Abstract
The following is a review of four qualitative studies carried out in the health industry and aimed at improving nursing practice. Each of the four studies has substantial data as none of them took less than six months to complete. They share several similarities. Most participants are cardiac patients, caregivers and those who are vulnerable to heart conditions. Researchers utilized open-ended questions for maximum data collection. The first study shows that the nurse’s role can be extended to consultation. The second study found that coronary heart disease is not considered to be a major health concern in Hong Kong due to presence of other more life threatening diseases and due to ignorance. The third study showed that hierarchical models of professional roles adversely affect communication and subsequent patient care. The fifth study provided evidence to show that the majority of spiritual patients practiced positive behavior in dealing with their health while those who exhibited negative behavior would require spiritual nursing care.
Experiences of doctors and nurses implementing nurse-delivered cardiovascular prevention in primary care: a qualitative study: A review
The role of a nurse has been limited to caring for the patient and administering prescriptions. This does not have to be the case as evidenced in the study by Voogdt-Pruis, Beusmans, Gorgels, and Van Ree (2011). The aim of this paper was to find out the factors necessary for the successful introduction of new strategies in the routine running of a health care facility. It accomplished this by observing the effectiveness of implementing a cardiovascular prevention consultation delivered by nurses to high risk patients. Data was collected from the experiences of both nurses and general practitioners. After randomly selecting participants from high risk patients, half of them were given nurse-delivered care while the other half was given standard care by general practitioners. This was the control group in the study.
The methods followed were scientific and credible. Interviews were conducted in a randomized trial manner. Participants consisted of six primary healthcare centers and the length of the study was two years. This length of time and the wide sampling gives highly representative and accurate data. Data collected was analyzed by two researchers working independently to reduce bias. To further this endeavor, all authors in the study checked and discussed the analysis.
This study added to a body of evidence that shows that nurses should take part in risk management for cardiovascular diseases. The researchers found that nurses were a significant factor when it came to implementing cardiovascular prevention steps. They also found that for nurses to successfully do this, they had to have confidence with other caregivers and vice versa. All healthcare professionals supported the nurses’ role and nurses supported the idea of further implementing cardiovascular prevention. Implementation was also promoted by job satisfaction that nurses derived from the exercise and their feeling of responsibility for having carried out the set guidelines successfully. Barriers detected included ignorance, poor communication, fear of losing nursing tasks, lack of motivation on the patient’s side and what to include in their lifestyle advice. Nurses were able to remove those barriers successfully.
The nurses who participated in this study had a few shortcomings. For example, they did not find it easy to get advice from older patients. They thought it took too long and could be difficult to apply. This was unlike General practitioners who consulted regularly. Patients at times saw no reason to see a nurse after having been to a specialist. This study reveals that a change in the perception of the nurse’s role will go a long way in improving the system.
A qualitative study of the perceptions of coronary heart disease among Hong Kong Chinese people: A review
Coronary Heart Disease ranks high among the diseases that cause the most deaths in the world. Its prevalence is partly attributed to peoples’ misconceptions of it, as well as poor lifestyle choices resulting from modernization and ignorance. The objective of the study by Chan, Lopez and Chung (2010) was to find out how the people of Hong Kong perceive coronary heart disease (CHD). To get a wide range of participants, the researchers used the snowballing method where a few participants actively volunteer to find other participants. The data collected was objectively analyzed through content analysis. It was obtained from participants with different levels of risk and was collected through focus groups. This took eight months with interviews lasting one to one and a half hours which ensured that ample data was collected to make substantial conclusions. Results were categorized into perceived seriousness, Perceived risk and perceived opportunities to understand CHD. To ensure that data was without bias, two researchers analyzed it separately before discussing it. Bias was also reduced by having an individual at the focus groups whose main purpose was to encourage all participants to voice their thoughts and to discourage dominant personalities from influencing the rest.
From the data collected, it was discovered that CHD was not perceived as a major health concern as it paled in comparison with other life threatening diseases in Hong Kong such as SARS. It was perceived as a disease that did not result in much suffering and was normally followed by an easy death. Results of perceived risk factors showed that 85% believed it was caused by obesity, 72% believed it was due to heredity while lack of exercise was given by 49% of sedentary participants. Perception of risk was also affected by positive thoughts, age, how great CHD suffering was perceived to be, and reliance on medical personnel. The young believed that they had a lower risk due to their age and those who relied on medical personnel were able to let go of their personal risk. Majority of participants in this study consistently reported a lack of access to information about CHD. In addition, they found that participants believed that CHD was a disease that was not easily understood.
This study shed more light on the gap that exists between the information provided to the public about CHD and what the public would like to know about CHD. Some participants stated that the information provided was not designed to be understood by laymen. Others claimed that the information they sought on CHD was nonexistent or vague. The authors attribute this occurrence to a lack of enough studies and diversion of attention to more pressing health matters in Hong Kong. By understanding the way that CHD was perceived, the researchers provided evidence that will be crucial in preventing this disease and in creating strategies that will promote health.
Communication barriers to patient education in cardiac inpatient care: A qualitative study of multiple perspectives: A review
Good communication in healthcare facilities is very important for patients to receive the right diagnosis, care and medication. Patients who find themselves in environments where there is effective communication are more likely to follow the treatment recommended, and fare well emotionally and physically (Fallowfield, 1999 as cited in Farahani, Sahragard, Caroll & Mohammadi, 2011). This qualitative study by Farahani et al., 2011) was carried out to obtain information from nurses, physicians and patients on barriers that may exist in communication. Identification of barriers is the first step in finding solutions to communication. Data collection consisted of open-ended questions which ensured that participant responses were not restricted or limited.
In this study, there were three themes used to categorize poor communication observed. The first theme was that among the team of health-care providers, there was a lack of collegiality and communication. Nurses felt that physicians were indifferent and did not give them support which negatively affected their morale and subsequent communication with patients. The second theme was problems in communication among patients, their families and physicians. Results showed that the confidentiality and privacy of patients was not respected, they were not shown empathy, and there was also use of medical language when talking to patients resulting in misunderstanding and fear. The last theme was challenges resulting from cultural differences. Cultural differences made it difficult for some patients to talk about intimate issues that were significant when it came to their health. Whenever patients and the healthcare team spoke different languages, it became difficult to get the message across. This study found that in all three categories, there was little and ineffective communication. Analysis of the data was done using content analysis a system that has been found to be very effective in eliminating bias.
This study collaborated evidence from other studies that show that collaborative models of professional roles are preferable to hierarchical ones. It successfully linked hierarchical systems with poor communication between the nurses and physicians. It also found that nurses wished to take a more active role in clinical decision making. Nurses have always wanted this role as they spend more time with patients and therefore understand them better than physicians. The results of this study show that patients distrust and are not satisfied with healthcare providers who do not get along as a team. It also cautioned against having too many members of the healthcare team delivering different messages to the patients and causing confusion. This point shows that the specialization of the different healthcare team members that is in place is important for accountability. This paper cited the use of cardiovascular nurses as interviewers as a limitation that may have introduced interviewer effect.
Spirituality, illness and personal responsibility: the experience of Jordanian Muslim men with coronary artery disease: A review
The influence of beliefs in the supernatural on the health and nursing care of the medically ill is of particular interest in highly religious communities. In some communities, nursing care does not incorporate spiritual care and this may have an effect on the physical well being of the patient. A study by Nabolsi and Carson (2011) sought to measure this in the Muslim religion. The aim of this study was to find out how Arab Muslim men suffering from coronary artery disease (CAD) experience spirituality. The participants were men as CAD is more common to men (Nabolsi & Carson, 2011). Interviews were carried out over six months’ time which is a lengthy enough time to obtain good representative data.
Data was collected through the use of semi-structured interviews. Results showed that all participants believed that they had been fated to fall sick as they believed that their destiny was in the hands of God. This study revealed that the participant’s acceptance of their CAD was made possible by faith which made it easier to cope. The researchers found that even though participants accepted the illness as a will of God, they accepted that risky lifestyles on their part had contributed. Their spiritual beliefs did not prevent them from seeking medical help. They were also guided to healthier diets and good health habits by religious instructions more than by health education tips. Their spirituality made their inner strength stronger which made it easier for them to accept their illness and to deal with it. Being ill was also found to make them more spiritual. They changed their priorities giving spirituality promoting practices more time and changing the way they lived.
Not all believers reported positive results from their spirituality. The study had those participants who could not balance all the qualities of spirituality and tended to believe more in fate and fatalism being exerted from without. These participants did not feel the desire to change or practice health activities. This is the point at which the nurse can become a valuable tool in the improvement of the patient’s spiritual health. In such cases, the authors recommend that nurses encourage the patient to have personal control, to be responsible, and improve self-confidence in the manner in which they take care of themselves. The involvement of the nurse in the spiritual well-being of the patient is suggested as a means of sharing with patients and to foster integration of spirituality into healthcare plans. This spiritual care was found to be a critical part of nursing care that was lacking in the Arab Muslim community studied.
Reference List
Chan, C., Lopez, V., & Chung, J., (2010). A qualitative study of the perceptions of coronary heart disease among Hong Kong Chinese people. Journal of Clinical Nursing, 20, 1151-1159.
Farahani, M. A., Sahragard, R., Caroll, J.K., & Mohammadi, E. (2011). Communication barriers to patient education in cardiac inpatient care: A qualitative study of multiple perspectives. International Journal of Nursing Practice, 17, 322-328.
Nabolsi, M., & Carson, A. (2011). Spirituality, illness and personal responsibility: the experience of Jordanian Muslim men with coronary artery disease. Scandinavian Journal of Caring Sciences, 25, 716-724.
Voogdt-Pruis, H., Beusmans, G., Gorgels, A., & Van Ree, J. (2011). Experiences of doctors and nurses implementing nurse-delivered cardiovascular prevention in primary care: a qualitative study. Journal of Advanced Nursing, 67 (8), 1758-1766.