Why are family carers of people with dementia dissatisfied with general hospital care?: a qualitative study

Background Families and other carers report widespread dissatisfaction with general hospital care for confused older people. Methods We undertook a qualitative interviews study of 35 family carers of 34 confused older patients to ascertain their experiences of care on geriatric and general medical, and orthopaedic wards of a large English hospital. Transcripts were analysed using a grounded theory approach. Themes identified in interviews were categorised, and used to build a model explaining dissatisfaction with care. Results The experience of hospital care was often negative. Key themes were events (illness leading to admission, experiences in the hospital, adverse occurrences including deterioration in health, or perceived poor care); expectations (which were sometimes unrealistic, usually unexplored by staff, and largely unmet from the carers’ perspective); and relationships with staff (poor communication and conflict over care). Expectations were influenced by prior experience. A cycle of discontent is proposed. Events (or ‘crises’) are associated with expectations. When these are unmet, carers become uncertain or suspicious, which leads to a period of ‘hyper vigilant monitoring’ during which carers seek out evidence of poor care, culminating in challenge, conflict with staff, or withdrawal, itself a crisis. The cycle could be completed early during the admission pathway, and multiple cycles within a single admission were seen. Conclusion People with dementia who have family carers should be considered together as a unit. Family carers are often stressed and tired, and need engaging and reassuring. They need to give and receive information about the care of the person with dementia, and offered the opportunity to participate in care whilst in hospital. Understanding the perspective of the family carer, and recognising elements of the ‘cycle of discontent’, could help ward staff anticipate carer needs, enable relationship building, to pre-empt or avoid dissatisfaction or conflict

`We treat them all the same' The experiences of nursing staff and of South Asian patients in a general hospital

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN017243 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Nurses' experiences of caring for South Asian minority ethnic patients in a general hospital in England

Healthcare provision for minority ethnic groups in the UK has generally revealed inequalities in access and differential service provision. British healthcare policy has started to address such issues. However, very few studies have specifically examined the experiences of nurses caring for minority ethnic patients. This paper focuses on the focus group interviews of a broader ethnographic study, aimed at describing nurses' experiences of caring for South Asian minority ethnic patients, in a general hospital in the south of England. A sample of 43 nurses of all grades from six medical wards took part in the focus groups: three ward sisters, 22 staff nurses and 18 care assistants; 40 participants were white, one was African-Caribbean and two were South Asian. Data analysis revealed eight themes: changes in service provision; false consciousness of equity; limited cultural knowledge; victim blaming; valuing of the relatives; denial of racism; ethnocentrism, and self-disclosure. The study revealed a good local service response to government policies in addressing inequality. However, there was a tendency to treat all minority ethnic patients the same, with evidence of ethnocentric practices, victim-blaming approaches and poor cultural competence in nursing staff, which raise questions about the quality of service provision. The study indicates that ongoing training and development in the area of cultural competence is necessary

Nurses' experiences of caring for South Asian minority ethnic patients in a general hospital in England

Healthcare provision for minority ethnic groups in the UK has generally revealed inequalities in access and differential service provision. British healthcare policy has started to address such issues. However, very few studies have specifically examined the experiences of nurses caring for minority ethnic patients. This paper focuses on the focus group interviews of a broader ethnographic study, aimed at describing nurses' experiences of caring for South Asian minority ethnic patients, in a general hospital in the south of England. A sample of 43 nurses of all grades from six medical wards took part in the focus groups: three ward sisters, 22 staff nurses and 18 care assistants; 40 participants were white, one was African-Caribbean and two were South Asian. Data analysis revealed eight themes: changes in service provision; false consciousness of equity; limited cultural knowledge; victim blaming; valuing of the relatives; denial of racism; ethnocentrism, and self-disclosure. The study revealed a good local service response to government policies in addressing inequality. However, there was a tendency to treat all minority ethnic patients the same, with evidence of ethnocentric practices, victim-blaming approaches and poor cultural competence in nursing staff, which raise questions about the quality of service provision. The study indicates that ongoing training and development in the area of cultural competence is necessary

Migrating registered nurses in the UK: Black and minority ethnic overseas nurses' perspectives

Purpose - The purpose of the study is to explore, describe and develop a greater understanding of overseas Black and minority ethnic nurses' experiences of, as well as the impact of, their experiences on the quality and service delivery in the UK's NHS. Design/methodology/approach - Phenomenology was adopted to explore overseas nurses' experiences. Twelve face-to-face interviews were completed and all participants involved were interviewed in their homes. Participants originated from Asia, Africa and the Caribbean. Findings - Findings revealed five themes such as building ties, reflecting on experience, moving on, reduced confidence and lack of support. Practical implications - Despite negative experiences, participants indicated that time working in the NHS was useful and contributed towards their development. In recruiting and retaining overseas nurses in the UK NHS, it is important to address their needs - demonstrating NHS commitment to a diverse workforce with ultimate effects on patients' care. Originality/value - This article shows that some overseas nurses are unhappy in the clinical environment and as a consequence they decide to seek alternative workplaces where they feel that they may be valued. © Emerald Group Publishing Limited

Migrating registered nurses in the UK: Black and minority ethnic overseas nurses' perspectives

Purpose - The purpose of the study is to explore, describe and develop a greater understanding of overseas Black and minority ethnic nurses' experiences of, as well as the impact of, their experiences on the quality and service delivery in the UK's NHS. Design/methodology/approach - Phenomenology was adopted to explore overseas nurses' experiences. Twelve face-to-face interviews were completed and all participants involved were interviewed in their homes. Participants originated from Asia, Africa and the Caribbean. Findings - Findings revealed five themes such as building ties, reflecting on experience, moving on, reduced confidence and lack of support. Practical implications - Despite negative experiences, participants indicated that time working in the NHS was useful and contributed towards their development. In recruiting and retaining overseas nurses in the UK NHS, it is important to address their needs - demonstrating NHS commitment to a diverse workforce with ultimate effects on patients' care. Originality/value - This article shows that some overseas nurses are unhappy in the clinical environment and as a consequence they decide to seek alternative workplaces where they feel that they may be valued. © Emerald Group Publishing Limited

Men's perceptions and experiences of the early detection of prostate cancer: A qualitative study using grounded theory approach

Background and objective: Despite significant progress in prostate cancer research over the last two decades, screening of the disease has remained controversial.From a socio-epidemiological perspective, little is known of patients' beliefs about their illness and why they often delay in seeking diagnosis.The purpose of this qualitative study was to understand the experiences and perceptions of men about the early detection of prostate cancer. Method: This study used a grounded theory approach incorporating the theoretical perspective of social constructionism. A purposive sampling of twelvemen from public and private sector hospitals who had received therapy were interviewed face to face in Persian using a semi-structured interview guide. Interviews were audio taped, then transcribed in full, translated into English by the investigator, and analysed usingMAXqda software. Results: The valuemenaccorded to early detection of prostate cancer was found to be conditional upon their beliefs of prostate illness and their experiences about cure. There was a lack of information about the early detection process. The men felt that medical intervention was focused on the biological aspects, ignoring the needs of the psychosocial concerns. The men were not expecting to have symptoms because of prostate treatment; this influenced their subsequent decision-making. Conclusion: Given men's perceptions and experiences of the illness, screening of prostate cancer seems to have wider implications. The findings suggest that early detection of the disease in Iran may need a screening model that incorporates both biomedical and psychosocial aspects. © EuroJournals Publishing, Inc. 2010

Research Perspectives applied to Primary Health Care

The Fourth Edition of this successful text focuses on new emergent agendas which affect primary care and public health education and service ..