaboration that contribute to patient-perceived positive psychosocial care. Methods: This study used a qualitative design in which semistructured interviews were conducted with patients, hospital workers, and primary health professionals. Results: Psychosocial care is often requested but also refused by patients with cancer. Based on this discrepancy, a distinction is made between psychosocial support and psychosocial interventions. Psychosocial support aims to reduce the chaos in patients" lives caused by cancer and is not shunned by patients. Psychosocial interventions comprise the formal care offered in response to psychosocial problems. Numerous patients are reluctant to use psychosocial interventions, which are often provided by psychologists. Conclusion: Psychosocial care aims to assist patients in bearing the difficulties of cancer and its treatment. Patients prefer informal support, given often in conjunction with physical care. Implications for Practice: This study confirms the important role of nurses in promoting psychosocial care. Patients perceive much support from nurses, although nurses are not considered to be professional psychosocial caregivers. Being perceived as approachable and trustworthy offers nurses a significant opportunity to bring more intense psychosocial interventions within reach of cancer patients