Διερεύνηση των συμπεριφορών φροντίδας στην ογκολογική νοσηλευτική σύγκριση των αντιλήψεων νοσηλευτών ασθενών και των οικογενειών τους

Abstract

Backgound In the evolution of nursing as a science, considerations were presented inthe definition of "care‖ and ―caring" in the literature." Special emphasis is given to therelationship between nursing and care as well as in determining the dimensions,characteristics and behaviors that make it as a central concept in nursing. Oncologynursing is a nursing specialty that responded early to the challenge in defining such acomplicated and significant concept.Aim The aim of this study was to examine the caring behaviors as perceived bynurses patients and their caregivers.Methodology: A descriptive correlational study was conducted with cross-sectionalcomparisons, for the three study groups (patients, caregivers, nurses), in medicaloncology clinics of three cancer hospitals in the Attica area. A qualitative research ofnurses‘ caring behaviors using three focus groups followed.The study sample: For the descriptive study a convenience sample of N = 138 pairs of patients receiving chemotherapy and their family caregivers, with a response rate of78.8%, and N = 72 nurses with a response rate of 68% was used. The focus groupswere conducted with a purposeful sampling of 18 nurses with socio-demographiccharacteristics similar to those of participants in the quantitative study.Instruments: For the quantitave study were used 1. A social and professional form. 2.The Caring Behaviors Inventory (CBI). 3. The Symptom Assessment Scale ShortForm (MSAS-SF) MSAS-SF for patients and their family caregivers. 4. The NurseStress Index NSI. The statistical program of SPSS 17.0. was used for data analysis. Inthe qualitative study, a formed interview guide was used and deductive contentanalysis was the method of analysis.Results: There was not any statistically significant difference between patients andtheir family caregivers. Nurses, patients and their caregivers agreed on the scoring in the first two most highly rated caring behaviors, ―Knowing how to give shots, IVs,etc‖ and ―Giving the patients‘ treatments and medications on time‖. Also all threegroups agreed on the two lowest rated caring behaviors ―Including the patient inplanning his or her care‖ and ―Talking with the patient‖.Associations between patients, family caregivers and nurses rating with all CBIsubscales showed a) no statistically significant difference between patients and theirfamily caregivers in any of CBI subscales b) statistically significant difference wasfound between patients and nurses in ―Knowledge and skill‖ (p=0,010), ―Respectfuldeference to others‖ (p=0,001) and ―Positive connectedness‖ (p=0,004). c)assosiations between family caregivers and nurses were found statistically significantdifference in subscale ―Knowledge and skill‖ (p=0,007), ―Assurance of humanpresence‖ (p=0,003), ―Respectful deference to others‖ (p=0,001) and ―Positiveconnectedness‖ (p=0,003).Associations of patients‘ symptoms and their caring behaviors showed that a) Caringbehaviors of subscale ―Knowledge and skill‖ rated lower when they had higher Total MSAS score (r-0,34 p<0,001), Global Distress (r-0,30 p<0,001), intenselyPsychological symptoms (r-0,28 p <0,001) and Physical symptoms (r-0,22 p=0,006).b) results for the subscale ―Positive connectedness‖ was found similar. c) subscales―Assurrance of human presence‖ and ―Respectful deference to others‖ when patientshad higher Global Distress Index (r-0,22 p=0,005), psychological symptoms (r-0,24p=0,003) and Total MSAS score (r-0,24 p=0,003). d) ―Respectful deference to others‖when patients had higher Global Distress Index (r-0,23 p=0,004) psychologicalsymptoms (r-0,25 p=0,001) and Total MSAS score (r-0,25 p=0,002).Associations of family caregivers rating of patients‘ symptoms with nurses‘ caringbehaviors showed that a) caring behaviors of subscale ―Knowledge and skill‖ ratedlower when Total MSAS score was rated higher (r-0,30 p=0,001), intensely physicalsymptoms (r-0,25 p=0,004), psychological symptoms (r-0,21 p=0,021) and greaterGlobal Distress (r-0,22 p=0,015) of their patients. b) Subscales of ―Assurance ofhuman presence‖ and ―Positive connectedness‖ rated lower when their patients hadmore intense physical symptoms (r-0,20 p=0,025) and (r-0,18 p=0,046) respectively,psychological symptoms (r-0,21 p=0,018) and (r-0,23 p=0,010) respectively, higherTotal MSAS score (r-0,25 p=0,004) and (r-0,26 p=0,004) respectively. c) Caringbehaviors indicating ―Respectful deference to others‖ were rated lower by familycaregivers as higher was the patients‘ Total MSAS score (r-0,20 p=0,026). Married nurses had significantly higher rating compared to those who were single ordivorced in all subscales of the CBI (p=0,01). No statistically significant correlationwas found between the total score of stress (NSI) and caring behaviors, additionallythe total score of stress (NSI) showed no high levels of job stress for nurses.In a multivariate approach, a stepwise multiple regression was used in order to findthe strongest predictors of CBI only the educational level, family caregiver and theTotal MSAS score were the three variables that significantly affected subscales of―Assurance of human presence‖ of CBI (p=0,001) for patients. Family caregivers‘Total MSAS score was the only variable that significantly affected ―Knowledge andskill‖ (p=0,005), ―Assurance of human presence‖ (p=0,008) and ―Positiveconnectedness‖ (p=0,004). At the end for nurses no model found to had a statisticalsignificant predictor ability.Content analysis of the qualitative study highlighted the following main categories 1.The perception of care as a humanistic value, professional responsibility, meetingneeds of patients and individualized care that gives satisfaction to patients and nurses.2. Respect for the human presence. 3. Patients information and effectivecommunication. 4. Creating relationship or connection with patient.5. Empathy ofpatients‘ experience. 6. Nurses‘ personal perception about the disease and finally 7.Nurses‘ perception of their role through the tasks, responsibilities, clinicalcompetence, interdisciplinary collaboration and patient advocacy, and the necessity ofcontinuing education and specialization.Conclusions: Patients, their caregivers and nurses agreed that the most importantbehaviors associated first with the clinical competence of nurses followed by ensuringpatient and then by behaviors expressing respect. The findings of the qualitative studyreinforced the quantitative findings clarifying that the perception of care, perceptionsand expressed nurses‘ behaviors dare affected from the context of the provision ofcare. In addition, relationships with patients and their caregivers are created moreeasily when the nurse has demonstrated clinical competency, which is an evaluationpoint among nurses and from patients and their caregivers to nurses.