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      Patients' perceptions of their experiences with nurse-patient communication in oncology settings: A focused ethnographic study

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          Abstract

          Background

          The nursing shortage and its impact on patient care are well-documented global issues. Patients living with cancer as a chronic illness have many psychosocial problems and often lack adequate support as a result of ineffective nurse-patient communication. A review of the literature on factors influencing the delivery of psychosocial care to cancer patients indicates that the delivery of psychosocial care in routine cancer nursing within a biomedical healthcare system has not been widely explored.

          Objective

          To explore patients’ perceptions of their experiences with nurse-patient communication in an oncological clinical environment.

          Method

          A focused ethnographic study was undertaken in two oncology wards of a hospital in Hong Kong. Data were collected through observations of the ward environment, the activities and instances of nurse-patient communication, semi-structured interviews with patients, and a review of nursing documents.

          Results

          Two main themes were identified: 1. Nurses’ workload and the environment and 2. Nurse-patient partnership and role expectations. Within these two themes were related subthemes on: Sympathy for the busy nurses; Prioritizing calls to the nurses; Partnership through relationship; Nurses’ role in psychosocial care; and Reduction of psychosocial concerns through physical care.

          Conclusions

          Many cancer patients do not expect to receive psychosocial care in the form of emotional talks or counseling from busy nurses, but appreciate the attention paid by nurses to their physiological and physical needs. Nurse-patient partnerships in cancer care may reduce the potential workload of nurses. The psychosocial needs of cancer patients could be optimized by providing good physical care through effective communication within a time-constrained oncology setting.

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          Most cited references44

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          The use of focused ethnography in nursing research.

          To provide an overview of the relevance and strengths of focused ethnography in nursing research. The paper provides descriptions of focused ethnography and discusses using exemplars to show how focused ethnographies can enhance and understand nursing practice. Orthodox ethnographic approaches may not always be suitable or desirable for research in diverse nursing contexts. Focused ethnography has emerged as a promising method for applying ethnography to a distinct issue or shared experience in cultures or sub-cultures and in specific settings, rather than throughout entire communities. Unfortunately, there is limited guidance on using focused ethnography, particularly as applied to nursing research. Research studies performed by nurses using focused ethnography are summarised to show how they fulfilled three main purposes of the genre in nursing research. Additional citations are provided to help demonstrate the versatility of focused ethnography in exploring distinct problems in a specific context in different populations and groups of people. The unique role that nurses play in health care, coupled with their skills in enquiry, can contribute to the further development of the discipline. Focused ethnography offers an opportunity to gain a better understanding and appreciation of nursing as a profession, and the role it plays in society. Focused ethnography has emerged as a relevant research methodology that can be used by nurse researchers to understand specific societal issues that affect different facets of nursing practice. As nurse researchers endeavour to understand experiences in light of their health and life situations, focused ethnography enables them to understand the interrelationship between people and their environments in the society in which they live.
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            Concepts and a model for the comparison of medical systems as cultural systems.

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              Patient and health professional's perceived barriers to the delivery of psychosocial care to adults with cancer: a systematic review.

              To explore the barriers experienced and perceived by health professionals and patients in the delivery of psychosocial care to adults with cancer. Systematic searches were undertaken using the PsychInfo, Medline and CINAHL electronic databases, up to October 2013. Research reporting health professional or patient experiences and perceptions of barriers to psychosocial care are included in the review. The systematic review includes studies that have non-experimental, exploratory and observational designs, as is appropriate to answer the review question. Included studies were critically appraised. The results of individual quantitative studies were aggregated. Qualitative content analysis was used to analyse the qualitative results. Twenty-five papers met the pre-specified inclusion criteria for the final review. The most commonly perceived barrier for patients relates to receiving adequate support from elsewhere and a lack of perceived need for psychosocial care. Health professionals report barriers at an organisational level most frequently followed by cultural and then individual clinician-related barriers. Barriers exist on a variety of levels. People with cancer need clear appropriate information and communication about psychosocial services, including information about the role of psychosocial care in addition to existing supports. Interventions that target the complex interplay of individual, organisational and cultural factors need to be developed. Strategies that improve health professional communication skills, identify clear referral pathways, improve acceptability of interventions and clearly identify the need for services could address many of the barriers identified in this review. Copyright © 2014 John Wiley & Sons, Ltd.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: Project administrationRole: SoftwareRole: ValidationRole: Writing – original draft
                Role: Formal analysisRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 June 2018
                2018
                : 13
                : 6
                : e0199183
                Affiliations
                [1 ] School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
                [2 ] School of Optometry, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
                Hamad Medical Corporation, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-4411-6200
                Article
                PONE-D-18-01416
                10.1371/journal.pone.0199183
                6005521
                29912967
                eb04a16f-569d-4b52-b065-3218508cfcf6
                © 2018 Chan et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 January 2018
                : 1 June 2018
                Page count
                Figures: 0, Tables: 0, Pages: 17
                Funding
                Funded by: General Research Fund
                Award ID: 156003/15H
                Award Recipient :
                This work was supported by Research Grant Council, Poly U 156003/15H to EAC. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Nurses
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Nurses
                Medicine and Health Sciences
                Health Care
                Psychological and Psychosocial Issues
                Medicine and Health Sciences
                Health Care
                Patients
                Medicine and Health Sciences
                Oncology
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Allied Health Care Professionals
                Biology and Life Sciences
                Psychology
                Emotions
                Social Sciences
                Psychology
                Emotions
                Social Sciences
                Economics
                Finance
                Medicine and Health Sciences
                Oncology
                Cancer Treatment
                Custom metadata
                All relevant data are within the paper.

                Uncategorized
                Uncategorized

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