Impacto Reglamentario

There were some noticeable differences between the medical, oncology and Macmillan nurses in their relationships with patients, with most of the oncology nurses describing an emotional and personal involvement with patients that was not evident in interviews with the medical or Macmillan nurses. Unlike the Macmillan nurses, the oncology and medical nurses provided hands-on nursing care 24 hours a day, and some of the nurses commented that nights where a time when patients might be more anxious, and more likely to be open with their feelings. The oncology nurses often got to know patients and their families very well, and formed close and personal relationships with them during prolonged and recurrent admissions. They worked physically close to the patients, providing round the clock nursing care and carrying out various procedures, which appeared to result in the formation of more personal relationships, where the nurses chatted to patients, sharing parts of their own lives, as well as sharing emotions

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with their patients (Box 15).

 ‘We were able to attend his funeral. Kind of closure for ourselves. It is only if I have been very involved with a patient and the relatives that I would want to go to the funeral. You cannot be a robot in this kind of situation and we do get very involved.’ (Oncology Nurse 1)

 ‘We had tears together, but we also had a giggle together. We become so attached to our patients.’ (Oncology Nurse 2)

 ‘She said “come and give me a hug”. I was in tears myself, with her. It was so emotional.’ (Oncology Nurse 3)

 ‘The deaths are all expected, but it doesn’t make it any easier … We often know the families very well, sometimes we look after these patients for years.’ (Oncology Nurse 4)

 ‘He was a lovely man and we had built up a good rapport. He’d been with us for a while, and he didn’t want to go anywhere else, not even to the Hospice or home.’ (Oncology Nurse 8).

Box 15 Oncology nurses’ more emotional relationships with patients

The medical nurses, on the other hand, often met patients briefly and knew little about them. On busy medical wards, time may be very limited and patients might die or be transferred to other areas soon after admission; however, some medical nurses did get to know patients well through longer and/or recurrent admissions. They provided nursing care for patients throughout the 24 hours, but were much less likely than the Macmillan and oncology nurses to be able to go back to their patients or their relatives, due to the fast turnover, which also resulted in the nurses having less time to build up relationships with patients. Some of the medical nurses commented on a lack of privacy in more sensitive communications with patients, as conversations could often be overheard by others. Further, patients may be very acutely ill and require immediate, urgent medical care. Responding to religious or spiritual concerns in this environment, when not

Discussion

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knowing the patients or their families, or anything about their possible beliefs, could be more difficult.

The Macmillan nurses ‘dipped in’ for, at times, very intensive visits, but did not provide ‘hands-on’, round the clock, nursing care. They were able to arrange to visit patients, go back and spend time with them, as required, allowing them to build strong and trusting relationships over a longer period of time. The Macmillan nurses, as well as the medical nurses, were caring and supportive in emotional situations, but did not express the more emotional involvement of the oncology nurses.

5.3.3. Responses

The Macmillan nurses were more likely than the other nurses to explore, look beyond the surface and try to establish what the patient was actually asking and why (Box 16). One particular Macmillan nurse went through a very structured ‘responding pathway’, with discussions with patients, exploration and clarifications. The medical nurses were more likely than the Macmillan and oncology nurses to experience a sense of responsibility for providing a direct answer or a resolution (Box 16).

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The Macmillan nurses tended to explore further:

 ‘Sometimes people want facts, sometimes they want to share feelings, and it’s just to suss out what they want and how to take it.’ (Macmillan Nurse 2)

 ‘I’d just let them speak through what their own thoughts and fears are. Find out what their greatest fear is.’ (Macmillan Nurse 5)

 ‘Clarifying what the patient is actually asking, what issues are of particular concern.’ (Macmillan Nurse 6)

The Medical nurses often felt a responsibility for providing an answer or a resolution:

 ‘It’s just trying to reassure her, that “no, you haven’t done anything to deserve this”.’ (Medical Nurse 2)

 ‘I just went on to explain to her about what I thought.’ (Medical Nurse 5)

 ‘We just said that we couldn’t help her to die, we’re not here for that sort of thing; we’re here to help people.’ (Medical Nurse 8)

Box 16 Differences in responses between the three groups of nurses

5.4. Limitations

This study was limited to medical and oncology nurses from one regional hospital in Scotland, and Macmillan nurses from one region of Scotland, and results may not be transferable to nurses from other areas. The response rates and rates of consent to attend for interview were low, which resulted in those who attended being self selected.

The nurses who consented to attend for interview were more likely than the non- consenting nurses to have religious or spiritual beliefs, although the lack of consistency between information provided in the questionnaires compared to that provided in the interviews, with regards to religious faith, means that little is known about the religious or spiritual beliefs of those nurses who were not interviewed. Only one of the interviewed nurses stated a complete lack of any religious or spiritual beliefs, both in

Discussion

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the questionnaire and in the interview, while most of the nurses who did not have any definite religious faith or belonging, expressed uncertainties or clearly spiritual beliefs compatible with the operational definition used in this study (Chapter 2.3) in their interviews. Therefore, it is not possible to come to any conclusions with regards to differences between those who did, and those who did not, have any religious or spiritual beliefs.

The options of ‘yes’, ‘no’, ‘uncertain’ in the questionnaire, to the question ‘Do you regard yourself as having any religious faith’, did not provide any meaningful information with regards to the nurses’ actual religious faith.

Participants selected their own incidents, which may have created biases. Although they were talking about what they did in real situations, rather than what they would do in a hypothetical situation, their recollections and accounts of the situations may not have been accurate.