Dr Liz Jestico

Background

Ecomaps are tools used in nursing practice to assess families’ social support systems. Whilst ecomaps have previously been used effectively within qualitative research, little attention has been given to them as a tool within the methodological approach of hermeneutic phenomenology.

Aim

To demonstrate that the use of ecomaps is congruent with the Heideggerian philosophical foundations associated with hermeneutic phenomenology. This paper demonstrates how ecomaps can illuminate nurses’ understanding about the experiences of patients and families by reflecting on a study where ecomaps were used to explore how parents of children with cancer are supported with decision-making about their child’s care.

Discussion

Exploration of the Heideggerian concepts of ‘being-in-the-world’, ‘being-with’, and ‘temporality’ prompted reflections about how constructing ecomaps furthers understanding about participants’ unique contexts. Using an ecomap within an in-depth interview enabled participants to return to their experiences of being supported with decision-making, and further developed the researcher’s understanding about how each participant’s experience was situated within their evolving relationships with others.

Conclusion

Constructing ecomaps within hermeneutic phenomenology is in tune with Heideggerian philosophical concepts. Ecomaps can open a door to participants’ experiences and, combined with understanding of philosophical concepts, deepen the researcher’s understanding and find further meaning in participants’ experiences.

Implications for practice

Ecomaps are a useful tool in shining a light on the lifeworld of research participants in hermeneutic phenomenological research. Practical tips are provided to optimise their use in future research.

Aim: To synthesise what is known from current international evidence about how parents are supported by significant others when they are faced with making decisions about their child's cancer care.

Background: Parents are faced with making challenging decisions when their child has cancer and may benefit from support. Whilst previous research has comprehensively explored how healthcare professionals can offer support, little attention has been given to how support may be informally provided from a parent's network of significant others.

Method: An integrative literature review was undertaken and reported following the ENTREQ framework. Literature was identified from comprehensive database searching across four relevant databases (CINAHL, PubMed, PsychINFO and British Nursing Database) and hand-searching reference lists of retrieved studies. Studies that met the inclusion criteria were critically appraised and then analysed using the Constant Comparative Analysis method.

Results: Twenty-six articles were included in the review. Two overarching themes were iden-tified. Theme 1— Dimensions of Decision- Making support— included three sub-themes: informational, emotional and instrumental mechanisms of support. Theme 2— Expectations of Decision- Making support— identified that parents’ expectations of their own role, and the role of their significant others, affected how decision-making was supported.

Conclusions: Parents may seek and receive support from various significant members of their network, but there is a fine line between supportive and unsupportive behaviours.

Relevance to clinical practice: Each family's unique personal, social and cultural context strongly impacts on their support needs, and nurses and other healthcare professionals should be mindful of how parents may access support from their significant others. Further in-depth research around this area would contribute important knowledge around parents’ support needs.

Survival rates for children with cancer continue to improve, so it is important to investigate the long-term effects of the disease that survivors may experience. The social interactions of children with cancer are often limited during a critical period of their social development; therefore, it may be beneficial to understand the potential consequences that this could subsequently have during their adolescence.

This article details an integrative literature review that explored the effects of being a survivor of cancer, diagnosed under the age of 18 years, on the social interactions of adolescents and young adults. Thematic analysis generated two overarching themes: evolving sense of self-esteem and evolving perspectives of relationships. The article discusses these themes and proposes an extended partnership model to support family-centred care, which acknowledges children’s developmental need for social interaction.

Background. In the UK children with cancer are cared for by children's nurses in a variety of settings, specialist and non-specialist. Whilst post-registration specialist education is available to some nurses, many nurses rely solely on pre-registration education to competently care for these children. This study explores whether nurses perceive that this adequately prepares them. Objectives. To explore the extent to which qualified nurses perceive that pre-registration nurse education prepares them to care for children with cancer; to consider the implications for children's nursing pre-registration curricula. Design. A small-scale qualitative study was undertaken using an interpretivist approach. Methods. Semi-structured interviews were conducted with six qualified children's nurses in two clinical areas - a specialist children's cancer inpatient ward, and a general children's ward where inpatients included children with cancer. Results. Findings are discussed in relation to three emergent themes: Learning in Theory and Practice, Care of the Child and Family, and Resilience. Participants attached significance to the quantity and quality of practice experience. They reflected on barriers to specific and transferable theoretical learning and stressed the importance of integrating theory and practice. Understanding of family-centred care formed a significant part of their preparation. Preconceptions, communication with families and the emotional impact of this speciality were stressful. Improved pre-registration preparation may have developed participants' resilience. Conclusion. The complexities of caring for children with cancer and their families require well-prepared nurses. Participants' perceptions of preparedness were influenced by aspects of pre-registration education. Their experiences suggest that curricula should be practice-focused and include a range of placements. Specialist theoretical content must be integrated with practice and transferability of knowledge and skills made explicit. Reflection and problem-based learning may foster coping mechanisms and resilience that will equip them to care for children with cancer.

Objectives. To explore the extent to which qualified nurses perceive that pre-registration nurse education prepares them to care for children with cancer; to consider the implications for children’s nursing pre-registration curricula.

Design. A small-scale qualitative study was undertaken using an interpretivist approach.

Methods. Semi-structured interviews were conducted with six qualified children’s nurses in two clinical areas - a specialist children’s cancer inpatient ward, and a general children’s ward where inpatients included children with cancer.

Results. Findings are discussed in relation to three emergent themes: Learning in Theory and Practice, Care of the Child and Family, and Resilience. Participants attached significance to the quantity and quality of practice experience. They reflected on barriers to specific and transferable theoretical learning and stressed the importance of integrating theory and practice. Understanding of family-centred care formed a significant part of their preparation. Preconceptions, communication with families and the emotional impact of this speciality were stressful. Improved pre-registration preparation may have developed participants’ resilience.

Conclusion. The complexities of caring for children with cancer and their families require well-prepared nurses. Participants’ perceptions of preparedness were influenced by aspects of pre-registration education. Their experiences suggest that curricula should be practice-focused and include a range of placements. Specialist theoretical content must be integrated with practice and transferability of knowledge and skills made explicit. Reflection and problem-based learning may foster coping mechanisms and resilience that will equip them to care for children with cancer.