Table 3 Facilitators and barriers to DT implementation according to the nurses’ experience, and representative quotations from qualitative analysis
Facilitators | Barriers | |
|---|---|---|
Subjective domain | Sensibility N1: “I discovered in her [the patient] a great deal of humanity that usually did not show, did not transpire and an openness… towards this endless love for people, towards mankind and to the ability…and that I fully share…” | Sensibility N3: “At the beginning it was quite tough, especially from a psychological point of view [….] From an organization point of view, it just requires getting things together, but it was challenging from a psychological point of view…” |
Motivation N2: “I think someone needs to do it. So, it’s better if we do it, since we’re a bit more incline or at least we’ve got a bit more…drive in doing it, rather than someone else who does so unwillingly…without having chosen it” | Feeling unprepared N2: “…at the beginning I was a bit scared, I mean I felt a bit… I don’t know how to say this….tiny compared to this huge project, since I was a bit ripe also in terms of experience…” N1: “…at the same time I had some things happening in my private life that surely took up additional time…and in terms of emotional energy… So, my main concern was staying on balance on what was happening to me…” | |
Relational domain | Promoting awareness of the meaning of one’s life N1: “Though there is one thing I’ve always appreciated about humankind, and that’s that each of us has…their own joys…that are uniquely personal” | Engaging too close of a relationship with the patient N1: “In any case there is this moment of intimacy that comes out so strongly … So […] I recall that at times it would be tough…just because of this…” N3: “I set in parallel my emotions of my short life up to now, with his [the patient] and I tried to draw a comparison… I don’t know, I put myself in his shoes… a bit difficult to bare…” |
Knowing the patient beyond his/her illness N3: “From my point of view it was enriching. Because we professionals give a lot for granted, we only see the patients in their pajamas and we overlook the 60–70 years gone by before they entered the hospital…practically their entire life!” | ||
Building opportunities for personal growth N2: “I believe it was very useful for the patients, because they had the chance to think about questions we often are unable ask ourselves in life, and that even we healthy people should be asking ourselves …” N1: “…I admit he [the patient] moved me, in the way that he made me live over what he had lived […] and reflect on my own experience…” | ||
Bringing to light existential and private issues N3: “Perhaps some patients were in distress over simple things that could have been easily solved, things that had not been said or other things like that. So, it [DT] helped patients to uncover a lot of things that could also help in the last month or in the last part of life. Not just those who had a month left, but also those who lived longer […] and that had a need for closeness but did not have the courage to ask for it. “ | Talking about private issues with an unknown person N2: “Though I felt they were a bit hesitant to open up…and open up with a stranger, especially on topics that are strictly personal…” | |
Providing holistic care N1: I thought that it [the DT] was a useful tool, both as additional communication tool, compared to the typical communication nurses engage with patients addressing dignity, and as a holistic perspective of taking the patient under one’s care… “ | ||
Perceiving the patient’s feeling of gratitude N2: “I saw there was a lot of appreciation for the work being done, that it was a big or very big deal for them. I saw her [the patient] happy and moved by the words she had confided to me, she thanked me…” | ||
Organizational domain | Good collaboration between professionals of the study group N2: “We had meetings to do a recap … with SDL [psychologist], even very useful as we would ask ourselves: in what way do ask this? How do you approach it? Do you keep distant…or do you try to establish a conversation… a friendly one… it gave me the tools to improve my interviews…” N3: “It happened that the PCU physician told me: ‘This thing that the patient told you is important because it’s the same thing I’m exploring with him at my consultation …’” | Difficult collaboration with colleagues not involved in the study N1:”… He [the ward nurse] knew I was inside the room doing the interview. He came into the room, like “I need to change the elastomer” because he had the patient’s therapy scheduled at 11… So fine, he had to have it at 11. …So, a person who must absolutely place an elastomer at 11 o’clock, couldn’t possibly have been able to administer DT…” |
Too time-demanding intervention N1: “Yeah, I mean it takes up a lot of time, since it’s never just an hour, and then with shifts… I mean, for me it’s practically impossible… But sure, I mean you need time for that too, it’s tiring” N2: “I usually carried it [DT] out only after my work shift. When I used to finish my shift, I’d ask patients if they were available for the interview…” | ||
Problems in delivering the Generative Document N2: “Many times I asked them [the patients] to come pick up their Document when they were coming here for their other appointments … Coming to the hospital again, would have been tough …” |