Pernilla Pergert

Obstacles to Transcultural Caring Relationships: Experiences of Health Care Staff in Pediatric Oncology

This qualitative study explores the caring situation of families with an immigrant background within the context of pediatric oncology care from the perspective of health care staff. Five focus group interviews and 5 complementary individual interviews were conducted after purposive and theoretical sampling, respectively. Grounded theory methodology revealed that obstacles to transcultural caring relationships are a main concern of the health care staff. These obstacles are divided into 4 main categories: linguistic, cultural and religious, social, and organizational. When health care staff fail to recognize obstacles to transcultural caring relationships, the result is inequity in care of families with an immigrant background. Equity in care for all does not mean identical treatment but, rather, care adjusted to the needs of the individual family regardless of background.

Bridging obstacles to transcultural caring relationships—Tools discovered through interviews with staff in pediatric oncology care

In this qualitative study we explored how health-care staff continuously resolve obstacles to transcultural caring relationships as they care for families with an immigrant background within the context of pediatric oncology care. A constant comparative method was used and data collection included 5 focus group interviews and 5 complementary individual interviews with health-care staff within pediatric oncology care. Bridging emerged as the way that health-care staff deal with obstacles to transcultural caring relationships. Bridging is a process in which various tools may be used and combined, including communicational tools, transcultural tools and organizational tools. Failure to use tools, or to use and combine them insufficiently, can bring the caring relationship to a halt, which leads to inequity in care. In order to ensure the provision of high-quality care despite differences in religion, culture, language and social situation, health-care staff need to bridge obstacles to transcultural caring relationships.

Balancing truth-telling in the preservation of hope: a relational ethics approach.

Truth-telling in healthcare practice can be regarded as a universal communicative virtue; however, there are different views on what consequence it has for giving or diminishing hope. The aim of this article is to explore the relationship between the concepts of truth-telling and hope from a relational ethics approach in the context of healthcare practice. Healthcare staff protect themselves and others to preserve hope in the care of seriously sick patients and in end-of-life care. This is done by balancing truth-telling guided by different conditions such as the cultural norms of patients, family and staff. Our main conclusion is that the balancing of truth-telling needs to be decided in a mutual understanding in the caring relationship, but hope must always be inspired. Instead of focusing on autonomy as the only guiding principle, we would like to propose that relational ethics can serve as a meaningful perspective in balancing truth-telling.

Experiences of Ethical Issues When Caring for Children With Cancer

Background: The treatment for pediatric cancer is often physically, socially, and psychologically demanding and often gives rise to ethical issues. Objective: The purpose of this study was to describe healthcare professionals’ experiences of ethical issues and ways to deal with these when caring for children with cancer. Methods: A study-specific questionnaire was given to healthcare professionals at a pediatric hospital in Sweden. Qualitative content analysis was used to analyze answers to open-ended questions. The data were sorted into 2 domains based on the objective of the study. In the next step, the data in each domain were inductively coded, generating categories and subcategories. Results: The main ethical issues included concerns of (1) infringing on autonomy, (2) deciding on treatment levels, and (3) conflicting perspectives that constituted a challenge to collaboration. Professionals desired teamwork and reflection to deal with ethical concerns, and they needed resources for dealing with ethics. Implications for Practice: Interprofessional consideration needs to be improved. Forums and time for ethics reflections need to be offered to deal with ethical concerns in childhood cancer care. Conclusions: Experiences of ethical concerns and dealing with these in caring for children with cancer evoked strong feelings and moral perplexity among nursing staff. The study raises a challenging question: How can conflicting perspectives, lack of interprofessional consideration, and obstacles related to parents’ involvement be “turned around,” that is, contribute to a holistic perspective of ethics in cancer care of children?

Protecting Professional Composure in Transcultural Pediatric Nursing

In this qualitative study, we used grounded theory to explore the category of “overwhelming emotional expressions” that emerged in a previous study. Using theoretical sampling, 12 individual interviews were conducted with nurses in Swedish pediatric care. Overwhelming emotional expressions have been found to override nurses professional preparedness; they continuously resolve this by protecting professional composure. Various strategies are used to protect professional composure, including rationalizing, controlled expression, power display, escape/avoidance, distancing, sharing, and management of space. Some of these strategies are similar to coping strategies. However, they differ in that they are about managing the situation and also include protecting the professional composure of the individual as well as the whole care situation. Nurses need to gain preparedness to meet overwhelming emotional expressions in transcultural care and to be aware of strategies for protecting professional composure so as to use them consciously and positively.

Ethics case reflection sessions: Enablers and barriers:

Background: In previous research on ethics case reflection (ECR) sessions about specific cases, healthcare professionals in childhood cancer care were clarifying their perspectives on the ethical issue to resolve their main concern of consolidating care. When perspectives were clarified, consequences in the team included ‘increased understanding’, ‘group strengthening’ and ‘decision grounding’. Additional analysis of the data was needed on conditions that could contribute to the quality of ECR sessions. Objective: The aim of this study was to explore conditions for clarifying perspectives during ECR sessions. Research design: Data were collected from observations and interviews and the results emerged from an inductive analysis using grounded theory. Participants and research context: Six observations during ECR sessions and 10 interviews were performed with healthcare professionals working in childhood cancer care and advanced paediatric homecare. Ethical considerations: The study was approved by a regional ethical review board. Participants were informed about their voluntary involvement and that they could withdraw their participation without explaining why. Findings: Two categories emerged: organizational enablers and barriers and team-related enablers and barriers. Organizational enablers and barriers included the following sub-categories: the timing of the ECR session, the structure during the ECR session and the climate during the ECR session. Sub-categories to team-related enablers and barriers were identified as space for inter-professional perspectives, varying levels of ethical skills and space for the patient’s and the family’s perspectives. Discussion: Space for inter-professional perspectives included the dominance of a particular perspective that can result from hierarchical positions. The medical perspective is relevant for understanding the child’s situation but should not dominate the ethical reflection. Conclusion: Conditions for ECR sessions have been explored and the new knowledge can be used when training facilitators as well as for those who organize/implement ECR sessions. Awareness of space for different perspectives, including the possible medical advantage over the nursing perspective, could reduce the somewhat unilateral attention and contribute to an inter-professionally shared reflection.