Academic journal article Research and Theory for Nursing Practice

Nurse Perceptions and Experiences of Patient Health Assets in Oncology Care: A Qualitative Study

Academic journal article Research and Theory for Nursing Practice

Nurse Perceptions and Experiences of Patient Health Assets in Oncology Care: A Qualitative Study

Article excerpt

Health assets, a term that refers to patients' strengths and potentials, has emerged as an important aspect of health care. A conceptual analysis of health assets revealed five core dimensions: mobilization, motivational, relational, volitional, and protective strengths. How nurses experience and use patients' health assets, however, is unknown. In this qualitative study, 26 expert nurses in cancer care participated in focus group interviews. The nurses had a large repertoire of experiences with cancer patients' health assets. When the data were subjected to thematic analysis, three new core dimensions were revealed: cognitive, emotional, and physical strengths. Balancing processes within and among health assets-identified as an overriding theme-appeared to be affected by individual and contextual variations. The nurses realized that patients' health assets could be better used and voiced a need for the clinical and organizational support to do so. New issues about health assets raised in this study may be caused by its novel context (e.g., expert nurses in oncology care). More research is needed on health assets in other contexts, such as patients with different health problems, and of possible strategies to support nurses' use of health assets.

Keywords: focus group interviews; health assets; nurse experience; patient participation; patient strengths; qualitative analysis

Patients' resources and strengths are central in nursing theory, as well as in the concept of health, an important aim of nursing care. However, health care providers tend to underestimate patients' existing internal resources (Mårtensson, Carlsson, & Lampic, 2008) and lack the skills and abilities to identify and support them (Eloranta, Routasalo, & Arve, 2008). Further, there are few, if any, systematic support for clinical practice that focuses on health, wellness, competencies, and strengths. Increased attention to patients' internal resources may improve nurses' ability to make correct assessments and provide for individualized care (Mårtensson et al., 2008).

Personal strengths have been part of nursing theories ever since Florence Nightingale (1860) stated that "health is not only to be well but to use well every power we have" (p. 298). Later nursing theorists like Virginia Henderson (1997) and Dorothea Orem (1991) addressed patients' strengths but used different concepts. Orem included in her theory the capacity and agency of self, which may be conditioned by available resources (Høy, Wagner, & Hall, 2007). However, these theories are based on a problem-oriented approach rather than one promoting strengths and health (Meleis, 2007). Existing theories and models need further development to better support patients' strengths and resources and, thereby, improve patient-centered care.

Salutogenesis is an example of a theory and approach that emphasizes a perspective on wellness rather than deficits and problems, and the determinants of health. Despite the amount of research conducted on salutogenesis, it is concluded that other concepts are needed to expand the understanding of determinants of health, especially including people's resources (Eriksson & Lindström, 2007; Langeland, 2003). Also, qualitative inquiries are encouraged (Eriksson & Lindström, 2007). The concept of health assets is recently recognized and recommended greater attention in clinical practice and research (Peterson & Seligman, 2004; World Health Organization, 2008). However, the concept of health assets is not often studied in a nursing context. To gain knowledge and understanding of the concept of health assets, the purpose of this article is to describe nurses' experiences and perceptions of patients' health assets in the context of cancer care.

BACKGROUND

We have conducted several studies to extend knowledge and understanding about patients' health assets. We began with a literature review and concept analysis of health assets (Rotegård, Moore, Fagermoen, & Ruland, 2010). …

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