AN INVESTIGATION ON THE ASSESSMENT OF THE PRESENCE OF NURSES BY CANCER PATIENTS ACCORDING TO THE...

AN INVESTIGATION ON THE ASSESSMENT OF THE PRESENCE OF NURSES BY CANCER PATIENTS ACCORDING TO THE

HUMANISTIC NURSING THEORY: A QUALITATIVE STUDY

Dr. Saliha Bozdogan Yesilot*Prof. Dr. Fatma Oz**

*Çukurova Unv. Faculty of Health Science, Nursing Department, Adana

**Hacettepe Unv. Faculty of Nursing, Ankara

21.04.2316th Healthcare Interdisciplinary Research Conference 4 & 5 November 2015 Dublin,

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16th Healthcare Interdisciplinary Research Conference 4 & 5 November

2015 Dublin, Ireland21.04.23


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Faculty of Health Science

Cukurova University


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Background

• Cancer is one of the most important health problems in the world.

• According to the World Health Organization (WHO), it is the second cause of death after the vascular disorders and 8.2 million people died due to cancer in 2012. (WHO, 2013)


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Background

• There are 14.1 million new cases and 32.6 million people have been living with the diagnosis of cancer for five years.

• In addition, it is foreseen that there will be 15 million cancer patients in 2020 (WHO 2013).


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Background

• In Turkey, approximately 159 thousand people; 97 thousand males and 62 thousand females get cancer each year according to the latest official data (http://kanser.gov.tr/).

• In parallel with the world, cancer is also the second cause of death after vascular disorders in Turkey (Republic Of Turkey Ministry Of Health 2010).


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Background

• The effects of cancer on the individuals and families are multidimensional.

• It affects all aspects of the individuals' lives such as physical, psychological, social, functional, economical and family dynamics aspects and causes various symptoms (Özkan, S. 2002).


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Background

• Patients frequently experience an existential

crisis that they feel themselves as vulnerable

and under a vital threat. They need to regard

themselves as an individual, to be understood,

to feel safe, and to control their lives and

bodies in this period.


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Background

• At this point, nurses should address the

patient as a whole with a humanistic approach (Rama, S. R., Catane, R., Kaufman, B., Isacson, R., Segal, A., Wein, S.,

Cherny, N. I. 2000).


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Background

• In the humanistic approach, the relationship between the nurse and the patient is based on the needs of the individual as a “human”.

• In this approach, nurses are responsible to know how the individuals they give care experience their presences and to recognize and develop their own presences.


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Background

• According to the theorists, nurses have interpersonal relationships at various levels during one-day work.

• This relationship is a real dialog established with the subject or felt as a “function or object” at the lowest level and as “presence” at the highest level.


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Background

• When a person and his/her function (director nurse, clinical nurse etc.) establishes a relationship as a “case or object” (cardiac, outpatient, re-hospitalization, chronic patient etc.), this means a lowest level of relationship.

• However, when a relationship is established with the presence of the individual as a “subject”, this means a relationship as a “presence” at the highest level.


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Background

• According to the Humanistic Nursing Theory, presence means “being with” the individual and “doing things” for the individual.

• With regard to this; the presence of nurses includes paying attention to/caring for the patient, understanding what the patient experiences now and here, and being open and available.


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Aim

• This study aim; • is to investigate how cancer patients, which

are a special group that need for humanistic approach due to their requirements and the times they feel vulnerable, perceive the presence of nurses based on the first theory on the presence of nurses; the Humanistic Nursing Theory.


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Method

• This is a qualitative phenomenological study.

• The study was conducted on the patient diagnosed with cancer who stay in two hospitals specialized on oncology in the capital city of Turkey, Ankara.


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Method

• The population of the study consisted of the patients diagnosed with cancer who stay in the said two oncology hospitals.


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Method

• The sample of the study was determined according to the inclusion criteria.

• These criteria are: – being at the age of 18 or older, – not having difficulty in speaking and communicating in order to make

an interview, – not having a surgery, painful initiative or chronic pain, – being volunteer to participate in the study, – staying in hospital for at least five days.

Five-day limit was determined in terms of receiving nursing care and having interacted with nurses.


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Method

•Moreover, the patients in single rooms who met the inclusion criteria were primarily preferred. •The aim of this preference was to ensure privacy and prevent interruption.

•Data saturation formed the basis for reaching the sample size, and the interviews were maintained until the themes/data are repeated.


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Method

• 16 patients were interviewed in total in the study.

• Appointment dates were determined for the interviews

considering the treatment and care plans together with the

patients who accepted to participate among those who

met the features listed above.

• The interviews were made on the dates determined and

each interview took 60-75 minutes in average.


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Method

• The interviews were made between September 15 and November

30, 2013.

• The interviews were made using the in depth interview method.

• Semi-structured question forms were used in the interviews.

• The questions were prepared by the researchers based on the

concept of “presence” in Paterson and Zderad's Humanistic Nursing

Theory.


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Method

• The permission of Hacettepe University Non-Invasive Ethics Committee in order to carry out the study.

• In addition, the written and oral consents of the patients were also obtained.

• Sound recording was made during the interviews upon obtaining the permissions of the patients before each interview.


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Data Analysis

• The Grounded Theory developed by Strauss and Corbin was used for data analysis.

• Strauss and Corbin (1990) define the qualitative data analysis process as “coding”.

• The researcher coding process was started

with data conceptualization.


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Data Analysis

• Conceptualization is a process to name an incident, thought or fact based on an observation, sentence or paragraph.

• The researcher asked some questions about the incidents and facts that are subject of this study. For example, “What is this? What this represents?” etc.


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Data Analysis • Then the incidents and facts were compared

based on the answers and the similar incidents were grouped together under the same names.

• At the end of this process, the researchers

grouped the concepts related to each other and reached various themes. Then the features and sub-dimensions of these themes were determined. (Murat Özdemir, Nitel Veri Analizi: Sosyal Bilimlerde Yöntembilim Sorunsalı Üzerine Bir Çalışma, (Qualitative Data Analysis: A Study on Methodology Question in Social Sciences) Eskişehir Osmangazi Üniversitesi Sosyal Bilimler Dergisi, 11(1)).


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Data Analysis • In this regard, content analysis were carried out at

three stages. • In the first stage, the sound records were decoded by

the researchers and all conservations were transferred to computers.

• In the second stage, each interview was read carefully, the words used most were determined as codes and the similar interviews were gathered together thereby forming the themes.

• The themes formed were renamed considering the description of the concept of presence in Paterson and Zderad's Humanistic Nursing Theory.


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Data Analysis

• The codes and themes were reformed and separately controlled by the same researchers, the first and second groups were compared and the final form of the themes was determined.

• The analyzes were also examined by a third person specialized in psychiatry nursing to ensure the validity of the data, the existing themes were evaluated and a mutual result was found.


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Data Analysis

• According to the Humanistic Nursing Theory, basis for the classification of the findings, the presence of nurses is the fact that nurses do some things “for the patient” and “with the patient”.

• With regard to this; nurses are expected to pay attention to/caring for the patient, understand what the patient experiences now and here, and be open and available.

• These expectations were evaluated as showing the presence of nurses.


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FINDINGS

• How cancer patients perceive the presence of nurses during their experiences while they receive care from nurses was analyzed based on the three themes mentioned above and according to the concept of “presence” in the Humanistic Nursing Theory.

• The expression of the patients were grouped discussed based on these three themes.


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Socio-demographic Characteristic of Patients

Characteristic

Number %

GenderWoman 6 37.5Man 10 62.5Marital StatusMarried 81.25 13Single 18.75 3Education8th grade 4 25High School 5 31.25College 7 43.75

Age means 44.7521.04.2316th Healthcare Interdisciplinary Research Conference 4 & 5 November 2015 Dublin,

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FINDINGS

• 1.Paying attention to/ caring for the patient: Patients define the fact that nurses show their interest with their attitudes and words every time nurses meet with patients and the initiatives they do as being themselves realized and give the message of realize me.

• The attitudes (nonverbal elements) and communication of nurses during their interaction affects patients negatively or positively.


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FINDINGS

• According to patients, nurses are the most important people in the hospital. “...The nurses are the most important criteria, important elements, the person you establish dialog most in the hospital.” (K15, age 34, male, married, university graduate).

• Communication of nurses also affect patients in addition to their attitudes. Communication was stated as the principal way to contact with nurses. “...Communication is important, you can't tell your problems without communication...” (age 34, male, married, university graduate).


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FINDINGS• Patients stated that they become happy and feel that

nurses interest in them when nurses greet them, call them with their names, ask them how they are. “...I become more pleased when they enter into the room and greet. When they say hello, how are you. Of course they always come once in a half an hour, or once in an hour; not every time. I become happy when they greet, ask for the patient when they come in the morning or while they passing the duty in the evening; it feels good to know that they care about me. They care about my disease. And this makes me feel happy...” (K7, age 33, male, married, university graduate).


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FINDINGS

• “...Being called with my name is very beautiful. Calling as sir and calling with name are different. Sir is anyone, anyone you call out on the street, but someone calling you with your name is someone who knows you, who has shared thing with you...” (K1, age 54, male, married, university graduate).


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FINDINGS

• The attitudes of nurses during their interactions with patients was regarded as another indicator of the interest in patients and affect how patients feel themselves. Patients feel happy when nurses treated smilingly. “...The smile on the faces of the nurses makes people feel happy...” (K5, age 42, male, married, university graduate). “...The smile of the nurses feels like a big bouquet, like an antibiotics or painkiller; it is so much valuable that they come, do their job and go smiling...” (K3, age 40, female, single, high school graduate).


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FINDINGS

• Patients expressed that in addition to the effect of nurses' interest on how they feel, it also positively affects their recovery. “…My disease decrease by a fifty percent when I feel the interest. I become morally high. If you do not receive the necessary interest, shall we say, the disease increase by a hundred percent. The greatest cure, the greatest medicine is peace, interest...” (K16, age 53, male, secondary school graduate).


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FINDINGS2. Understanding what the patient experiences now and

here and supporting them: understand me:

• Patients define themselves as “patients” in the hospital and “the people having a hard time and emotional difficulties.”

• Nurses should understand that they usually are anxious, emotional and sensitive during the processes and waiting for the test results and what they experience at that “moment” and support them, and should not increase the stress of patients due to their interventions during the processes.


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FINDINGS• It is stated that patients become less anxious when nurses recognize their

emotional reactions, do what patients want them to do and make an effort to do it, answer the questions of patients and make explanations in a way for them to understand.

“…We are a little more sensitive. I wasn't angry this much but now I'm much angrier, I get depressed or be happy more quickly. Cancer patients are emotionally depressive, they think 'will I die or will I live?' It's a sensitive period. Orthopedics, internal medicine etc. are not so dependent on morale, but oncology is directly dependent on it. You even pay attention to the water in that glass. Everything has changed, flavors or your taste have changed. Point of view has changed. A mistake of nurses can pass you away but you know they will do the correct thing, and you feel safe. Otherwise patients get anxious too.” (K7, age 33, male, married, university graduate).


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FINDINGS

• “…She got worried when she can't do anything, I saw it. She made an effort, wanted, tried. It's not necessarily about doing that, she made an effort... Their sincerity is moral or conscientious rather than their job, the fact that nurses possess these values as a human..... It is enough for us to understand that nurses are conscientious, they don't necessarily have to complete the work” (K2, age 29, male, single, university graduate).


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FINDINGS• Patients expressed that they relax when nurses take

care about the initiatives and ask for help from another nurse when they cannot do without being insistent as they understand the stress of patients in addition to understand the emotions of them at that “moment”.

• This sensitivity of nurses is regarded by patients as another indicator of the fact that nurses understand what happens now and here. “…being insistent on their work, for example insistently trying to find the vein... it is much better when they ask for help from other nurses in these cases…” (K14, age 45, female, married, secondary school graduate).


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FINDINGS

• “…She comes at night and wake me up slightly, says 'I will measure your fever and blood pressure, I wake you up, sorry.' My husband is sleeping at that moment and she puts the tools so slowly that she makes me happy. Even the fact that she puts those tools quietly so as not to wake my husband shows her thoughtfulness. This is a great respect and I'm pleased with it...” (K1, age 54, male, married, university graduate).

“…I don't know if I'm at the first or the last person but they don't have the expression that says 'I will finish my job and go as soon as possible, they treat nicely... They are willing” (K11, age 43, male, married, university graduate).


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FINDINGS

3. Openness and Availability of Nurses: I'm here for you: Nurses should be available and open for patients as a presence and a human. Patients mentioned about being physically available and the factors beyond being physically available.


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FINDINGS• Patients stated that they know where they can find nurses,

they trust that nurses will come immediately when they are called, and being regularly controlled facilitates accessing nurses. They expressed that knowing these makes them feel safe and pleased. “…My fever and blood pressure are measured, and the required medications are administered at the hourly controls without I need to ask help from them. I know I can access them at those times. (K3, age 40, female, single, high school graduate)”. “…Patients can ask for help for the things they can't do themselves, for anything… they are right here. I can reach them…” (K4, age 54, female, married, high school graduate).


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FINDINGS

“…There is a button here, when you press they will come, I never tried it but they will come... I know...” (K11, age 43, male, married, university graduate). “…...You know you can be controlled regularly, and it relaxes you, you become not worried, and I feel good because I'm not worried, and naturally this is reflected on my disease, on my morale, everything”. (K15, age 34, male, married, university graduate).


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FINDINGS

• However, other factors of being available were indicated except for being physically available. The facts that nurses come immediately when they are asked for help, treat interestedly with a smile on their face while helping, do not try to go out from the room as soon as possible, or sometimes wait quietly give the message that they are availabe as a person.


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FINDINGS• “…We've been together for a longer time with the nurses, we have a

deeper relationship, you get closer when they come and go and you ask more easily. And this relaxes me for asking. You hesitate at first but you ask more easily as the dialog is improved...” (K7, age 33, male, married, university graduate).

• “…They don't leave me alone, they both wash me up and do my other works.... You can ask for help from nurses about everything…” (K4, age 42, female, married, high school graduate).

• “...Unavoidably there is also a spiritual aspect. About taking care about your disease, about giving morale. I think we get this mostly. We already have a good dialog. They got very closer at certain points beyond the nurse-patient relationship, and this naturally relaxes you spiritually, talking feels good. We need to talk and they relieve us positively (K15, age 34, male, married, university graduate).


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FINDINGS• Except for all the facts above, some negative moments that

nurses' presence are felt negatively were also stated by patients.

• Patients listed those negative behaviors that prevents them from asking questions or asking for help as: doing their job without greeting, going out without giving information, using an offensive, imperative voice, sulking, not being sensitive, acting carelessly on the analyzes or procedures, answering unkindly to the questions asked, or treating impatiently. They expressed that they become unpleased when they encounter such behaviors (16 patients).


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FINDINGS

• “…I can't ask questions when nurses do not answer correctly, scold me, treat nervously, do not make an explanation, or reprimand me; and I'm not pleased with those behaviors”. (K6, age 50, female, married, university graduate).


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FINDINGS• “…Offensive tone of voice, sulking, imperative talk

disturbs and upsets people. Patients are more sensitive, and patient psychology should be treated more sensitively, and these wear people much more.”

• “…A nurse saying that he just do his job. Like any bank official... A nurse saying 'I'm doing my job, and I don't care about the rest does not make you happy. A bank official takes the receipt and do the work, and says 'go to the pay-office' or something, but you feel a warmth if he asks 'how are you?'” (K1, age 54, male, married, university graduate).


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FINDINGS

• Patients stated that they hesitate to ask for

help when they see the behaviors and

attitudes they are not pleased with and wait

for the closer nurse, and avoid reacting to

prevent nurses from treating unkindly.


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Conclusion

• Patients feel the presence of nurses within their relationships with the nurses.

• When patients perceive the presence of nurses positively, they feel satisfied, secure ve being taken care.


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Conclusion

• Nurses’ tense behavior, their hectic look, or their sullen face give a message to the patients –unapproachable- and thus, this message creates a negativity against presence of nurses.


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Thank you for your attention…


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