Influencing Factors of Intention and Behavior of Patient Delay in Elderly Benign Prostatic Hyperplasia: a Descriptive Qualitative Study

Background: Most elderly patients with BPH have experienced patient delay. Based on the TPB, the aim of this study was to describe the influencing factors of BPH patients' intention and behavior of patient delay and to provide a reference for the development of a patient delay intention scale and personalized intervention.Methods: This descriptive qualitative study was carried out 4 months in 2021 in China. The participants were 20 patients with BPH ages 60 to 82 years old who experienced patient delay and were selected through purposive sampling method. The study was performed in a large general hospital and a community hospital. The data were collected via face-to-face semi-structured interviews.Results: The following themes were relevant to BPH patients with intention and behavior of patient delay: “Insufficient cognition of symptoms (low symptom alertness, symptom benign attribution)”, “Experience coping instead of going to a doctor”, “Negative attitude toward seeking medical care (Underestimation of the consequences of delayed medical treatment, Negative evaluation of early medical treatment)”, “The influence of others on decision-making for seeking medical care(People who approve or disapprove of going to a doctor, Do or do not follow the opinions of others)”, “Obstacles to seeking medical care(Factors from the patient, Factors from medical institutions)”Conclusion: The delay was longer in rural areas than in urban areas. BPH patients' intention and behavior of patient delay are the result of a combination of many factors. Therefore, it is recommended to develop a scale to evaluate the patient delay intention for BPH, and provide personalized interventions based on the scale to improve patient delay in elderly BPH patients

Responding to a Tragedy: Evaluation of a Postvention Protocol Among Adult Psychiatry Residents

Objective In a time of “zero suicide” initiatives and rising suicide rates, resident physicians are particularly susceptible to the psychological and professional ramifications of patient suicide. An adult psychiatry residency program developed and implemented a postvention protocol to address the impact of patient suicide among resident physicians. The current study is a formal evaluation of a training program’s postvention protocol from June 2018 to April 2020. Methods Process and outcome indicators were identified to assess protocol implementation and effectiveness. Process indicators included were postvention protocol adherence. Outcome indicators were perceived helpfulness of postvention protocol–related supports, occupational and general health measures, posttraumatic growth, and posttraumatic stress symptoms following resident participation in the postvention protocol. Results Study response rate was 97% (n = 57/59) and 81% completed the entire survey (n = 48/59). Twenty percent of residents (n = 10/48) experienced patient suicide during residency. Postvention protocol adherence was between 57 and 100%. Protocol-related supports, such as speaking with attendings who had previously experienced an adverse event, were more helpful than other supports (p < 0.01). Compared to residents who had not experienced patient suicide, mean work empowerment, burnout, mental health, and quality of life scores were not significantly different from residents who participated in the postvention protocol (p > 0.05). Posttraumatic growth was positively correlated with self-determination at work (p = 0.01). Conclusions The postvention protocol was helpful to residents and potentially effective at mitigating the psychological and professional consequences of patient suicide. Study findings may inform standardization of postvention protocols among psychiatry training programs.

Nursing Students' Experiences with Patient Deaths during Clinical Practice

Purpose: The purpose of this study was to explore nursing students' experiences with patient deaths during clinical practice. Methods: The participants were ten nursing students who had experienced patient deaths during clinical nursing practice at a university hospital in Korea. Individual in-depth interviews were conducted, and the data were analyzed using the content analysis method suggested by Graneheim and Lundman (2004). Results: The participants' experience was structured into six categories: experiencing various emotions in facing patient deaths, viewing oneself as a nursing student at the scene of a patient's death, thinking about death again, finding a pathway of understanding and support for patient death experiences, impressions and regret felt while actually observing terminal care, and picturing oneself as a future nurse dealing with a patient's death. Conclusion: Based on this study, stress management and self-reflection programs are suggested for nursing students who have experienced patient deaths. Practical nursing education for patient death and end of life care is also needed.