Crying babies, tired mothers - challenges of the postnatal hospital stay: an interpretive phenomenological study

ABSTRACT: BACKGROUND: According to an old Swiss proverb, 'a new mother lazing in childbed is a blessing to her family'. Today mothers rarely enjoy restful days after birth, but enter directly into the challenge of combining baby- and self-care. They often face a combination of infant crying and personal tiredness. Yet, routine postnatal care often lacks effective strategies to alleviate these challenges which can adversely affect family health. We explored how new mothers experience and handle postnatal infant crying and their own tiredness in the context of changing hospital care practices in Switzerland. METHODS: Purposeful sampling was used to enroll 15 mothers of diverse parity and educational backgrounds, all of who had given birth to a full term healthy neonate. Using interpretive phenomenology, we analyzed interview and participant observation data collected during the postnatal hospital stay and at 6 and 12 weeks post birth. This paper reports on the postnatal hospital experience. RESULTS: Women's personal beliefs about beneficial childcare practices shaped how they cared for their newborn's and their own needs during the early postnatal period in the hospital. These beliefs ranged from an infant-centered approach focused on the infant's development of a basic sense of trust to an approach that balanced the infants' demands with the mother's personal needs. Getting adequate rest was particularly difficult for mothers striving to provide infant-centered care for an unsettled neonate. These mothers suffered from sleep deprivation and severe tiredness unless they were able to leave the baby with health professionals for several hours during the night. CONCLUSION: New mothers often need permission to attend to their own needs, as well as practical support with childcare to recover from birth especially when neonates are fussy. To strengthen family health from the earliest stage, postnatal care should establish conditions which enable new mothers to balanc the care of their infant with their own need

A master of nursing science curriculum revision for the 21st century : a progress report

Background: Preparing a 21st century nursing workforce demands future-oriented curricula that address the population’s evolving health care needs. With their advanced clinical skill sets and broad scope of practice, Advanced Practice Nurses strengthen healthcare systems by providing expert care, especially to people who are older and/or have chronic diseases. Bearing this in mind, we revised our established Master of Nursing Science curriculum at the University of Basel, Switzerland. Methods: Guided by the Advanced Nursing Practice framework, interprofessional guidelines, fundamental reports on the future of health care and the Bologna declaration, the reform process included three interrelated phases: preparation (work packages (WPs): curriculum analysis, alumni survey), revision (WPs: program accreditation, learning outcomes), and regulations (WPs: legal requirements, program launch). Results: The redesigned MScN curriculum offers two specializations: ANP and research. It was implemented in the 2014 fall semester. Conclusions: This curriculum reform’s strategic approach and step-by-step processes demonstrate how, beginning with a solid conceptual basis, congruent logical steps allowed development of a program that prepares nurses for new professional roles within innovative models of care

Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals : study protocol

With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs.Mit diesem Studienprotokoll wird ein Forschungsprogramm eingeführt. Dessen Ziel ist das Vorbereiten der Instrumente und das Durchführen des ersten Monitorings von Pflegekontextfaktoren an drei Universitäts- und zwei Kantonsspitälern in der Schweiz noch vor Einführung der DRG-basierten Finanzierung, sowie darauf aufbauend das Weiterentwickeln des theoretischen Modells und der dazu gehörenden Methodologie für zukünftige Monitorings nach Einführung der DRGs

Randomized clinical trial to evaluate a cancer pain self-management intervention for outpatients.

Objective Unrelieved pain is common in patients with advanced cancer. Although psychoeducational interventions were found to decrease pain, effects were moderate. The purpose of this study was to evaluate the efficacy of a pain self-management intervention compared with usual care and to explore participants' experiences with pain management and study participation. Methods A multicenter randomized controlled trial design with post-trial interviews was used. Outpatients with cancer pain and their family caregivers were recruited from three Swiss university hospitals. The intervention group (IG) received the six-week intervention consisting of education, skills building, and nurse coaching. The control group (CG) received usual care. Outcome variables were analyzed using multilevel models. Interpretive description guided the qualitative study part. Results Twenty-one patients with advanced cancer and seven family caregivers completed the study. The group x time effect showed a statistically significant decrease in average pain (P ​= ​0.04), but no significant group x time effect for worst pain (P ​= ​0.06). Pain scores, pain-related knowledge, Pain Management Index, self-efficacy, and performance status improved in the IG (P ​< ​0.05). Almost all of the interviewed participants perceived the pain management diary, tailored intervention sessions, and weekly support as useful. None experienced study participation as burdensome. Conclusions This study was the first to test the efficacy of a psychoeducational cancer pain self-management intervention in a German-speaking context, with most patients receiving palliative care. Clinicians can recommend the use of pain management diaries. Tailoring interventions to an individual's situation and dynamic pain trajectory may improve patients' pain self-management. Registration number This study has been registered via ClinicalTrials.gov: NCT02713919.https://clinicaltrials.gov/ct2/show/NCT02713919?term=NCT02713919&amp;draw=2&amp;rank=1

Validation of the newly developed Advanced Practice Nurse Task Questionnaire: A national survey.

AIM To describe psychometric validation of the newly developed Advanced Practice Nurse Task Questionnaire. DESIGN Cross-sectional quantitative study. METHODS The development of the questionnaire followed an adapted version of the seven steps described in the guide by the Association for Medical Education in Europe. A nationwide online survey tested the construct and structural validity and internal consistency using an exploratory factor analysis, Cronbach's alpha coefficient and a Kruskal-Wallis test to compare the hypotheses. RESULTS We received 222 questionnaires between January and September 2020. The factor analysis produced a seven-factor solution as suggested in Hamric's model. However, not all item loadings aligned with the framework's competencies. Cronbach's alpha of factors ranged between .795 and .879. The analysis confirmed the construct validity of the Advanced Practice Nurse Task Questionnaire. The tool was able to discriminate the competencies of guidance and coaching, direct clinical practice and leadership across the three advanced practice nurse roles clinical nurse specialist, nurse practitioner or blended role. CONCLUSION A precise assessment of advanced practice nurse tasks is crucial in clinical practice and in research as it may be a basis for further refinement, implementation and evaluation of roles. IMPACT The Advanced Practice Nurse Task Questionnaire is the first valid tool to assess tasks according to Hamric's model of competencies independently of the role or the setting. Additionally, it distinguishes the most common advanced practice nurse roles according to the degree of tasks in direct clinical practice and leadership. The tool may be applied in various countries, independent of the degree of implementation and understanding of advanced nursing practice. REPORTING METHOD The STARD 2015 guideline was used to report the study. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution

Being in the hospital : an interpretive phenomenological study of terminally ill cancer patients' experiences

This article describes a study exploring terminally ill cancer patients' experiences of being in hospital and the meanings patients assigned to the hospital as their temporary residence. Ten patients and their closest family members participated in this interpretive phenomenological study during the patients' hospitalization. Data were collected in a public tertiary hospital in Switzerland. Patients' care was observed and participants were interviewed repeatedly. Data analysis included thematic analysis as well as searching for paradigm cases and exemplars. Patients described their existence in the hospital on a continuum from "prison" to "heaven." For most of their stay, patients occupied some place between these extremes and could be called "guests of necessity" who accepted the hospital as necessity but were longing for home. The quality of hospital life was not constant rather, patients' experiences were transitory and some faded away. The study revealed an aspect hitherto undescribed in the literature: patients' experiences of the hospital as a temporary residence. Its findings can heighten health care professionals' awareness of patients' experiences. Recognizing patients' perspectives regarding the hospital as their temporary living place will allow professionals to individualize patient care

Living with terminal illness : patient and family experiences of hospital end-of-life care

AIM: The study explored terminally ill patients' and their families' experiences of hospital end-of-life care. DESIGN: A qualitative approach--interpretive phenomenology--was applied prospectively. Sample and setting. Ten patients and their closest family members were recruited in one Swiss university hospital. METHODS: Data collection included repeated observations, conversations with patients, and interviews with family members. FINDINGS: People led unique lives; when a terminal illness intruded and during hospital stays, they continued to live their particular life. The hospital was experienced differently, as prison, heaven, or necessary sojourn. A caring stance of the professionals was crucial to patients' and families' sense of being well cared for. When care providers lacked skills or did not recognize patients and family members as persons, they suffered. In contrast, adequate care interventions improved their quality of life. CONCLUSIONS: The experience of being in the hospital cannot be separated from patients' and families' life stories

Family experiences of hospital end-of-life care in Switzerland : an interpretive phenomenological study

AIM: Experiences of family members of terminally ill patients with hospital end-of-life care were explored. The study is part of a larger study that investigated patients' and families' experiences; this study describes family members' unique experiences. DESIGN: A qualitative method, interpretive phenomenology, was used. SAMPLE AND SETTING: Ten closest family members of patients were recruited in one Swiss tertiary care hospital. METHODS: Data were mainly collected through interviews with family members. FINDINGS: Family members suffered greatly when they witnessed patients' suffering. They experienced different approaches by professionals: non-recognition; a rather passive but welcoming attitude; active care for the family. The patient's wellbeing had priority for families; they cared for patients by providing company and being advocates or becoming co-caregivers. Family members experienced consequences of accompanying a terminally ill patient: they felt exhausted and their everyday taken-for-granted world was changed. Caring for the patient had become the only priority. CONCLUSION: Nurses can best improve families' experiences of hospital end-of-life care when they are aware of families' priorities and take excellent care of the patient first, but, in addition, recognize family members, approach them actively and integrate them as co-caregivers as much as wished by patient and family member

[Experiences of patients and family members during the stay on a nursing unit]

In 2004, the university hospital of Berne ran a pilot project with a Nursing Unit (NU). In this unit patients who no longer needed a close surveillance by physicians were cared for. They needed primarily complex professional nursing care which could not be provided by other hospitals, nursing homes, home care or family members. The nurses were responsible for the coordination of care. This qualitative study investigated experiences of patients and family members with the care concept of the NU. Thematically focused interviews were conducted with nine patients and five family members. Qualitative content analysis was used for data analysis. Results show that patients and family members mostly accepted the new care concept. They positively experienced the quiet and restful atmosphere, the patient-centred and continuous care by competent nurses, the education and the discharge planning. Some study participants reported missing information at the time of their transfer to the NU, insufficient assessments or unsuitable educational scripts. The study provides evidence to positive effects of a patient-centred care approach