| Research BackgroundNursing needs reflects patients’wish in nursing needs service. Try to meet patients’rational nursing needs, maybe beneficial for stabilizing and arousing their positive moodiness, and helping them to stepping from passive moodiness, such as loss, agony, uneasy and loneliness, which is advantageous to promote patients restoring health and recovery. We have searched11related themes about nursing needs in patients with stroke from National Knowledge Infrastructure (CNKI) database.8of all papers are focus on nursing needs in stroke patients outside the hospital, and3are nursing needs in stroke patients in the hospital. It can be seen that more and more researchers have shifted their focus to nursing needs outside the hospital gradually and omitted patients’nursing needs in hospital.Elderly stroke patients received nursing cares depending on the education, knowledge and clinical experience of nurses in china, lacking of patients’subjective perception to evaluate nursing needs. In the other hand, nurses always passively receives useful nursing information under the leadership of "top-to-down" management model. By means of qualitative research, researchers in nursing try to interpret participants’ life experiences and fragments, made of living situations, issues or actions and so on from a view of attitude, behaviors and cognition. We directly and indirectly explored how to make elderly stroke patients be satisfied with their nursing needs, by means of accurate perception of their live experiences.Research Objectives1. To elevate elderly stroke patients’live perception in hospital, provides evidences for supplying personalized nursing services and satisfying personalized nursing needs.2. To explore nurses’live perceptions about elderly stroke patients and their body and mind feelings during their clinical practice, provides theoretical basis for nursing administrators in human resource management and nursing instructors in individualized education. In one hand, we utilized excellent nursing administration and nursing education to promote the development of nursing practice, which indirectly makes elderly stroke patients be satisfied with their nursing needs3. In this study, we didn’t simply investigate the participants’perception in psychological, but we totally investigated the participants’perception in all kinds of aspects from their phenomenon in hospital.Research significance1. It lays a foundation for the application of research results to nursing practice for research objects basing on a live situation. It is useful to strengthen relationship between nurse and patient by means of the method of collecting information.2. Both nursing research and practice are in spiral uprising trend, the development of method in qualitative research got much more profound understanding for introducing qualitative nursing assessment.3. To investigate active, passive, or paradoxical experiences from different medical role encountering with the same setting and disease, makes feasible nursing intervention and improves the quality of clinical nursing. Research methodsThis study used phenomenological approach in qualitative research. Phenomenological approach is usually used to explore experience by induction and description on consciousness, without any presuppositions. It is based on philosophical thinking. This approach is considered suitable to explore the essence of life experiences, because phenomenology provides a description of how one understands and focuses on the lived experience of phenomena and its essences. So in this study, we interpreted elderly stroke patients and nurses’live experiences when they are in the same medical environment from a phenomenological perspective.Part I Live perceptions in elderly patients with stroke:a qualitative studyParticipants were identified by purposive selection. Elderly stroke patients were enrolled from a department of neurology of a tertiary-level hospital in Guangzhou city from2010December to2011July. All participants were recruited in accordance with the inclusion criteria. Participants were informed in writing (details in Appendix NO.3) and orally that they could opt out of the study at any time gave before the interview.16informants were collected by use of Semi-structured face-to-face interview strategy and observation method, the process of data collecting will be stopped when information is saturated. On the basis of Colaizzi7steps of interpretative phenomenological analysis and We used a software for qualitative research, Nvivo8, to storage, code, retrieval and analyze unintelligent data.Part II The qualitative research of caring experiences of elderly stroke patientsParticipants were identified by purposive selection. Nurses were recruited with caring experiences of elderly stroke patients in a department of neurology of a tertiary-level hospital in Guangzhou city from2010December to2011July.9participants were enrolled to take a Semi-structured face-to-face interview strategy and observation method, the process of data collecting will be stopped when information is saturated. The detailed method of data analysis is same as part I.Research ResultsPart I Live perceptions in elderly patients with stroke:a qualitative studyBefore the formal study, we familiarized the clinical pathways, disease category and layout of ward area in the department of neurology. Then we observed and recorded elderly stroke patients’behavior, speech and their daily life. When to interview had been scheduled at the beginning of study. After informed consent was obtained, we had an interview with every participant. Record was also obtained. Simultaneously, we also gained useful information from concerned persons, such as nurses, nursing assistant and their family member. If the information was meaningful, we have an informal interview with them at a casual time and place. At the end of this study,16elderly stroke patients participated in the formal interview. The length of time for the interviews lasted from20to65minutes. Interviews information transcribed and induced verbatim by researcher. Then the text data were imported into NVivo8.0qualitative research software and examined the transcripts line by line, the data were encoded and analyzed responses that emerged from the data into themes by means of phenomenology-based analysis methods. We have obtained some meaningful results as followed:1. Perception in attitude:Subjects have an urgent attitude towards their misfortune. They felt helpless when they had to encounter with stroke, and they though their bad health status couldn’t cope with it. They also felt lonely because the environment and interpersonal interaction suddenly changed. The elderly patients had expressed after they suffered stroke.2. Perception in behaviors:They usually insisted on finishing their own things by themselves whatever if they could do it. They choose to self-adjust themselves to solve new problem, but didn’t tell doctor what have happened to them timely when there was new symptoms occurred. However, they could receive active treatment rationally even if they got little about the disease.3. Perception in cognition:Because they have suffered from a great attract in physical and mental health, they gradually formed a right comprehension on their disease and health problem when they stayed in a medical environment.Part II The qualitative research of caring experiences of elderly stroke patientsWe observed and recorded nurses’behavior, speech and so on. When to interview had been scheduled at the beginning of study. After informed consent (details in Appendix NO.4) was obtained, we had an interview with every participant.9nurses participated in the formal interview. The length of time for the interviews lasted from20to45minutes. Interviews were recorder recorded and later transcribed verbatim by researcher. Then the text data were imported into NVivo8.0qualitative research software and examined the transcripts line by line, the data were encoded and analyzed responses that emerged from the data into themes by means of phenomenology-based analysis methods. We have obtained some meaningful results as followed:1. Perception in attitude:In the process of caring for elderly stroke patients, nurses recognized that they were expressed the kinds of emotions such as sense of achievement, numbness, boredom. Nurses fear that they could suffer a stroke. The nurses felt at all sympathetic toward elderly stroke patients who were puzzled over disease.2. Perception in behaviors:Nurses always mechanically follow the working routine to carry out their nursing duties; Nurses thought whether or not their knowledge could meet nursing need for patients; Nurses are satisfied with current working status.3. Perception in cognition:Role ambiguity. They thought their main duty just was nursing care from patients’ physical aspect. Since they had a long time to stay with elderly stroke patients, nurses experienced that they had become old quickly, there is a larger gap between physiological age and mental age than their reality.Research conclusions1. Participants described positive, negative, paradoxical experiences while living with stroke, however negative and paradoxical experiences were primary, their experiences reflected nursing needs. Nurses should support individualized nursing intervention to satisfy patients’ nursing needs according to their different experiences.2. This research revealed nurses’ inner experiences are related to job, disease and nursing role. Dynamic role of consciousness, which explains nurses’ inner experiences have guiding significance to clinical practice, therefore, nursing manager should strengthen the communication with nurses to understand their negative experiences that is decrease reverse phenomenon caused by human factors during the process of nursing in essence.Issues and solving ways1. To develop the method of data collection by pre-experiment (n=2) and to illustrate the feasibility of these conditions.2. We stayed sample place as long as possible to increase extrinsic validity. In addition, the intrinsic validity was improved by the communication with experts and using of recorder.3. In order to have an interview with participants in a nature, we stayed in the ward area for a long time, and had familiar with patients’ schedule time, and then made a plan that when and how often would have an interview. Informed and verbal consent were obtained from all participants.4. This research using SPMSQ to screen patients with moderate or severe conscious disturbance for its validity. |
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