6-C FIRST

Caring and uncaring behaviors from perspective of patient: a qualitative study

Xiao Peng, MSNc, RN is a graduate student in Nursing Science, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Her mentor is Yilan Liu and her major area of study is caring. She is interested in human caring and appreciates it very much.

Yilan Liu, PhD, RN master instructor, director of Nursing Department , Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China. A visiting scholar at School of Nursing ,University of Michigan in 2008. Executive director of the Nurses Association of Hubei Province.

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Union hospital武汉协和医院

Caring and noncaring behaviors from perspective of inpatients:

a qualitative study

Xiao Peng, MSNc, RN; Yilan Liu, PhD,RN;

—Union Hospital of Tongji Medical College,Huazhong University of Science and Technology, Wuhan, China.

Union Hospital,WuhanMotto:Love Mercy Integrity Harmony

Union hospital武汉协和医院

Griffith John

founded in 1866

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Union hospital武汉协和医院

Three parts: main districttumor centrewestern part

Real estate: 2.07 billionEmployees: 4399 Beds: 4000 or so

Clinic dept. 43

Clinic lab. 14

Institute 7

Therapy center 15

Research lab 103

Clinic dept. 43

Clinic lab. 14

Institute 7

Therapy center 15

Research lab 103

main district

Union hospital武汉协和医院

Dr. Yilan Liu, PhD.,RN

Director of Nursing Department,Union Hospital

Union hospital武汉协和医院

Pilot departments for human caring model

神经内科10楼、骨科27楼、 乳腺甲状腺外科、胰腺外科、

小儿血液科 、 CCU、 ICU 、综合科10楼

内分泌科21楼呼吸内科17楼呼吸内科15楼消化内科12楼神经内科9楼血液内科7楼骨科26楼肝胆外科23楼乳甲外科一楼西

小儿外科骨科一楼东骨科三楼东胃肠外科19楼眼科29楼妇科14楼妇科13楼NICU感染科二楼一

心外科ICU、心内科10楼保健9楼肿瘤中心7病区肿瘤中心8病区急诊科整形科门诊口腔科门诊

The 1st batch of pilot departments (8)

The 2nd batch of pilot departments(26)

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Union hospital武汉协和医院

---Linda A Ryan and Gwendolyn Kinney visit our hospital

---caring experience sharing ---caring moment bulletin

Union hospital武汉协和医院

---dating activity for single nurses

---birthday card for nurses

Background

• Caring is considered to be core of nursing• Caring behaviors demonstrated by nurses

have been linked to high patient satisfaction and caring satisfaction,both were important predictors of intent to return to a facility for care in this time of economic incentives for quality services (Elder et al. 2004, Longo 2011)

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• Halldórsdóttir(1988) identified 7 major themes of clients' responses to uncaring encouters:

1.Puzzlement and disbelief2.Anger and resentment3.Despair and helplessness4.Feelings of alienation and identity-loss5.Feelings of vulnerability6.Perceived effects on healing7.Long-term effects of uncaring encounters

Background

• Published researches on caring behaviors by nurses from mainland of China is scanty.

• Leininger discovered that caring is diversified among different culture backgrounds

• Few of studies explored noncaring behaviors and actions from the perspective of patients

Background

Study Purpose

• Exploring how patients experienced nurses' caring and noncaring behaviors and actions during hospitalization

• Finding out which aspects should be enhanced to improving nursing service and patients satisfaction

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Study Method

• Phenomenologyby semi-structured interview

• ReasonPhenomenology focuses on the structure of participants’ live experience, the content of phenomenology is comprised of the data of the experience, its meaning for the subject and the essence of the phenomena

Setting

• a 4000-plus bed large-sized, tertiary comprehensive hospital

• located in Wuhan, the Capital city of Hubei province, PRC

• primary nursing model was adopted

Participants

Sampling method:Purposive sampling technique

Inclusion criterion : age≥18 years oldlength of staying in this hospital≥5 daysclear consciousness and in a stable disease

conditionsChinese-speakingable to articulate the experience of self

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Data Collection

• Socio demographic questionnaire

• Semi-structured in-depth interviews were conducted

• Field notes

Data Collection

Outline of in-depth interview:During your hospitalization, what

behaviors do you perceive as demonstrating nurses caring for you?;During your hospitalization, what

behaviors do you perceive as demonstrating nurses noncaring for you?Do you think what aspects of hospital

should strengthen caring?

Data Analysis

Conventional content analysis:Reading and rereading the transcriptsHighlighting words on describing caring

and noncaring behaviorsLike transcripts segments were grouped Developing codesExtracting categoriesIdentify examplars for each themes from

data

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Findings

• 93.33% (14/15) of the participants haveexperiences of caring

• 33.33% (5/15) of the participants haveexperiences of noncaring

TABLE 1.Demographics of SampleData n=15

GenderMale 10Female 5

Age,y21-35 436-50 251-65 5>65 4

Marital StatusUnmarried 1Married 13Widowed 1

Note：mean value of age is 51.53±17.345 y

TABLE 1.Demographics of Sample(continued)Data n=15

Education levelPrimary education 1Secondary education 7Associates degree 2Bachelor degree and above 5

DepartmentInternal medical 8Surgical medical 7

OccupationFarmer 3Administration staff 2Retiree 6Other 4

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Findings

• Categories of caring behaviorsPsychological supportMutual respectConsiderationExcellent nursing skillsQuick responseEffective communication

Psychological support

Being encouraged

Gentle touch

Mutual respect

No discriminationPolite mannersPut emphasis on patients complaintsProtect patients' privacy

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ConsiderationLove can be living out through many

trivial matters:repair ward door,change dirty sheet,buy lunch,sewing box,microwave oven,etc

Being sensitive to patients needshelp them proactively when you find them in need instead of help them only when they call you

Sense of belongings

Excellent nursing skillsIf a nurse doesn’t possess good nursing

skills,...would lead to increasing patients pain and wasting the nurse much time, thus influencing others’ treatment. The important point is that I would be lack confidence to her skills next time.’

A little worried to be serviced by nursing interns

• Categories of noncaring behaviors

Lack of effective communication skillsInsufficient professional knowledgePoor maintenance of ward environmentMedical resources in short supply

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Lack of effective communication skills‘I was very hurt by the nurse saying “how can

you do it like this, there are no such provision here.’‘She (the nurse) speaks very fast and I cannot

follow up with her.’‘She seems to have no patience to explain my

confusion.’

Insufficient professional knowledge

‘Sometimes, I asked the nurse "what is the function of medicine I was transfusing", she said, "I do not know, you can ask your doctor".’

'...you should master the common disease knowledge of your department as much as possible, you should not implement doctor’s order just mechanically.’

Poor maintenance of ward environment

‘...many visitors come and go, and they often talk loudly, …and the television noise, I cannot have a good rest for only one day.’

‘I think I lack of fresh air. the window is rarely opened or opened very small, so the ventilation between indoors and outdoors is insufficient.’

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Medical resources in short supply

lack of human resources

lack of material resources

• The findings in this study have some similarities and differences compared with similar researches

• This research provided insight into the experience of caring and noncaring,and a better understanding of what is needed to support inpatients is recognized.

• Strengthening communication skills and professional quality providing patients with healthy physical environment, trying their best to solve patients’and family members’ difficulties, increasing medical resources,creating caring atmosphere are recommended for nursing leaders and nurse practitioners

Summary

• Halldorsdottir S.(1988)The essential structure of a caring and an uncaring encounter with a nurse -- from the client's perspective.Master dissertation, The University of British Columbia, Vancouver.

• Halldórsdóttir S.& Hamrin E. (1997) Caring and uncaring encounters within nursing and health care from the cancer patient's perspective.Cancer Nursing 20(2),120-128.

• Husserl E. (2012) Ideas: General Introduction to Pure Phenomenology. Routledge, New York.

• Hsieh H. & Shannon S E. (2005) Three approaches to qualitative content analysis.Qualitative Health Research 15(9),1277-1288.

• Kalisch B.J. & Liu Y. (2009) Comparison of Nursing:China and the United States. Nursing Economics 27(5),322-331.

• Karaöz S. (2005) Turkish nursing students’ perception of caring.Nurse Education Today 25(1), 31-40.

References

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• Larson P.J. (1984) Important nursing caring behaviors perceived by patients with cancer. Oncol NursForum 11(6),46-50.

• Leininger M.M. (1980) Caring: A central focus of nursing and health care services.Nursing and Health Care1(3), 135-143,176.

• Leininger M.M. (1986) Care facilitation and resistance factors in the culture of nursing.Topics in clinical nursing8(2),1-12.

• Leininger M.M. (1988) Leininger's Theory of Nursing: Cultural Care Diversity and Universality1(4),152-160.

• Lincoln Y S. & Guba E G. (1985) Naturalistic Inquiry. Newbury Park, CA: SAGE publications,Inc,California.

• Longo J. (2011) Acts of Caring:Nurses Caring for Nurses. Holist Nurs Pract 25(1),8-16.

• Morse J.M., Solberg S.M., Neander W.L., Bottorff J.L. & Johnson J.L. (1990) Concepts of caring and caring as a concept. Advances in Nursing Science 13 (1), 1-14.

References

The End

Florence Nightingale:

“Nursing is a noble profession，but it is up to you nurses to make it noble."