Aesthetic Expression as a Means to Nurture "Self" in a Basic Nursing Care Practicum.

ABSTRACT: Nursing students develop their professional "self" through clinical placement experiences. Aesthetic expression can be used as a means to reflect students' personal knowing and to convey self as nurtured during their clinical journey. In a postconference session of the Basic Nursing Care Practicum course, six students were asked to draw pictures reflecting their clinical experience and then share their stories. It appeared that nursing students learned the meaning of nursing and caring, and through these meanings, their actual self as nurses was also developed.

Situational Analysis of Barriers to Continuity of End-of-Life Care in Urban Areas, Bangkok.

This qualitative study was designed to describe the continuity of end-of-life care and identify barriers to continuity in urban Bangkok. Continuity of care is considered an essential part of palliative care to promote the quality of life of patients at the end of life. The majority of studies have been conducted exploring continuity of care in rural communities. However, few studies have focused on urban areas, particularly in big cities. Twelve healthcare providers were the participants, including nurses in inpatient units, and in the Health Community and Continuity of Care Unit, a palliative care physician, and social workers. The data collection consisted of individual interviews, field notes, and observations. Content analysis was used to analyze data and identify barriers. The continuity of end-of-life care in a selected setting was fragmented. Three main barriers to the continuity of end-of-life care consisted of misunderstandings about patients who required palliative care, staff workloads, and incomplete patient information. The development of a comprehensive patient information sheet for communication among a multidisciplinary team could promote continuity of end-of-life care from hospital to home. An interprofessional training course on continuity of end-of-life care is also recommended. Finally, the staff workload should be monitored and managed.

Experiences of discharge planning practices among Indonesian nurses: A qualitative study.

Background: Discharge planning is vital to preventing hospital readmission, and nurses play a key role. The COVID-19 pandemic has posed challenges to hospital services that may persist or recur. Therefore, exploring nurses' experiences with discharge planning practices before and during this pandemic is crucial. Objective: This study aimed to describe the experiences of discharge planning practices among nurses at an Indonesian tertiary hospital before and during the COVID-19 pandemic. Methods: A qualitative descriptive study design was used. Telephone interviews were conducted to collect data among ten nurses from March 2019 and continued between December 2020 and August 2021. Content analysis was done for data analysis. Results: Two main themes emerged: 1) Challenges in discharge planning practices and 2) Perceived discharge planning as a professional responsibility. Implementing the inpatient ward fusion policy as part of the hospital's pandemic response presented greater challenges to nurses in coordinating care and performing discharge planning. Fear of COVID-19 infection, social distancing measures, and using personal protective equipment also affected how nurses delivered discharge education during the pandemic. However, the nurses sensed a greater responsibility to ensure the maintenance of essential components of discharge planning procedures to guarantee the patient's capability to perform self-care at home. Conclusion: Nurses viewed discharge planning practices as their responsibility and continued them during the pandemic despite facing various challenges. In addition to recognizing the significance of nurses' roles in discharge planning practices and overall patient care, it is crucial to anticipate and address the diverse working patterns and styles among healthcare professionals in unified wards, ensuring effective coordination.

Institutional ethnography of hemodialysis care: Perspectives of multidisciplinary health care teams in Nepal.

Background: Hemodialysis is the most commonly used renal replacement therapy for end-stage renal disease. The collaborative efforts of multidisciplinary teams comprising nephrologists, nurses, pharmacists, and dietitians play a crucial role in enhancing patient outcomes, improving the quality of care, and reducing treatment costs. However, various factors such as healthcare cost reduction, limited resources, profit-driven systems, organizational structure, and involvement in patient care decisions impact the provision of hemodialysis care by the multidisciplinary teams. Objective: This study aimed to explore the institutional practices of multidisciplinary teams within a hemodialysis unit. Methods: This institutional ethnography study was conducted between April 2019 to February 2020 in a hemodialysis unit of a public university hospital in Kathmandu, Nepal. Data were collected through face-to-face interviews with ten nurses (including supervisors and incharge), two nephrologists, two dietitians, two pharmacists, and two technicians. Additionally, 167 hours of observation, two focus groups with nurses, analysis of institutional texts, and field notes were conducted. Participants were purposively selected based on their ability to provide diverse information regarding institutional practices in hemodialysis care. Interviews were recorded and transcribed. Results: The analyzed data were presented in: 1) the context of hemodialysis care, 2) textual practices: the ruling relations of hemodialysis care (staffing, protocol, job description), 3) hemodialysis decision, and 4) institutional support. Conclusion: Hemodialysis care provided by multidisciplinary teams is constrained by limited resources, particularly in terms of physical space, dialysis machines, nurses, doctors, and dietitians. The hospital's cost-cutting policies lead to reduced investment in patient care equipment, particularly dialysis machines, which significantly impact the workload of nurses and technicians. Insufficient nurse staffing necessitates the provision of other renal care responsibilities, resulting in increased workload, reduced time available for hemodialysis care, and unfinished tasks. The absence of clear job descriptions for hemodialysis care places an additional burden on nurses, who are often required to fulfill the responsibilities of other healthcare teams. Doctors hold the authority in making care decisions, which are subsequently followed by other team members.

Palliative care needs of patients with hematologic malignancies and family caregivers and challenges of palliative care provision in Asia: A review of evidence.

Patients with hematologic malignancies often experience fatigue, lack of vitality, and energy, and high psychological distress. High levels of unmet care needs of patients with hematologic malignancies in Asia were identified. This review provides an overview of current evidence on the experiences and palliative care needs of patients with hematologic malignancies and their families and the barriers and challenges of integrating palliative care into hematology care in Asia. Patients with hematologic malignancies who received palliative care could benefit from less aggressive end-of-life treatments. However, the uncertain and variable nature of the prognosis and illness trajectories of hematologic malignancies increase the difficulties of integrating palliative care into hematologic care. Patients and their families are often referred to palliative care services late, which leaves a short window for palliative care teams to provide holistic needs assessment and person-centered care for those who need it. In addition, cultural differences in medical decision-making patterns and complex social norms and interactions among patients, families, and healthcare staff make it even more challenging to initiate palliative care conversations in Asia. Future research should focus on the development and evaluation of culturally appropriate palliative care for patients with hematologic malignancies and their family caregivers in Asia, given that the low rate of service intake and poor public awareness of the important role of palliative care in disease trajectories were reported. The socio-cultural context surrounding individuals should be taken into consideration to ensure the provision of person-centered care for this group of patients. Digital health could be one of the possible solutions forward to address local needs and challenges.

Growth and development of oncology nursing in Asia.

Oncology nursing is increasingly recognized around the world as being vitally important for an effective cancer control system. Granted, there is variation between and among countries/regions regarding the strength and nature of that recognition, but oncology nursing is clearly seen as a specialty practice and as a priority for development in cancer control plans, especially for high resource countries/regions. Many countries/regions are beginning to recognize that nurses are vitally important to their cancer control efforts and nurses require specialized education and infrastructure support to make a substantial contribution. The purpose of this paper is to highlight the growth and development of cancer nursing in Asia. Several brief summaries are presented by nurse leaders in cancer care from several Asian countries/regions. Their descriptions reflect illustrations of the leadership nurses are providing in cancer control practice, education, and research in their respective countries/regions. The illustrations also reflect the potential for future development and growth of oncology nursing as a specialty given the many challenges nurses face across Asia. The development of relevant education programs following basic nursing preparation, the establishment of specialty organizations for oncology nurses, and engagement by nurses in policy activity have been influential factors in the growth of oncology nursing in Asia.

The Effect of a Nurse-Led Family Involvement Program on Anxiety and Depression in Patients with Advanced-Stage Hepatocellular Carcinoma.

Psychological distress is commonly reported in patients with advanced cancer. Family is considered a psychological supporter for patients during their cancer journey. This study aimed to examine the effect of a nurse-led family involvement program on anxiety and depression in patients with advanced hepatocellular cancer. This is a quasi-experimental study with a two-group, pre-post-test design. Forty-eight participants were recruited at a male medical ward in a university hospital in Southern Thailand, and assigned to either the experimental or the control group. The experimental group received the nurse-led family involvement program, while the control group received only conventional care. Instruments included a demographic data form, clinical data form, and the Hospital Anxiety and Depression Scale. Data analyses were performed using descriptive statistics, chi-square, Fisher's exact test, and t-test. The results revealed that the mean scores of anxiety and depression in the experimental group at post-test were significantly lower than on the pretest and significantly lower than those of the control group. The results indicate that a nurse-led family involvement program has a short-term effect on the reduction of anxiety and depression in male patients with advanced HCC. The program can be useful for nurses to encourage family caregivers to engage in patient care during hospitalization.

Decision to Withdraw Life- Sustaining Treatments: The Experience of Thai Family Caregivers.

End-of-life decision-making is a complex process and more challenging when decisions are made for others. Little is known about Thai family members' involvement in decision-making to withdraw life-sustaining treatments (LSTs) from loved ones with serious illnesses. This qualitative study explores the experiences of family caregivers in Southern Thailand regarding decisions related to LST withdrawal. In-depth interviews were used to gather data from fifteen primary caregivers, who were involved in LST withdrawal decision-making. Content analysis was applied, and several techniques, such as member-checking and peer debriefing, were used to enhance trustworthiness. Four main themes were identified: facing dilemmas, weighing up options, making a consensual decision, and accepting the reality of life. The findings pointed out the significant roles played by family meetings and early end-of-life discussion in the process of decision-making to withdraw LSTs from loved ones. Further research on communication among patients' family members and health care providers is recommended.

Textual Organization of Hemodialysis Nursing Practice: An Institutional Ethnography.

BACKGROUND: Nursing today deals with organizational changes and reforms within the increased demands of care amid competing resources. In some developing countries, dealing with text documents is a challenge in hemodialysis service organizations. This study aimed to explicate the social organization of textual nursing practices in a hemodialysis unit of a public university hospital in Nepal. METHODS: This is a qualitative study that followed institutional ethnography design. Ten registered nurses who worked for at least six months in the hemodialysis unit were included for in-depth interviews. Data were also collected through 167 hours of observations, field notes, and two focus groups. Texts including policy, protocols, and record documents were incorporated in the analysis. Data analysis followed Smith's (1987) institutional ethnographic analysis. RESULTS: Nepalese nursing work in a hemodialysis unit was mainly organized by the free hemodialysis policy of the government which was not available to the nurses at the hemodialysis unit, but it determined most of the nursing activities of patient care and documentation. Hemodialysis record form, hemodialysis schedule, and free hemodialysis claim form also had a great influence on nursing work. However, the nurses were not quite aware of how the textual documents determined their practices to meet the politico-economic interests of the hospital and government. CONCLUSIONS: The hospital and Nepal's health ministry established the activities and recording requirements. Identification of texts and exploration of their influences on nurses' decisions, patient care, and documentation are essential to find the optimal solutions in daily care and determine the appropriate support for nurses in hemodialysis settings.

Factors supporting career pathway development amongst advanced practice nurses in Thailand: A cross-sectional survey.

BACKGROUND: Thailand has recently reformed its health care system and this change has contributed to the rapidly increasing need for skilled and experienced specialist nurses and in 2003 a new Advanced Practice Nursing role was formally introduced. While Advanced Practice Nursing is now accepted as a clinical career option, there is little understanding of the factors conducive to successful career development. This study offers the first examination of factors associated with successful career progression for Advanced Practice Nurses in Thailand. OBJECTIVES: 1. To provide a description of the Advanced Practice Nurse population in Thailand, as represented by a purposive stratified national sample. 2. To examine the factors influencing successful career pathway development of Advanced Practice Nurses in Thailand. 3. To examine the factors which influence the extent to which Advanced Practice Nurses in Thailand engage in evidence-based practice and research. DESIGN: National cross-sectional survey. SETTING: Thailand. PARTICIPANTS: 333 currently practicing Advanced Practice Nurses. METHODS: A national cross-sectional survey was conducted in Thailand in order to identify and examine key influencing factors on the successful development of Advanced Practice Nurses. The research tool was a specifically designed questionnaire in the Thai language, informed by international academic literature on the development of the Advanced Practice Nurse role, validated and piloted with 30 Advanced Practice Nurses to assess its reliability using Cronbach's alpha. The data were analysed in SPSS (version 21). Initial parametric testing was done using the Kolmogorov-Smirnov test and Pearson's correlation analysis was performed to examine the relationship between the independent variables (those measuring demographic and support factors) and the dependent variables (measuring career pathway development). RESULTS: A response rate of 90% was achieved. A lack of clear progression routes in the Advanced Practice Nurse structure was identified along with inconsistent patterns of working including variation in the number of days per week (range: 1-5 days) that nurses dedicated to the Advanced Practice Nurse role and the amount of autonomy achieved in this role. The study highlighted a lack of research productivity in and production of outputs (59% had never published) and given the expectation of Advanced Practice Nurses to both produce and utilise research evidence, this constitutes a significant gap in current practice. Other factors reported as important for career pathway development of Advanced Practice Nurses related to the environment, peer networks, institutional (hospitals) and external (government and the Thai Nursing Council) support. CONCLUSIONS: Our study offers insights for national and local policymakers and highlights the need to firmly establish, standardised career pathways in Advanced Practice Nursing to support career progression and the implementation of evidence into practice. These findings also have implications for clinical departments which have a responsibility to ensure they provide an enabling environment for Advanced Practice Nurses to fully carry out their roles. Tweetable abstract: Our study reports findings from a first national survey in Thailand investigating the factors which support career development in Advanced Practice Nurses.

Transitional care programs to improve outcomes in patients with traumatic brain injury and their caregivers: A systematic review and meta-analysis.

Background: Effective nursing interventions for caring for patients with moderate to severe traumatic brain injury are still challenging during a transition from hospital to home. Since traumatic brain injury has deep-rooted sequelae, patients and their caregivers require better arrangement and information on the condition to achieve improved outcomes after discharge. Objective: This study aimed to assess transitional care programs to improve outcomes of patients with traumatic brain injury and their caregivers. Methods: A systematic review and meta-analysis were performed on studies retrieved from ProQuest, PubMed, Science Direct, CINAHL, and Google Scholar from January 2010 to July 2021. RevMan 5.4.1 software was used for meta-analysis. Results: Nine studies were systematically selected from 1,137 studies. The standard approaches of interventions used in patients with traumatic brain injury and their caregivers were education, mentored problem-solving, home-and community-based rehabilitation, counseling, skill-building, and psychological support. We observed that there was significant evidence indicating beneficial effects of intervention in increasing the physical functioning of patients with traumatic brain injury (SMD = -0.44, 95% CI -0.60 to -0.28, p <0.001), reducing the psychological symptoms among caregivers (SMD = -0.42, 95% CI -0.59 to -0.24, p <0.001), and increasing the satisfaction (SMD = -0.35, 95% CI -0.60 to -0.11, p = 0.005). Conclusion: Education, skill-building, and psychological support should be the main components in transitional care nursing programs for patients with traumatic brain injury and their caregivers.

Experience and management of stigma among persons living with HIV in Bali, Indonesia: A descriptive study.

AIM: This study aimed to describe the level of HIV stigma experience and the HIV stigma management strategies used by persons living with HIV (PLWH) in Bali, Indonesia. METHODS: A cross-sectional descriptive study was conducted from March to May 2019. In total, 215 respondents were recruited using purposive sampling from hospitals and HIV private clinic. The research tools consisted of the demographic characteristics form, the 28-Item Internalized HIV Stigma Scale, and the Stigma Management Strategies Checklist. This study used descriptive statistics and non-parametric statistics to analyze the data. RESULTS: Overall, the transformed mean score of HIV stigma experience was at a low level (mean = 42.88, SD ± 17.59). There was no statistically significant difference between demographic characteristics and HIV stigma (p > .05). Of the 38 stigma management strategies, prayer (70.7%) was reported as the most common, whereas forgiving one's spouse (4.1%) was the least utilized strategy of the respondents. The most often reported reason to manage stigma was to alleviate and/or avoid stress (68.8%). In addition, the most effective stigma management strategy was prayer (28.8%). Conversely, the least effective was staying alone (21.9%). CONCLUSIONS: HIV stigma is present in Bali, Indonesia, and PLWH struggle to accept their HIV status. Furthermore, they use prayer as a stigma management strategy to get closer to God. The findings of this study could serve as evidence to inform HIV stigma reduction programs in the community. In addition, the development of faith-based stigma management interventions is recommended.

Moving from fear to realization: Family engagement in tuberculosis prevention in children living in tuberculosis Sundanese households in Indonesia.

OBJECTIVE: Children living in tuberculosis households need protection. However, families need to be engaged to prevent tuberculosis transmission to children. This study aimed to analyze the details of "moving from fear to realization," which is one category of a substantive theory of family engagement in tuberculosis prevention in children. METHODS: Fourteen family caregivers participated as key informants after their families met the criteria. The participants were recruited at a lung clinic in West Java, Indonesia and followed up at their homes. The data were gathered using in-depth interviews and analyzed following the coding procedures of the Straussian grounded theory. FINDINGS: "Moving from fear to realization" was the main category that emerged from the experiences of the Sundanese families to begin engaging in tuberculosis prevention in children living in tuberculosis households. It was composed of four sub-categories, namely, fear of tuberculosis, seeking information, following God's will, and awareness of tuberculosis transmission risks. CONCLUSIONS: This study showed how a family moves from fear to the realization of tuberculosis transmission risks. Its findings are useful for nurses to provide optimum care in order to prevent tuberculosis transmission to children with household contact by providing both education and counseling for families.

Palliative Care Nursing Competence of Chinese Oncology Nurses and Its Related Factors.

In China, the development of palliative care is challenging because of limited available resources and rapidly increasing demands. The nurses' competence is a significant element in providing high-quality palliative care. This cross-sectional study aimed to describe the palliative care competence among oncology nurses and to examine the relationships between it and palliative care knowledge, attitudes, and workplace learning conditions. A total of 220 nurses with more than 6 months of experience and who worked in inpatient wards were invited to participate in this study. Four questionnaires were administered to collect data-the Palliative Care Quiz for Nurses, the Attitudes Toward Palliative Care Scale, the Workplace Learning Conditions scale, and the Palliative Care Nursing Self-competence Scale. The data were analyzed using descriptive statistics and Pearson correlations. The moderate level of competence was reported by 212 participants (response rate, 96.36%). The scores were lower in the aspects of competence such as spiritual care and ethical and legal issues. Competence was positively related to workplace learning conditions and knowledge but not attitudes. The results highlighted the necessity of improving the palliative care competence among oncology nurses. The optimization of learning conditions in the hospital is recommended to be a vital force in strengthening competence.

Lived experience of caring for dying patients in emergency room.

BACKGROUND: Dying often occurs in hospitals and frequently in emergency rooms. Understanding caring for critical and dying patients is necessary for quality nursing. PURPOSE: This study described the meaning of nurses' lived experience of caring for critical and dying patients in the emergency rooms. METHODS: This study was conducted in three emergency rooms of tertiary hospitals in southern Thailand. Twelve nurses met the inclusion criteria: nurses working in emergency room for at least 2 years, and experienced caring for critical and dying patients in an emergency department. Data were collected using in-depth individual interviews. Data transcription and analysis used van Manen's hermeneutic phenomenological approach. Trustworthiness was established following Lincoln and Guba's criteria. FINDINGS: Experiences of caring for critical and dying patients revealed four thematic categories: defying death; no time for palliative care; lacking support for family; and privacy for peaceful deaths. These thematic categories reflected van Manen's four lived worlds of body, time, relations and space. CONCLUSIONS: The study described the meaning of the experience of caring for critical and dying patients while supporting the development of nursing knowledge for palliative and end-of-life care in emergent settings. IMPLICATIONS FOR NURSING POLICY: Findings of the study influence nursing policies toward enhancing education of nurses regarding palliative and end-of-life care in emergency settings. These findings can also influence the value of caring-healing environments for critical and dying patients and their families. Policies can focus on practice and education of families particularly about end-of-life care for critical and dying patients.

Moving Beyond Suffering: the Experiences of Thai Persons With Advanced Cancer.

BACKGROUND: Cancer is a leading cause of death in Thailand; however, little research is available that describes the end-of-life experiences of cancer patients. Data presented here are part of a descriptive qualitative study that investigated dying experiences in patients with advanced cancer. Two core themes were identified-living with suffering and moving beyond suffering. In this publication, we focus on 1 of the core themes: moving beyond suffering. OBJECTIVE: The objective of this study was to explore how Thai persons with advanced cancer move beyond suffering at the end of their life. METHODS: A series of interviews and observations were conducted on 15 patients with terminal advanced cancer. The informants were followed through from the point of referral at the hospital to their death at home or in hospital. An inductive qualitative analysis was applied. RESULTS: Thai persons with advanced cancer tried to find ways to go on living with suffering. Three themes emerged from the interview data: adopting religious doctrine, being hopeful, and being surrounded by the love and care of the family. CONCLUSIONS: This study highlights the roles of religious faith and spirituality in helping Thai patients transcend suffering and move on toward their end of life. IMPLICATIONS FOR PRACTICE: Nurses need to be sensitive toward the religious faiths of their patients and provide culturally appropriate care for them. Nursing interventions to maintain hope and connectedness should be promoted by respecting the patients' expressions of hope and supporting the involvement of family members in end-of-life care.

Symptom experience and management among people with acute myeloid leukaemia in Thailand.

In Thailand, haematological malignancy is one of the most common types of cancer. This cross-sectional study, conducted in Southern Thailand, aimed to describe the symptom experiences of and symptom management strategies among patients with acute myeloid leukaemia (AML). Sixty hospitalized patients with AML were recruited. The Symptom Experience Scale and two open-ended questions regarding symptom-management strategies were used to collect data via face-to-face interviews 2 weeks after the induction phase of the AML protocol. The data was analysed using descriptive statistics and content analysis. High fever, weakness, nausea, and anorexia were the four most prevalent symptoms reported. Other prevalent symptoms included weight loss, bleeding, nausea and vomiting, dysphagia, and a cluster of psycho-emotional symptoms: worrying, fear, feeling discouraged, and feeling bored. Patients used various approaches and strategies to alleviate their symptoms, which could be categorized into five groups: preventive, direct, distraction, complementary, and restorative approaches. This study has provided important information for the development of symptom-management nursing programmes for patients with AML, particularly in Thailand.

Socio-demographic and AIDS-related factors associated with tuberculosis stigma in southern Thailand: a quantitative, cross-sectional study of stigma among patients with TB and healthy community members.

BACKGROUND: Tuberculosis (TB) remains one of the most important infectious diseases worldwide. A comprehensive approach towards disease control that addresses social factors including stigma is now advocated. Patients with TB report fears of isolation and rejection that may lead to delays in seeking care and could affect treatment adherence. Qualitative studies have identified socio-demographic, TB knowledge, and clinical determinants of TB stigma, but only one prior study has quantified these associations using formally developed and validated stigma scales. The purpose of this study was to measure TB stigma and identify factors associated with TB stigma among patients and healthy community members. METHODS: A cross-sectional study was performed in southern Thailand among two different groups of participants: 480 patients with TB and 300 healthy community members. Data were collected on socio-demographic characteristics, TB knowledge, and clinical factors. Scales measuring perceived TB stigma, experienced/felt TB stigma, and perceived AIDS stigma were administered to patients with TB. Community members responded to a community TB stigma and community AIDS stigma scale, which contained the same items as the perceived stigma scales given to patients. Stigma scores could range from zero to 30, 33, or 36 depending on the scale. Three separate multivariable linear regressions were performed among patients with TB (perceived and experience/felt stigma) and community members (community stigma) to determine which factors were associated with higher mean TB stigma scores. RESULTS: Only low level of education, belief that TB increases the chance of getting AIDS, and AIDS stigma were associated with higher TB stigma scores in all three analyses. Co-infection with HIV was associated with higher TB stigma among patients. All differences in mean stigma scores between index and referent levels of each factor were less than two points, except for incorrectly believing that TB increases the chance of getting AIDS (mean difference of 2.16; 95% CI: 1.38, 2.94) and knowing someone who died from TB (mean difference of 2.59; 95% CI: 0.96, 4.22). CONCLUSION: These results suggest that approaches addressing the dual TB/HIV epidemic may be needed to combat TB stigma and that simply correcting misconceptions about TB may have limited effects.