Reidun Hov

Patients’ preferences in palliative care: A systematic mixed studies review

Background: It is necessary to develop palliative care to meet existing and future needs of patients and their families. It is important to include knowledge of patient preferences when developing high-quality palliative care services. Previous reviews have focused on patient preferences with regard to specific components of palliative care. There is a need to review research on patient’s combined preferences for all elements that constitute palliative care. Aim: The aim of this study is to identify preferences for palliative care among patients in the palliative phase of their illness, by synthesizing existing research. Data sources: Studies were retrieved by searching databases – the Cochrane Library, Medline, CINAHL, PsycINFO, Scopus and Sociological Abstracts – from 1946 to 2014, and by hand searching references in the studies included. Design: A systematic mixed studies review was conducted. Two reviewers independently selected studies for inclusion and extracted data according to the eligibility criteria. Data were synthesized using integrative thematic analysis. Results: The 13 qualitative and 10 quantitative studies identified included participants with different illnesses in various settings. Four themes emerged representing patient preferences for care. The theme ‘Living a meaningful life’ illustrated what patients strived for. The opportunity to focus on living required the presence of ‘Responsive healthcare personnel’, a ‘Responsive care environment’ and ‘Responsiveness in the organization of palliative care’. Conclusion: The four themes may be useful for guiding clinical practice and measurements of quality, with the overall goal of meeting future needs and improving quality in palliative care services to suit patients’ preferences.

Patients' perceptions of palliative care quality in hospice inpatient care, hospice day care, palliative units in nursing homes, and home care : a cross-sectional study

BackgroundPatients’ perceptions of care quality within and across settings are important for the further development of palliative care. The aim was to investigate patients’ perceptions of palliative care quality within settings, including perceptions of care received and their subjective importance, and contrast palliative care quality across settings.MethodA cross-sectional study including 191 patients in late palliative phase (73 % response rate) admitted to hospice inpatient care, hospice day care, palliative units in nursing homes, and home care was conducted, using the Quality from the Patients’ Perspective instrument-palliative care (QPP-PC). QPP-PC comprises four dimensions and 12 factors; “medical–technical competence” (MT) (2 factors), “physical–technical conditions” (PT) (one factor), “identity–orientation approach” (ID) (4 factors), “sociocultural atmosphere” (SC) (5 factors), and three single items (S); medical care, personal hygiene and atmosphere. Data were analysed using paired-samples t-test and analysis of covariance while controlling for differences in patient characteristics.ResultsPatients’ perceptions of care received within settings showed high scores for the factors and single items “honesty” (ID) and “atmosphere” (S) in all settings and low scores for “exhaustion” (MT) in three out of four settings. Patients’ perceptions of importance scored high for “medical care” (S), “honesty” (ID), “respect and empathy” (ID) and “atmosphere” (S) in all settings. No aspects of care scored low in all settings. Importance scored higher than perceptions of care received, in particular for receiving information. Patients’ perceptions of care across settings differed, with highest scores in hospice inpatient care for the dimensions; ID, SC, and “medical care” (S), the SC and “atmosphere” (S) for hospice day care, and “medical care” (S) for palliative units in nursing homes. There were no differences in subjective importance across settings.ConclusionStrengths of services related to identity–orientation approach and a pleasant and safe atmosphere. Key areas for improvement related to receiving information. Perceptions of subjective importance did not differ across settings, but perceptions of care received scored higher in more care areas for hospice inpatient care, than in other settings. Further studies are needed to support these findings, to investigate why perceptions of care differ across settings and to highlight what can be learned from settings receiving high scores.

Critical thinking, research utilization and barriers to this among nursing students in Scandinavia and Indonesia:

The aim of this study was to describe and compare perceptions of critical thinking, attitudes to and availability of research, research utilization and barriers to this among nursing students in Scandinavia and Indonesia. Data were collected at the beginning, middle and end of education from nursing students in Norway, Sweden (bachelor’s diploma) and Banda Aceh (bachelor’s diploma). Critical Thinking and Research Utilization Questionnaires were used along with the Barrier Scale. Descriptive analyses, comparisons between and within groups were performed. At the end of education, all samples exhibited positive attitudes to research and the main barrier was related to the setting. Scandinavian students reported higher critical thinking. Indonesian students perceived greater barriers on two Barrier subscales. No differences were found between the samples regarding research utilization. Significant changes over time varied among the samples except for the Norwegian sample. Indonesian students (diploma) exhibited most changes over time. Teachers must support nursing students to strengthen their critical thinking ability and develop professional competence.

Nurses' contributions to health: Perceptions of first-year nursing students in Scandinavia and Indonesia:

Nursing students need an understanding of how nurses care for peoples health from a global perspective. The aim of this study was to explore how nurses can contribute to health from the perspectives of first-year nursing students in Scandinavia (Sweden, Norway) and Indonesia. Data were collected using an open-ended question about nurses’ contribution to health, and analysed using qualitative content analysis. Three common categories emerged: ‘Promoting health and preventing disease’, ‘Performing care and treatment’, ‘Establishing a relationship with patients and being compassionate’. ‘Possessing and implementing knowledge and skills’ was common to Norway and Indonesia. ‘Being a team member’ was emphasised by the Indonesian participants. The Norwegian participants focused on health promotion, whereas those from Indonesia prioritised disease prevention. The Scandinavian participants emphasised individuality, while those from Indonesia focused on the community. The findings indicate that nursing education should take account of different cultures and include student exchange programmes.

A Healthy Person The Perceptions of Indonesian and Scandinavian Nursing Students

The purpose of this exploratory study was to investigate how nursing students in Indonesia and Scandinavia characterize a healthy person. Two hundred thirty-two nursing students from Indonesia, 50 students from Sweden, and 119 students from Norway participated by answering an open-ended question. Qualitative content analysis was used to identify patterns of health in a cultural and national context. The characteristics of a healthy person were summarized in the theme “external and inner balance,” which are intertwined because of the wholeness of self-image and appearance. The subcategories were having a strong and positive body image, feeling well and having inner harmony, following the rules of life, coping with challenges, and acting in unison with the environment. There were more similarities than differences between the Indonesian and Scandinavian nursing students’ understanding of being a healthy person. The difference is that the Scandinavian students mentioned individuality, whereas the Indonesian students referred to collective values.