Dr Sue Schutz

Background

Ecomaps are tools used in nursing practice to assess families’ social support systems. Whilst ecomaps have previously been used effectively within qualitative research, little attention has been given to them as a tool within the methodological approach of hermeneutic phenomenology.

Aim

To demonstrate that the use of ecomaps is congruent with the Heideggerian philosophical foundations associated with hermeneutic phenomenology. This paper demonstrates how ecomaps can illuminate nurses’ understanding about the experiences of patients and families by reflecting on a study where ecomaps were used to explore how parents of children with cancer are supported with decision-making about their child’s care.

Discussion

Exploration of the Heideggerian concepts of ‘being-in-the-world’, ‘being-with’, and ‘temporality’ prompted reflections about how constructing ecomaps furthers understanding about participants’ unique contexts. Using an ecomap within an in-depth interview enabled participants to return to their experiences of being supported with decision-making, and further developed the researcher’s understanding about how each participant’s experience was situated within their evolving relationships with others.

Conclusion

Constructing ecomaps within hermeneutic phenomenology is in tune with Heideggerian philosophical concepts. Ecomaps can open a door to participants’ experiences and, combined with understanding of philosophical concepts, deepen the researcher’s understanding and find further meaning in participants’ experiences.

Implications for practice

Ecomaps are a useful tool in shining a light on the lifeworld of research participants in hermeneutic phenomenological research. Practical tips are provided to optimise their use in future research.

Mental health nurses working in inpatient settings are at increased risk of being assaulted by patients. Systematic reviews have synthesised predominantly quantitative evidence relating to the prevalence, contributing factors, effects and adverse outcomes of violence towards mental health nurses. This article details a systematic review that used a meta-aggregative approach to provide a synthesis of qualitative evidence on the experiences of mental health nurses who have been assaulted by patients in inpatient settings. The review found that mental health nurses consider violence against them to be a significant and unacceptable issue that can have significant and pervasive effects on their personal and professional lives. Nurses may avoid or suppress their emotions following an assault, finding it challenging to share and
report their experiences. Mental health nurses’ perceptions of factors that contribute to and can prevent violence and assault included the environment, workforce, relationships, gender and restrictive practice. By focusing on findings generated through the use of qualitative research methods, this literature review enhances the depth of existing evidence, bringing the voice of nurses who have been assaulted to current understanding.

Aim 

Blood pressure guidelines have undergone multiple revisions in accordance with updated science. Understanding patients’ hypertension symptoms can assist healthcare professionals’ awareness of individual, cultural, and behavioural responses and improve diagnostic accuracy to optimize treatment. Therefore, the purpose of this review was to evaluate and synthesize current literature exploring symptoms experienced by patients with hypertension. 

Methods 

Databases searched included MEDLINE® (PubMed®), CINAHL® (EBSCO), Scopus, and Web of Science™ from January 2010 to January 2022 for studies with reported hypertension symptoms.  The search followed the PRISMA guidelines.  The McMaster critical review forms were used to determine quality of both qualitative and quantitative articles. Synthesis of the data was guided by the Joanna Briggs Institute Convergent Integrated Approach to Mixed Study Systematic Reviews. 

Results 

Forty-one articles were included in the review, including nine qualitative studies and thirty-two quantitative.  Quality of the articles varied. Symptoms included commonly reported symptoms and some less prevalent, including some reporting absence of symptoms. Factors that affected symptoms included culture, beliefs, psychosocial factors and knowledge. We also found that there may be a bidirectional relationship with symptoms and behaviours that may lead to self-management. 

Conclusion 

Hypertension is common and symptoms are frequently reported. Hypertension management is related to multiple factors. Symptoms continue in a number of individuals after initial diagnosis. Evaluating symptoms after initial diagnosis may help to optimally manage and meet BP guidelines.  

Keywords: hypertension, symptoms, mixed methods review, systematic review 

Background

Heart Failure is a life-limiting condition with a poor and uniquely unpredictable prognosis. The aim of this review is to present and synthesise the current evidence around bereaved caregivers’ experiences of end of life care for people with Heart Failure.

Methods

A systematic review of the literature was conducted using four electronic databases (CINHAL, Medline, BND, PsycINFO). Data was analysed and presented using a narrative synthesis approach.

Results

Eight articles were included within this review. Themes included: Limited and inadequate communication around the condition (including prognosis, preparations for death and the aim of palliative care), the burden of caregiving, and the limited provision of services and formal support.

Conclusion

Bereaved caregivers experience unique and significant challenges when caring for someone dying from Heart Failure. However, further research is required to greater understand the experiences of bereaved caregivers of people with Heart Failure.

Objectives: During the SARS-CoV-2 pandemic, clinicians were instructed to move all but emergency consultations to remote means to reduce the spread of the virus. The aim of this study was to evaluate patients’ and clinicians’ experiences of moving to remote means of consultation with their health care professionals during the SARS-CoV-2 pandemic. Methods: The study design was a qualitative service evaluation. Twenty-six clinicians and forty-eight patients who met the inclusion criteria consented to be interviewed. Clinician participants were from either medical, nursing, or allied health professional backgrounds. Patients were recruited from diabetes, acute care, and haematology and cancer areas. Data analysis was conducted using a thematic analysis framework. Results: Following coding and thematic analysis of the data collected from clinicians, five themes were identified: personal and professional well-being; providing a safe and high-quality experience; adapting to a new way of working; making remote consultations fit for purpose and an awareness of altered dynamics during consultation. Patient data was coded into 3 themes: remote consultation adds value; remote consultation brings challenges and concerns about remote consultation. Conclusions: Clinician and patient experiences reported here are reflected in the literature. The study indicates that remote consultation is not suitable for all patients and in all contexts. Whilst maintaining the benefits to patients, remote means of consultation needs organisational support and preparation. A way forward that maintains the benefits whilst addressing concerns seems urgent.

Aim: To synthesise what is known from current international evidence about how parents are supported by significant others when they are faced with making decisions about their child's cancer care.

Background: Parents are faced with making challenging decisions when their child has cancer and may benefit from support. Whilst previous research has comprehensively explored how healthcare professionals can offer support, little attention has been given to how support may be informally provided from a parent's network of significant others.

Method: An integrative literature review was undertaken and reported following the ENTREQ framework. Literature was identified from comprehensive database searching across four relevant databases (CINAHL, PubMed, PsychINFO and British Nursing Database) and hand-searching reference lists of retrieved studies. Studies that met the inclusion criteria were critically appraised and then analysed using the Constant Comparative Analysis method.

Results: Twenty-six articles were included in the review. Two overarching themes were iden-tified. Theme 1— Dimensions of Decision- Making support— included three sub-themes: informational, emotional and instrumental mechanisms of support. Theme 2— Expectations of Decision- Making support— identified that parents’ expectations of their own role, and the role of their significant others, affected how decision-making was supported.

Conclusions: Parents may seek and receive support from various significant members of their network, but there is a fine line between supportive and unsupportive behaviours.

Relevance to clinical practice: Each family's unique personal, social and cultural context strongly impacts on their support needs, and nurses and other healthcare professionals should be mindful of how parents may access support from their significant others. Further in-depth research around this area would contribute important knowledge around parents’ support needs.

This article describes and reflects upon ethical dilemmas encountered during the data collection phase of a doctoral study exploring the experiences of mental health nurses who have been assaulted by patients in secure settings. It considers the researcher's position as an ‘insider’ and highlights the potential for this status to influence assumptions, conflicts and decisions in relation to ethical considerations. The projection of the researcher's own emotional experience onto participants is recognised to be a significant factor, emphasising the importance of reflection and reflexivity during the process. The dilemmas discussed are situated in and influenced by the context of the COVID-19 pandemic.

The community respiratory nurse specialist (CRNS) supports patients at different stages of lung disease, witnessing the challenge of living with chronic obstructive pulmonary disease (COPD), a progressive illness for which there is no cure. Breathlessness is the most prominent and debilitating symptom experienced; it is frightening, distressing and very difficult to manage. Little is known about the experience of CRNSs in witnessing the distress of patients, specifically those experiencing breathlessness. The nurse may have cared for such patients over many months or years. In witnessing this distress, CRNSs engage in emotional labour, which is associated with burnout and poor-quality care. This paper seeks to identify bearing witness to suffering and vulnerability as components of emotional labour in the context of the CRNS role. It highlights the need for research to explore the experience of CRNSs and insights into supporting people with long-term breathlessness. It is more likely that wellsupported staff can provide sustained, supportive care to patients living with breathlessness.

Objectives. This paper aims to investigate pre-registration nursing students' experiences and perceptions of their clinical placements in nursing homes in order to develop recommendations for nurse educators. Evidence indicates that nursing students do not view nursing home placements as favourably as acute hospital placements. Therefore, nurse educators are challenged to facilitate a change in students' perceptions towards working in the nursing home environment.

Design. An integrative literature review allowed for the analysis and synthesis of the data relating to students' experiences and perceptions of nursing home practice, from studies with diverse research designs.

Methods. An electronic database search of CINAHL (Ebsco), Pubmed, British Nursing Database (BND), ERIC and social service abstracts, published from 2008 to April 2020 in English was completed. Papers were included using pre-allocated criteria and 649 qualified for closer examination. After exclusion, 21 papers underwent final analysis and synthesis using NIVIO 12.

Results. Five main themes were derived from the literature; i) the importance of effective supervision; ii) students' experiences and perceptions of the learning environment; iii) understanding the roles of care staff, iv) comprehensive orientation to the learning environment, and v) curriculum preparation. From these five categories, two synthesised themes were developed: nursing home placement encounters and enhancing learning opportunities.

Conclusions. Increasing the visibility of caring for older people in the curriculum is urgent in order to address nursing students' perceived misconceptions about placements in nursing homes. The development of standalone older people pathways, delivered by experienced and knowledgeable faculty, as well as the provision of compulsory clinical placements in settings exclusive to nursing older people and supervised by registered nurses are recommended. Failing to resolve this immediate problem will result in a further shortage of nurses who are adequately prepared to meet future nursing needs.

Background. Heart Failure is highly prevalent with poor outcomes yet only a small proportion of patients receive specialist palliative care services.
Aim. To explore if a programme focussing on support and symptom management of people with heart failure in a hospice environment would be acceptable and of benefit to patients. Methods: A pre/post intervention study design using mixed methods was used to evaluate the programme. The programme was delivered in two-hour time slots over a period of 8 weeks. Participants completed 3 questionnaires pre and post and were interviewed within one week of completion. The study was conducted between June 2014 and January 2015.
Findings. A response rate of 51.7% gave a final sample size of 12 patients. The questionnaire results showed a positive impact on participants’ well-being and views regarding the use of a hospice, but a desire for greater focus on emotional support. Four key themes emerged from inductive qualitative analysis: demystifying perceptions about hospice; positivity about well-being; learning together and consideration of end of life preparation.
Conclusion. This adapted programme provides a useful model for the increased integration of palliative care into the provisions for those living with advancing heart failure.