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Liosatos K, Tobiano G, Gillespie BM. Patient participation in surgical wound care in acute care settings: An integrative review. Int J Nurs Stud 2024; 157:104839. [PMID: 38901124 DOI: 10.1016/j.ijnurstu.2024.104839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Surgical site infections can significantly impact postoperative recovery. Patient participation, which involves patients actively engaging in wound care, has been linked to improved healing and reduced wound complications. However, there is limited synthesis of the literature that explores the patient's role and participation in the context of surgical wound care. OBJECTIVE To explore patients' perceptions of how they participate in surgical wound care, within 30 days post-operation. DESIGN An integrative review guided by Whittemore and Knafl's methodology. This review was registered with PROSPERO (CRD42022363669). DATA SOURCES Searches were conducted in Medline (Ovid), CINAHL (Complete), and EMBASE (Elsevier) databases in October 2023, supplemented by forward and backward citation searching. REVIEW METHODS Based on a priori eligibility criteria, two authors independently screened articles to select relevant studies. The quality of the included research articles was critically appraised using the Mixed Methods Appraisal Tool. A descriptive and thematic synthesis was used to synthesise the findings. RESULTS Of the 4701 records screened for titles and abstracts, 25 studies using qualitative, quantitative, and mixed-methods designs were included. Three key themes were identified. In theme 1, 'I am healing: how my wound shapes me and my journey,' physical symptoms, psychological factors and previous experiences significantly influenced patients' engagement in wound care. Theme 2, 'Taking charge of my healing: my active engagement in wound care' described how patient participation in surgical wound care goes beyond clinical procedures and can include the use of technology and holistic self-care. Finally, theme 3, 'Navigating the path to recovery: How others shape my experience' showed that effective communication is crucial for promoting participation, yet issues like inadequate information can leave patients unprepared for wound management. CONCLUSIONS This review highlights opportunities to personalise and prioritise a patient-oriented approach to surgical wound care. Clinicians and educators should adopt an individualised approach by tailoring patient participation based on patient factors (i.e. physical symptoms) and adopt patient-centred communication approaches. Researchers should focus on exploring approaches to self-care and technology, as these approaches may enhance patient participation in wound care.
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Affiliation(s)
- Kita Liosatos
- School of Nursing and Midwifery, Griffith Health, Gold Coast Campus, Queensland 4222, Australia.
| | - Georgia Tobiano
- NHMRC Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia; Gold Coast Hospital and Health Service, Queensland 4215, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith Health, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia; Gold Coast Hospital and Health Service, Queensland 4215, Australia
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Hutchinson A, Khaw D, Malmstrom-Zinkel A, Winter N, Dowling C, Botti M, McDonall J. Embedding the Use of Patient Multimedia Educational Resources Into Cardiac Acute Care: Prospective Observational Study. JMIR Nurs 2024; 7:e54317. [PMID: 39024556 DOI: 10.2196/54317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/07/2024] [Accepted: 04/17/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Multimedia interventions may play an important role in improving patient care and reducing the time constraints of patient-clinician encounters. The "MyStay Cardiac" multimedia resource is an innovative program designed to be accessed by adult patients undergoing cardiac surgery. OBJECTIVE The purpose of this study was to evaluate the uptake of the MyStay Cardiac both during and following the COVID-19 pandemic. METHODS A prospective observational study design was used that involved the evaluation of program usage data available from the digital interface of the multimedia program. Data on usage patterns were analyzed for a 30-month period between August 2020 and January 2023. Usage patterns were compared during and following the lifting of COVID-19 pandemic restrictions. Uptake of the MyStay Cardiac was measured via the type and extent of user activity data captured by the web-based information system. RESULTS Intensive care unit recovery information was the most accessed information, being viewed in approximately 7 of 10 usage sessions. Ward recovery (n=124/343, 36.2%), goal (n=114/343, 33.2%), and exercise (n=102/343, 29.7%) information were routinely accessed. Most sessions involved users exclusively viewing text-based information (n=210/343, 61.2%). However, in over one-third of sessions (n=132/342, 38.5%), users accessed video information. Most usage sessions occurred during the COVID-19 restriction phase of the study (August 2020-December 2021). Sessions in which video (P=.02, phi=0.124) and audio (P=.006, phi=0.161) media were accessed were significantly more likely to occur in the restriction phase compared to the postrestriction phase. CONCLUSIONS This study found that the use of digital multimedia resources to support patient education was well received and integrated into their practice by cardiac nurses working in acute care during the COVID-19 pandemic. There was a pattern for greater usage of the MyStay Cardiac during the COVID-19 pandemic when access to the health service for nonfrontline, essential workers was limited.
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Affiliation(s)
- Anastasia Hutchinson
- Centre for Quality and Patient Safety Research-Epworth Partnership, Institute of Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Damien Khaw
- Centre for Quality and Patient Safety Research-Epworth Partnership, Institute of Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
| | | | - Natalie Winter
- Centre for Quality and Patient Safety Research-Epworth Partnership, Institute of Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Chantelle Dowling
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Mari Botti
- Centre for Quality and Patient Safety Research-Epworth Partnership, Institute of Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
| | - Joanne McDonall
- Centre for Quality and Patient Safety Research-Epworth Partnership, Institute of Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
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Gyberg A, Brezicka T, Wijk H, Ulin K. From identifying patient safety risks to reporting patient complaints: A grounded theory study on patients' hospital experiences. J Clin Nurs 2024. [PMID: 38951123 DOI: 10.1111/jocn.17355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/31/2024] [Accepted: 06/21/2024] [Indexed: 07/03/2024]
Abstract
AIM To explore how patients with hospital experience construct patient safety, from the identification of a patient safety risk to the decision to file a complaint. BACKGROUND Patients play an important role in the prevention of adverse events in hospitals, but the ability of patients to act and influence their own safety is still challenged by multiple factors. Understanding how patients perceive risk and act to prevent harm may shed light on how to enhance patients' opportunities to participate in patient safety. DESIGN The research design of this study is qualitative and exploratory. METHODS Twelve participants who had experienced Swedish hospital care were interviewed between June 2022 and July 2023. The method of analysis was constructivist grounded theory, focusing on social processes. The COREQ checklist for qualitative research was followed. RESULTS Four categories were constructed: (1) defining the boundary between one's own capacity and that of the hospital, (2) acting to minimize the impact on one's safety, (3) finding oneself in the hands of healthcare professionals and (4) exploring the boundaries between normality and abnormality of the situation. This process was captured in the core category of navigating the path of least suffering. This illustrated how the participants constructed meaning about patient safety risks and showed that they prevented multiple adverse events. CONCLUSIONS Provided that participants were able to act independently, they avoided a multitude of adverse events. When they were dependent on healthcare professionals, their safety became more vulnerable. Failure to respond to the participants' concerns could lead to long-term suffering. RELEVANCE TO CLINICAL PRACTICE By responding immediately to patients' concerns about their safety, healthcare professionals can help prevent avoidable suffering and exhaustive searching for someone in the healthcare system who will take their needs seriously. PATIENT CONTRIBUTION A member check was performed with the help of one of the participants who read the findings to confirm familiarity.
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Affiliation(s)
- Anna Gyberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Geriatrics, and Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Brezicka
- Department of Quality Assurance, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Quality Assurance, Sahlgrenska University Hospital, Gothenburg, Sweden
- Center of Health Care Architecture, Chalmers University, Gothenburg, Sweden
| | - Kerstin Ulin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Geriatrics, and Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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Knutsen K, Solbakken R, Normann B. The diverse invitations to participate in early rehabilitation - A qualitative study of nurse-patient interactions in the intensive care unit. Intensive Crit Care Nurs 2024; 80:103556. [PMID: 37793317 DOI: 10.1016/j.iccn.2023.103556] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES To gain insight into the interaction between nurses and patients in early rehabilitation and the role of patient participation in this context. RESEARCH DESIGN AND SETTING A qualitative study with a phenomenological-hermeneutic approach was conducted in two units/hospitals from January 2022 to January 2023, utilizing observations and video recordings of eight nurse/patient dyads combined with post observation interviews with the nurses. The study was analysed by systematic text condensation and video analysis, informed by interaction theory. FINDINGS Two contrasting categories emerged: 1) Absent invitations: the nurse performed procedures without involving the patient; in other situations, the nurse informed the patient without requesting participation. Simultaneously, spontaneous patient movements were not acknowledged by the nurse. The nurses explained that this practice occurred due to time pressure, oversights, a lack of belief regarding patients' capacities, the unit's culture and little training. 2) Invitations that strengthened participation: the nurse verbally requested activity that often resulted in an inadequate response, or bodily extended invitations that sometimes led to joint active movement. Patients were the most active participants when nurses combined verbal prompts, eye contact, physical handling, and dialogue. In the interviews, the nurses emphasized giving patients enough time to participate and repeatedly encouraged participation because the patient's condition and capacity constantly fluctuated. CONCLUSION Interactions that combine verbal and bodily invitations appear crucial for patient participation in early rehabilitation in the intensive care unit, emphasizing the importance of integrated tailored bodily communication. The nurses' lack of insight into and attention to the patient's bodily potential for active movement combined with a paternalistic approach to the patient's situation may hinder patients' active participation. IMPLICATIONS FOR CLINICAL PRACTICE Integrated forms of interaction that explore patients' capacity and potential for participation should be employed in line with verbal communication. Developing competence in early rehabilitation should be emphasized in critical care nurses' education and training.
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Affiliation(s)
- Karina Knutsen
- Faculty of Nursing and Health Science, Nord University, Mailbox 1490, 8049 Bodoe, Norway. https://twitter.com/@karinaknutsen1
| | - Rita Solbakken
- Faculty of Nursing and Health Science, Nord University, Mailbox 1490, 8049 Bodoe, Norway.
| | - Britt Normann
- Faculty of Nursing and Health Science, Nord University, Mailbox 1490, 8049 Bodoe, Norway.
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Jørgensen K, Hansen MS, Hansen M, Karlsson B. Health professionals' perceptions of user involvement in a mental health centre: A critical discourse analysis. Int J Ment Health Nurs 2024. [PMID: 38251782 DOI: 10.1111/inm.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/02/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
The objective of this study was to investigate the engagement between healthcare professionals and users of mental healthcare at the individual level in a mental health hospital. A qualitative research design with purposive sampling was adopted. Five audio-recorded focus group interviews were conducted with nurses and other health professionals at a mental health hospital in Copenhagen and were explored using Fairclough's discourse analysis framework. This study shows how users can be subject to paternalistic control despite the official aim that user involvement be an integral part of the care and treatment offered. As evidenced in discussions by health professionals, the users were involved in plans based on conditions determined by the health professionals who were predominantly focused on treating diseases and enabling the users to live a life independent of professional help. Our results can contribute to dealing with the challenges of incorporating user involvement as an ideology in mental health hospitals.
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Affiliation(s)
- Kim Jørgensen
- Institute for People and Technology, Roskilde University, Roskilde, Denmark
| | | | - Morten Hansen
- Educator and Peer Supporter, Bostedsteamet, Psychiatric Outpatient Clinic, Ishøj, Denmark
| | - Bengt Karlsson
- Department of Health, Social, and Welfare Studies, Faculty of Health and Social Sciences, University of Southeastern Norway, Notodden, Norway
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Unbeck M, Lidgren F, Tabbakh E, Nymark C. The patient's experience of participation when admitted for elective surgical procedures: an interview study. Int J Qual Stud Health Well-being 2023; 18:2163958. [PMID: 36617889 PMCID: PMC9833403 DOI: 10.1080/17482631.2022.2163958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To describe the patient's experience of participation in their care when admitted for elective surgical procedures. MATERIALS AND METHODS A purposive sample of 14 patients who had undergone elective surgery was included in semi-structured individual interviews at a university hospital. The data was analysed using qualitative content analysis. RESULTS One theme was identified: Creating a meaningful relationship to enable participation in the care, based on three categories; Abilities, willingness, and a lack of experience affect participation, A professional approach with an open communication and individualized information, and The importance of structural factors. CONCLUSIONS To meet the patient's individual needs and wishes regarding participation, meaningful relationships need to be created between patient and healthcare personnel. The results also indicate that the patients have insufficient knowledge about their role regarding participation. To improve patient participation, its meaning needs to be clarified individually to the patient, emphasizing the importance to be active involved in his or her own care.
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Affiliation(s)
- Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden,Department of Neurobiology, Care sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Filippa Lidgren
- Emergency and Reparative Medicine Theme, Department of Plastic and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ella Tabbakh
- Heart, Vascular and Neuro Theme, Department of Thoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Carolin Nymark
- Department of Neurobiology, Care sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden,Heart, Vascular and Neuro Theme, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden,CONTACT Carolin Nymark Heart, Vascular and Neuro Theme, Department of Cardiology, Karolinska University Hospita, StockholmSE-171 76, Sweden
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Heumann M, Röhnsch G, Zabaleta‐del‐Olmo E, Toso BRGDO, Giovanella L, Hämel K. Barriers to and enablers of the promotion of patient and family participation in primary healthcare nursing in Brazil, Germany and Spain: A qualitative study. Health Expect 2023; 26:2396-2408. [PMID: 37565592 PMCID: PMC10632623 DOI: 10.1111/hex.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/02/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Most health systems are insufficiently prepared to promote the participation of chronically ill patients in their care. Strong primary health care (PHC) strengthens patients' resources and thus promotes their participation. The tasks of providing continuous care to people with chronic diseases and promoting self-management are the responsibility of PHC nurses. Recent research assessing enablers of or barriers to nurses' efforts to support patients' participation has mostly not considered the special situation of patients with chronic diseases or focused on the PHC setting. OBJECTIVE To investigate enablers of and barriers to PHC nurses' efforts to promote the participation of chronically ill patients in their care. METHODS We interviewed 34 practicing PHC nurses and 23 key informants with advanced knowledge of PHC nursing practice in Brazil, Germany and Spain. The data was analyzed using thematic coding. RESULTS We identified four categories of barriers and enablers. (1) Establishing bonds with patients: Interviewees emphasized that understanding patients' views and behaviours is important for PHC nurses. (2) Cooperation with relatives and families: Good relationships with families are fundamental, however conflicts within families could challenge PHC nurses efforts to strengthen participation. (3) Communication and cooperation within PHC teams: PHC nurses see Cooperative team structures as a potential enabler, while the dominance of a 'biomedical' approach to patient care is seen as a barrier. (4) Work environment: Interviewees agreed that increased workload is a barrier to patient participation. DISCUSSION AND CONCLUSIONS Supporting patient participation should be acknowledged as an important responsibility for nurses by general practitioners and PHC planners. PHC nurses should be trained in communicative competence when discussing participation with chronically ill patients. Interprofessional education could strengthen other professionals' understanding of patient participation as a nursing task. PATIENT OR PUBLIC CONTRIBUTION This study is part of a research project associated with the research network 'forges: User-oriented care: Promotion of health in the context of chronic diseases and care dependency'. The study's focus and provisional results were discussed continuously with partners in health and social care practice and presented to and discussed with the public at two conferences in which patient representatives, professionals and researchers participated.
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Affiliation(s)
- Marcus Heumann
- Department of Health Services Research and Nursing Science, School of Public HealthBielefeld UniversityBielefeldGermany
| | - Gundula Röhnsch
- Division Qualitative Social and Education Research, Department of Education and PsychologyFreie Universität BerlinBerlinGermany
| | - Edurne Zabaleta‐del‐Olmo
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol)BarcelonaSpain
- Nursing DepartmentUniversity of GironaGironaSpain
- Primary Care Directorate, Barcelona Regional ManagementInstitut Català de la SalutBarcelonaSpain
| | | | - Ligia Giovanella
- Department for Health Administration and Planning, National School of Public HealthFundação Oswaldo CruzRio de JaneiroBrazil
| | - Kerstin Hämel
- Department of Health Services Research and Nursing Science, School of Public HealthBielefeld UniversityBielefeldGermany
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Wan CS, Cheng H, Musgrave-Takeda M, Liu MG, Tobiano G, McMahon J, McInnes E. Barriers and facilitators to implementing pressure injury prevention and management guidelines in acute care: A mixed-methods systematic review. Int J Nurs Stud 2023; 145:104557. [PMID: 37453248 DOI: 10.1016/j.ijnurstu.2023.104557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Evidence-based pressure injury prevention and management is a global health service priority. Low uptake of pressure injury guidelines leads to compromised patient outcomes. Understanding clinicians' and patients' views on the barriers and facilitators to implementing guidelines and mapping the identified barriers and facilitators to the Theoretical Domains Framework and behaviour change techniques will inform an end-user and theoretically informed intervention to improve guideline uptake in the acute care setting. OBJECTIVES To synthesise quantitative and qualitative evidence on i) hospital clinicians' and inpatients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines. DESIGN A convergent integrated mixed-methods systematic review was conducted using the JBI approach. DATA SOURCE English language peer-reviewed studies published from 2009 to August 2022 were identified from MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central Library. REVIEW METHODS Included studies reported: i) acute care hospital clinicians' and patients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines. The Mixed Methods Appraisal Tool was used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data, comparing clinicians' and patients' views. Barriers and facilitators associated with each main theme were mapped to the Theoretical Domains Framework and allocated to relevant behaviour change techniques. RESULTS Fifty-five out of 14,488 studies of variable quality (29 quantitative, 22 qualitative, 4 mixed-methods) met the inclusion criteria. Four main themes represent factors thought to influence the implementation of evidence-based guidelines: 1) nurse-led multidisciplinary care, 2) patient participation in care, 3) practicability of implementation and 4) attitudes towards pressure injury prevention and management. Most barriers identified by clinicians were related to the third theme, whilst for patients, there were multiple barriers under theme 2. Barriers were mainly mapped to the Knowledge domain and Environmental Context and Resources domain and were matched to the behaviour change techniques of "instruction on how to perform a behaviour" and "restructuring the physical environment". Most facilitators mentioned by clinicians and patients were related to themes 1 and 2, respectively, and mapped to the Environmental Context and Resources domain. All patient-related attitudes in theme 4 were facilitators. CONCLUSIONS These review findings highlight the most influential factors related to implementing evidence-based pressure injury care from clinicians' and patients' views and mapping these factors to the Theoretical Domains Framework and behaviour change techniques has contributed to developing a stakeholder-tailored implementation intervention in acute care settings. PROSPERO REGISTRATION CRD42021250885.
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Affiliation(s)
- Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - Heilok Cheng
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mika Musgrave-Takeda
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mark Guosheng Liu
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Georgia Tobiano
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Gold Coast University Hospital, Gold Coast Health Nursing and Midwifery Education and Research Unit, Queensland, Australia
| | - Jake McMahon
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Lantz ACH, Gunningberg L, Eriksson G, Eldh AC, Wenemark M, Pöder U. Evaluation of patient participation in relation to the implementation of a person-centered nursing shift handover. Worldviews Evid Based Nurs 2023; 20:330-338. [PMID: 37431567 DOI: 10.1111/wvn.12666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/28/2023] [Accepted: 05/28/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND It has been suggested that nursing shift-to-shift handover should be a more team-based dialogue with and for the patient rather than about a patient. AIM The aim of this study was to evaluate patient participation in relation to the implementation of the person-centered handover (PCH). METHOD A pretest-posttest design was used without a comparison group, including patients from nine units in a university hospital at pretest (n = 228) and after implementing PCH (posttest, n = 253) per the framework integrated-Promoting Action on Research Implementation in Health Services. The PCH is inspired by an Australian bedside handover model. The Patient Preferences for the Patient Participation tool was used to rate the preference for and experience of participation on 12 items, combined into three levels of preference-based participation (insufficient-fair-sufficient). RESULTS There were no differences regarding experience or preference-based participation between patients at pretest-posttest; however, posttest patients experienced participation in the item Reciprocal communication to a lesser extent than the pretest patients. Only 49% of the posttest group received PCH; of those not receiving PCH, some would have wanted PCH (27%), while some would have declined (24%). Patients receiving PCH had sufficient participation (82%), to a greater extent, regarding the item Sharing one's symptoms with staff than patients at pretest (72%). Patients receiving PCH also had sufficient participation, to a greater extent, than patients at posttest who did not receive, but would have wanted PCH, regarding four items: (1) sharing one's symptoms with staff, (2) reciprocal communication, (3) being told what was done, and (4) taking part in planning. LINKING EVIDENCE TO ACTION Most patients want to be present at PCH. Therefore, nurses should ask for the patients' preferences regarding PCH and act accordingly. Not inviting patients who want PCH could contribute to insufficient patient participation. Further studies are needed to capture what assistance nurses would want in identifying and acting in alignment with patient preferences.
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Affiliation(s)
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marika Wenemark
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Unit of Public Health and Statistics, Region Östergötland, Linköping, Sweden
| | - Ulrika Pöder
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Selvin M, Almqvist K, Fogelkvist M, Lundqvist LO, Schröder A. Patient Participation in Forensic Psychiatric Care: The Initial Development and Content Validity of a New Instrument. JOURNAL OF FORENSIC NURSING 2023; 19:204-213. [PMID: 37590943 PMCID: PMC10453349 DOI: 10.1097/jfn.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
ABSTRACT Patient participation is central in modern health care. However, it is a complex phenomenon that lacks a clear definition, and what constitutes participation varies depending on the context and theoretical perspective. It is known that patient participation in forensic psychiatric care is often rated as low by both patients and professionals, and it can be assumed that interventions to increase it are beneficial. In this process, management and staff could benefit from assessing perceived patient participation, and reliable and valid measurement instruments are essential. The aim of this study was to develop an instrument that could be used to measure experiences of participation in forensic psychiatric care from a patient perspective and test it for content validity. A definition of patient participation in forensic psychiatric care was formulated and operationalized in an instrument that an expert group, consisting of patients with ongoing care, evaluated for content validity. In total, 50 items were sorted into five different dimensions: to have good communication, to be involved, to have mutual trust, to trust the care, and to take responsibility. After psychometric testing, the instrument has the potential to become a tool to use in research, clinical work, and development work in the field of forensic psychiatric care. In addition to being used as a measure, the Patient Participation in Forensic Psychiatric Care can also be used to encourage a dialogue about their care and to make both patients and staff more aware of patient participation.
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Affiliation(s)
- Mikael Selvin
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
| | - Kjerstin Almqvist
- Department for Social and Psychological Studies, Karlstad University
| | - Maria Fogelkvist
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
| | - Lars-Olov Lundqvist
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
| | - Agneta Schröder
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
- Faculty of Health, Care and Nursing, Department of Nursing, Norwegian University of Science and Technology (NTNU)
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Roaquin L. Participatory Grieving: A Concept Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231184744. [PMID: 37338900 DOI: 10.1177/00302228231184744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Grief is a psychobiological response to loss as manifested by intense feeling of sadness, along with thoughts, mental images and memories of the deceased loved one. In order for the patient to attain successful grieving process, it is fundamental among nurses to recognize and understand the loss or impending loss experienced by the patient and/or its significant others. With the use of Walker and Avant's concept analysis, together with thorough literature review pertaining to bereavement and grieving, the defining attributes, antecedents and consequences of participatory grieving were determined. Furthermore, the results of this concept analysis provide a better view on the significant roles and responsibilities of nurses during the grieving process.
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Affiliation(s)
- Lucky Roaquin
- Master of Arts in Nursing spec, Medical-Surgical Nursing, College of Nursing, Saint Tonis College Inc Dean
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12
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Schøllhammer H, Jørgensen TM, Jensen HI. Documenting care together with patients: the experiences of nurses and patients. BMC Nurs 2023; 22:143. [PMID: 37106369 PMCID: PMC10133905 DOI: 10.1186/s12912-023-01309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND One way in which patients can participate in care is by taking part in medical documentation. Producing documentation together with patients has been found to decrease the amount of incorrect information, help patients to be involved, and promote shared decision-making. The aims of this study were to develop and implement a practice of producing documentation together with patients and to examine staff and patient experiences of this practice. METHODS A quality improvement study was conducted from 2019 to 2021 at a Day Surgery Unit in a Danish University Hospital. Before implementing a practice of documenting together with patients, nurses' perceptions of doing documentation together with patients were examined via a questionnaire survey. After an implementation period, a similar follow-up survey with staff was conducted, together with structured patient phone interviews. RESULTS A total of 24 nursing staff out of 28 (86%) filled in the questionnaire at baseline and 22 out of 26 (85%) at follow-up. A total of 61 out of 74 invited patients (82%) were interviewed. At baseline, the majority (71-96%) of participants agreed that documentation done together with the patient would contribute to increased patient safety, fewer errors, real-time documentation, patient involvement, visible patient perspective, correction of errors, more accessible information and less duplication of work. At follow-up, significant decreases in the staffs' positive perceptions of the benefits of documenting together with patients were found for all areas except for "real-time documentation" and "less duplication of work". Almost all patients found it okay that the nurses wrote up medical documentation during the interview, and more than 90% of patients found the staff responsive or very responsive and present during the reception interview. CONCLUSION Before implementation of a practice of documenting together with patients, the majority of staff assessed such documentation as being beneficial, but a significant decrease in positive assessment was found at follow-up, with challenges such as feeling less connected with the patient and practical, IT-related issues being described. The patients found the staff to be present and responsive and felt that it was important to know what was being written in their medical record.
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Affiliation(s)
- Helle Schøllhammer
- Day Surgery Unit, Kolding Hospital, Sygehusvej 24, Kolding, DK - 6100, Denmark.
| | | | - Hanne Irene Jensen
- Day Surgery Unit, Kolding Hospital, Sygehusvej 24, Kolding, DK - 6100, Denmark
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløwsvej 19.3, Odense C, 5000, Denmark
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13
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Adetunji O, Bishai D, Pham CV, Taylor J, Thi NT, Khan Z, Bachani AM. Patient-centered care and geriatric knowledge translation among healthcare providers in Vietnam: translation and validation of the patient-centered care measure. BMC Health Serv Res 2023; 23:379. [PMID: 37076905 PMCID: PMC10116792 DOI: 10.1186/s12913-023-09311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/20/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND People are living longer, and the majority of aging people reside in low- and middle-income countries (LMICs). However, inappropriate healthcare contributes to health disparities between populations of aging people and leads to care dependency and social isolation. Tools to assess and evaluate the effectiveness of quality improvement interventions for geriatric care in LMICs are limited. The aim of this study was to provide a validated and culturally relevant instrument to assess patient-centered care in Vietnam, where the population of aging people is growing rapidly. METHODS The Patient-Centered Care (PCC) measure was translated from English to Vietnamese using forward-backward method. The PCC measure grouped activities into sub-domains of holistic, collaborative, and responsive care. A bilingual expert panel rated the cross-cultural relevance and translation equivalence of the instrument. We calculated Content Validity Indexing (CVI) scores at both the item (I-CVI) and scale (S-CVI/Ave) levels to evaluate the relevance of the Vietnamese PCC (VPCC) measure to geriatric care in the Vietnamese context. We piloted the translated instrument VPCC measure with 112 healthcare providers in Hanoi, Vietnam. Multiple logistic regression models were specified to test the a priori null hypothesis that geriatric knowledge is not different among healthcare providers with perception of high implementation compared with low implementation of PCC measures. RESULTS On the item level, all 20 questions had excellent validity ratings. The VPCC had excellent content validity (S-CVI/Ave of 0.96) and translation equivalence (TS- CVI/Ave of 0.94). In the pilot study, the highest-rated PCC elements were the holistic provision of information and collaborative care, while the lowest-rated elements were the holistic attendance to patients' needs and responsive care. Attention to the psychosocial needs of aging people and poor coordination of care within and beyond the health system were the lowest-rated PCC activities. After controlling for healthcare provider characteristics, the odds of the perception of high implementation of collaborative care were increased by 21% for each increase in geriatric knowledge score. We fail to reject the null hypotheses for holistic care, responsive care and PCC. CONCLUSION The VPCC is a validated instrument that may be utilized to systemically evaluate the practice of patient-centered geriatric care in Vietnam.
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Affiliation(s)
- Oluwarantimi Adetunji
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - David Bishai
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cuong Viet Pham
- Center for Injury Policy and Prevention Research (CIPPR), Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Ngan Tran Thi
- Center for Injury Policy and Prevention Research (CIPPR), Hanoi University of Public Health, Hanoi, Vietnam
| | - Zainab Khan
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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14
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“Evaluation of Simulation Using Objective Structured Clinical Examination (OSCE) Among Undergraduate Nursing Students: A Systematic Review”. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2023. [DOI: 10.1016/j.ijans.2023.100553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
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15
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Tobiano G, Roberts S, Muir R, Jerofke-Owen T, Ting C, Thorning S, Heyland DK, Marshall AP. Patient-mediated interventions in hospital: A systematic review. J Adv Nurs 2023; 79:418-441. [PMID: 36408930 DOI: 10.1111/jan.15500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/13/2022] [Accepted: 11/06/2022] [Indexed: 11/22/2022]
Abstract
AIMS To describe the characteristics of hospital-based, patient-mediated interventions and their impact on patient, clinician and organization outcomes. DESIGN Systematic review. DATA SOURCES Health literature databases (MEDLINE, CINAHL and EMBASE) were searched in August 2021. Backward and forward citation searching was conducted. REVIEW METHODS Studies investigating patient-mediated interventions, targeted at adult hospitalized patients were eligible. Data were extracted related to study and intervention characteristics. Narrative synthesis was used to understand intervention impact on patient, clinician and organization outcomes (as per a framework). Methodological quality was assessed using the Mixed Methods Assessment Tool. RESULTS Thirty-three studies, reporting 18 interventions, were included. Twelve interventions prompted patients to report health information about their own health/needs/concerns and six interventions encouraged patients to provide feedback about clinical practice. Across all interventions, there was evidence that patients used patient-mediated interventions and that they may improve patient communication. Healthcare professional outcomes were mixed for actual/intended use, acceptability and usefulness of interventions; yet there was some evidence of healthcare professional behaviour change. Interventions that encouraged patients to report health information about their own health/needs/concerns appeared more successful than other types of interventions. CONCLUSIONS There is some evidence that hospital-based patient-mediated interventions may influence patient communication and healthcare professional behaviour. Patient-mediated interventions that encourage patients to report patient data before a clinical encounter may be more impactful than interventions that encourage patient feedback during or post-encounter. IMPACT To date, most patient-mediated intervention research has been conducted in primary care settings; we uncovered the types of patient-mediated interventions that have been trialled in hospitals. We found that patient communication and healthcare professional behaviour may be influenced by these patient-mediated interventions. Future researchers could explore the suitability and effectiveness of a wider range of hospital-based patient-mediated interventions. NO PATIENT OR PUBLIC CONTRIBUTION There was no funding to remunerate a patient/member of the public for this review.
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Affiliation(s)
- Georgia Tobiano
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Shelley Roberts
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rachel Muir
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | | | - Christine Ting
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Sarah Thorning
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.,Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Andrea P Marshall
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
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16
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van den Berg G, de van der Schueren M, Vermeulen H, Huisman-de Waal G. Opportunities for Patient Participation in Perioperative Malnutrition Care: A Qualitative Study. SAGE Open Nurs 2023; 9:23779608231193743. [PMID: 37691726 PMCID: PMC10483977 DOI: 10.1177/23779608231193743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/26/2023] [Accepted: 07/22/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction In the perioperative period of hospitalization, barriers to food intake are common due to special nutritional needs, compromised nutritional status, and metabolic stress. Good nutritional care call for an interdisciplinary approach. And patients themselves may also play an essential role in managing nutritional care. Objective This study aimed to explore how patients with malnutrition experience nutritional care, their perspectives on patient participation, and their own role in malnutrition care in the perioperative period of hospitalization. Methods A qualitative study was conducted using an interpretive phenomenological approach. To follow patients' experiences, in-depth longitudinal interviews were undertaken before, during, and after hospitalization. Interview transcripts were analyzed thematically using open, axial, and selective coding and interpreted in an iterative process. Results Fifty-six interviews were undertaken with 26 patients with malnutrition scheduled for surgery and during the perioperative period of hospitalization. Four themes were identified: (1) unawareness and stigmata about being malnourished, (2) feasibility of optimal nutritional care, (3) needs and expectations for self-management, and (4) barriers and facilitators of taking own responsibilities in nutritional care. Conclusion Awareness and responsiveness to patients' perspectives, motivation, and compliance are prerequisites for patient participation in malnutrition care. This requires good communication between healthcare professionals and patients in all phases of hospitalization.
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Affiliation(s)
- Gerda van den Berg
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud University Medical Center–Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Marian de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Hester Vermeulen
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud University Medical Center–Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Getty Huisman-de Waal
- Radboud University Medical Center–Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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17
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Jerofke-Owen TA, Tobiano G, Eldh AC. Patient engagement, involvement, or participation - entrapping concepts in nurse-patient interactions: A critical discussion. Nurs Inq 2023; 30:e12513. [PMID: 35871476 DOI: 10.1111/nin.12513] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 01/25/2023]
Abstract
The importance of patients taking an active role in their healthcare is recognized internationally, to improve safety and effectiveness in practice. There is still, however, some ambiguity about the conceptualization of that patient role; it is referred to interchangeably in the literature as engagement, involvement, and participation. The aim of this discussion paper is to examine and conceptualize the concepts of patient engagement, involvement, and participation within healthcare, particularly nursing. The concepts were found to have semantic differences and similarities, although, from a nursing perspective, they can be summoned to illustrate the establishment of a mutual partnership between a patient and a nurse. The individualization of such processes requires the joint effort of engagement, involvement, or participation, represented by interactive actions of both the patient (asking questions, telling/speaking up, knowledge acquisition, learning, and decision-making) and the nurse (recognizing, responding, information sharing, teaching, and collaborating). Suggesting that the concepts can be used interchangeably comes with some caution, requiring that nurses embrace patients playing a role in their health and healthcare. Further research and practice development should focus on how patients and nurses receive and respond to each other to establish patient engagement, involvement, and participation.
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Affiliation(s)
| | - Georgia Tobiano
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia.,Gold Coast Health, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Ann C Eldh
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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18
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Dehn P, Munch Simonsen S, Olesen ML. Multidimensional factors determine skill acquisition development in Guided
Self‐Determination
: A qualitative study. Scand J Caring Sci 2022; 37:549-560. [PMID: 36533327 DOI: 10.1111/scs.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/26/2022] [Indexed: 12/23/2022]
Abstract
AIM The aim of the study was to investigate nurses' skill acquisition in Guided Self-Determination according to the Dreyfus model of skill acquisition and Patricia Benner's studies based on the same model. BACKGROUND Globally, person-centred care is acknowledged as an essential aspect of quality in health care. To succeed with person-centred care methods and skills are necessary. Guided Self-Determination is a person-centred method developed in the field of nursing. The method represents a new way of skill acquisition requiring knowledge of how skills are acquired, unfolded and best supported in Guided Self-Determination. DESIGN Qualitative interview study. METHOD From January 2019 to August 2019, 16 nurses were interviewed about their experiences of learning and using Guided Self-Determination in three different gynaecological settings: cancer, endometriosis and sexual abuse. The study was registered with the Danish Data Protection Agency (file no.: VD-2018-445, I-Suite no.: 6700). RESULTS The spectrum in Guided Self-Determination acquisition skills ranged from following schematical procedures in a rigorous way to an extended understanding of exploring and supporting the person-centred concept. Two main themes were identified: Elements in the transition of knowledge from theory to practice and Aspects associated with Guided Self-Determination skill acquisition. CONCLUSIONS Nurses practised Guided Self-Determination at different levels. Quantity of practising Guided Self-Determination was not the only aspect determining rapid progression. The Dreyfus model lacked several explanatory components of skill acquisition, such as personal dispositions, preferences, motivation, personal values and context.
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Affiliation(s)
- Pernille Dehn
- Department of Obstetrics and Gynaecology Aarhus University Hospital Aarhus N Denmark
- Department of Gynaecology, Juliane Marie Centre Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Susan Munch Simonsen
- Section for Competence Development Centre for Human Resources Hellerup, The Capital Region of Denmark Denmark
| | - Mette Linnet Olesen
- Department of Gynaecology, Juliane Marie Centre Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
- Childrens and families Health Department, Juliane Marie Centre Interdiciplinary Research Unit for Womens Copenhagen Denmark
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19
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Eknemar M, Persson F, Nilsson A. Patients' Experiences of Patient-Controlled Sedation: An Interview Study of Patients who Underwent Endoscopy. J Perianesth Nurs 2022; 37:883-888. [PMID: 35595604 DOI: 10.1016/j.jopan.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Patient-controlled sedation (PCS) allows patients to self-administer sedative drugs during endoscopic retrograde cholangiopancreatography (ERCP). There is a paucity of research on the experiences of patients who used PCS. Therefore the purpose of this study was to describe the perioperative experiences of patients who used PCS during ERCP. DESIGN Prospective study using semi-structured interviews. METHODS Qualitative content analysis facilitated a latent understanding of the manifest content. FINDINGS Eleven interviews revealed three main themes and underlying categories that summarized the patient experience: participation (control and perioperative sedation); communication (personnel, information, safety, insecurity, and concern); and sensation (effects and side effects). CONCLUSIONS The participatory experience of PCS resulted not from the opportunity for patient involvement but, rather, the establishment of a patient-professional relationship. Specifically, the interactions between patients and health care professionals played a vital role in the patients' overall experience of PCS.
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Affiliation(s)
- Marcus Eknemar
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Anesthesia and Intensive Care, Malmö, Sweden
| | - Fredrik Persson
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Anesthesia and Intensive Care, Linköping, Region Östergötland, Sweden
| | - Andreas Nilsson
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Anesthesia and Intensive Care, Linköping, Region Östergötland, Sweden.
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Jørgensen K, Hansen M, Karlsson B. Recovery-Oriented Practices in a Mental Health Centre for Citizens Experiencing Serious Mental Issues and Substance Use: As Perceived by Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10294. [PMID: 36011927 PMCID: PMC9408666 DOI: 10.3390/ijerph191610294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Recovery-oriented practices have become a means of promoting user recovery during hospitalisation, but we do not know much about the concrete means of practicing recovery-orientation for the most vulnerable users with serious mental difficulty and substance use. AIMS We investigated the concrete means of practicing recovery-orientation in care work and the elements, dimensions, outcomes, or steps of it in a special department of mental health centres. METHOD Focus group interviews were conducted with 16 health professionals with experience with users with serious mental difficulty and substance use. Qualitative content analysis was undertaken. RESULTS The main theme was "holistic recovery on structural terms" based on two themes and four subthemes. The first theme was "recovery based on an individual approach" with subthemes "detective-find hope" and "how to do recovery-oriented practice". The next theme was "recovery subject to structural framework" with subthemes "tension between different interests" and "symptoms as a barrier". CONCLUSIONS recovery-oriented practice is understood as an approach where health professionals emphasise forming relationships based on trust, being hopeful for the users' future, spending time with users, and respecting users' experiences and knowledge from their own life. There are cross-pressures between different interests. The desire to meet the users' perspectives and respect these perspectives but at the same time live up to mental health centre purposes to stabilise the users' health and achieve self-care.
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Affiliation(s)
- Kim Jørgensen
- Science in Nursing Department of Public Health, Bartholins Allé 2, 8000 Aarhus, Denmark
| | - Morten Hansen
- Psychiatric Outpatient Clinic Ishøj, Bostedsteamet, Store Torv 20, 2635 Ishøj, Denmark
| | - Bengt Karlsson
- Center for Mental Health and Substance Abuse, Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University of Southeastern Norway, Postbox 7053, 3007 Drammen, Norway
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21
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Shirozhan S, Arsalani N, Seyed Bagher Maddah S, Mohammadi-Shahboulaghi F. Barriers and facilitators of rehabilitation nursing care for patients with disability in the rehabilitation hospital: A qualitative study. Front Public Health 2022; 10:931287. [PMID: 36033757 PMCID: PMC9402936 DOI: 10.3389/fpubh.2022.931287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Nurses play a key role in providing rehabilitation care. In this regard, identifying the factors that affect their practice can be useful in planning to improve the quality of rehabilitation nursing care. This study aims to explore the experience of nurses and members of the rehabilitation team about barriers and facilitators of rehabilitation nursing care of patients with disability in the rehabilitation hospital. This qualitative study was conducted in the main public rehabilitation hospital in Tehran, Iran. Eighteen persons including 12 nurses in clinical and managerial positions, an occupational therapist, a physical medicine specialist, a patient, and an informal caregiver participated in this study. Participants were selected based on purposeful sampling. Data were collected through 18 in-depth semi-structured interviews and analyzed based on qualitative content analysis principles. Three themes were derived from the data analysis, which represented Barriers and facilitators related to nurses (specialized knowledge and skills, psychological status, mentoring, professional communication), barriers and facilitators related to the work environment (nurses' performance evaluation, nursing workforce, comprehensive care facilities, workplace design, specialized unit), barriers and facilitators related to patients and caregivers (patient's participation in nursing care, patient adaptation, efficiency of formal caregivers). The experiences of the rehabilitation team shows that not only nurses, but also the environment, patients, and caregivers can affect the provision of care and change the quality of care. Identifying these factors can help managers, researchers, and clinical nurses to facilitate and improve rehabilitation nursing care by modifying the influencing factors.
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Affiliation(s)
- Shima Shirozhan
- Nursing Department, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Narges Arsalani
- Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,*Correspondence: Narges Arsalani ;
| | | | - Farahnaz Mohammadi-Shahboulaghi
- Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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22
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Engqvist Boman L, Sundberg K, Petersson LM, Backman M, Silén C. A pedagogical model to enhance nurses' ability to support patient learning: an educational design research study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:176-186. [PMID: 35909338 PMCID: PMC9911139 DOI: 10.5116/ijme.62c2.b9c4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To design, apply, evaluate, and analyse a pedagogical model to enhance nurses' ability to create pedagogical encounters to support patients' learning. METHODS The study relies on an educational design research approach. A pedagogical model based on learning theories was designed, applied, evaluated, and analysed in a specialist nursing programme in cancer care. All students (n=28) who attended the programme accepted to participate in the evaluation of the model. Their perception of the learning activities was evaluated in a questionnaire, and 16 (57%) students responded. The students' learning was assessed in written assignments, including all students. Descriptive statistics, content analysis and theoretical reasoning, were used to analyse data and interpret the usefulness and shortcomings of the model. RESULTS The most appreciated learning activities were to study learning theories, observe pedagogical encounters, act as a critical friend, and document one's own pedagogical encounters. The written assignments about observing and performing their own pedagogical encounters with patients showed students' increased awareness of how to support patients' learning. The clinical supervisors' lack of pedagogical knowledge inhibited the feedback on students' performances. CONCLUSIONS The theoretical analysis of the evaluation identified strengths and needs for further development. The strengths tend to be the ongoing learning process created by learning activities supporting students to continuously study, experience, and apply their knowledge. Nurse supervisors and other stakeholders at the clinics are suggested to be involved in improving the design and require pedagogical competence. Further research should include observational and interview studies related to students' performance in pedagogical encounters.
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Affiliation(s)
- Lena Engqvist Boman
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
| | - Kay Sundberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
| | - Lena-Marie Petersson
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
| | - Malin Backman
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
| | - Charlotte Silén
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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23
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Tobiano G, Marshall AP, Gardiner T, Jenkinson K, Shapiro M, Ireland M. Development and psychometric testing of the patient participation in bedside handover survey. Health Expect 2022; 25:2492-2502. [PMID: 35898173 PMCID: PMC9615084 DOI: 10.1111/hex.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/19/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction When handover is conducted at the patient's bedside, active patient participation can be encouraged, which may improve the safety and quality of care. There is a need for valid and reliable tools to measure patient perceptions of participation in bedside handover, to ensure the rising number of implementation and improvement efforts are consistently and effectively evaluated. The aim of this study is to systematically develop and evaluate the psychometric properties of a self‐report survey to measure patients' perceptions of participation in bedside handover. Methods In Phase 1, our team developed a conceptual framework and item pool (n = 130). In Phase 2, content validity was assessed with four health consumers, four nurses and four researchers. Next, 10 current hospital inpatients tested the survey for end‐user satisfaction. In Phase 3, 326 inpatients completed the survey, allowing exploratory factor analysis, reliability analyses and convergent/divergent validity analyses to occur. Results Phase 1 and 2 resulted in a 42‐item survey. In Phase 3, 321 surveys were available for analysis. Exploratory factor analysis revealed a three‐factor solution, with 24 items, which matched our conceptual framework. The three factors were: ‘Conditions for patient participation in bedside handover’, ‘Level of patient participation in bedside handover’ and ‘Evaluation of patient participation in bedside handover’. There was strong evidence for factor reliability and validity. Additionally, the correlation between factors was strong. Conclusion This study furthers our conceptual understanding by showing that nurse facilitating behaviours are a strong precursor for patient participation and perceived handover outcomes, justifying the need for nursing training. A robust survey has been developed to measure patient perceptions of participation in bedside handover, which can effectively evaluate this approach to care. Engaging consumers and nurses as research team members was invaluable in ensuring that the survey is acceptable for end‐users. Patient or Public Contribution A health consumer and nurse partnered as members of the research team from study inception to dissemination.
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Affiliation(s)
- Georgia Tobiano
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia.,NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Andrea P Marshall
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Therese Gardiner
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Kim Jenkinson
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Margaret Shapiro
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Michael Ireland
- School of Psychology and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia
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Morton D, Linton J, Hatala AR. Integrative review protocol for Indigenous youth participation in health equity promotion. BMJ Open 2022; 12:e055568. [PMID: 35863835 PMCID: PMC9310184 DOI: 10.1136/bmjopen-2021-055568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Indigenous youth participation in decision-making is internationally recognised as a pathway to promote health equity, decolonisation and social inclusion. Hearing Indigenous youth voices and actively involving them in decisions that affect their lives and their communities has the potential to address disproportionate health and social challenges they encounter. Yet the existing evidence-base on participatory approaches remains fragmented and vast leading to a lack of integration. METHODS AND ANALYSIS An integrative review methodology will be used to conduct a comprehensive, multidisciplinary review of the literature about Indigenous youth participation in health equity promotion. The literature search is anticipated to be carried out in July-August 2022. We will search online databases Scopus, Ovid MEDLINE, Embase and PsycINFO along with several interdisciplinary databases indexed in EBSCOhost and ProQuest. Key Indigenous research journals not consistently indexed in the online databases will be examined to identify additional journal articles. We will employ a blinded, dual-reviewer two-step selection process with established inclusion/exclusion criteria and limit data to English-language publications related to Indigenous populations in Canada, USA, Aotearoa New Zealand and Australia. Focusing on qualitative empirical and theoretical studies, they will undergo quality appraisal and Covidence software will be used to manage the review. Data will be sorted, extracted and analysed. We will codify data for descriptive reporting and conduct a narrative synthesis to identify a common conceptualisation for Indigenous youth participatory approaches across disciplines, its barriers and facilitators, and knowledge gaps. ETHICS AND DISSEMINATION Ethical review is not required for the integrative review. The review will be shared through various publication and non-academic platforms as well as our university and community research networks. Findings will have broad relevance for those seeking to involve Indigenous youth to be active decision-makers across a range of fields, but with specific implications for health equity.
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Affiliation(s)
- Darrien Morton
- Department of Community Health Sciences, Max Rady Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janice Linton
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew R Hatala
- Department of Community Health Sciences, Max Rady Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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25
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Muir R. Patient participation in critical care research, service design, and care delivery. Intensive Crit Care Nurs 2022; 73:103298. [PMID: 35871958 DOI: 10.1016/j.iccn.2022.103298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rachel Muir
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, UK
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26
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Idilbi N, Grimberg Z, Drach-Zahavy A. Haemodialysis patient's adherence to treatment: Relationships among nurse-patient-initiated participation and nurse's attitude towards patient participation. J Clin Nurs 2022. [PMID: 35854651 DOI: 10.1111/jocn.16449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the relationship between nurse-patient-initiated participation, nurses' attitudes towards patient's participation, and patients' adherence to treatment. Specifically, to (1) explore nurse-patient participation during haemodialysis and quantify the information into measurable indices; (2) determine the haemodialysis patient's adherence to treatment; (3) describe nurses' attitudes towards patient participation; and (4) establish the relationships between nurse-patient-initiated participation, nurses' attitudes towards patient participation and patients' adherence to treatment. BACKGROUND To improve haemodialysis patients' health, it is crucial to identify nurses' and patients' factors facilitating adherence to treatment. DESIGN An exploratory-sequential mixed-methods (quantitative and qualitative) design. METHODS All nurses working at a dialysis ward (n = 30) and their randomly selected patients (n = 102) participated. Qualitative data on nurse-patient-initiated participation were derived from transcribed nurse-patient conversations and quantified for further analyses. Nurses' attitudes towards patient participation were collected via questionnaire, and adherence to treatment via observed reduction in prescribed haemodialysis time. [CONSORT-SPI guidelines]. RESULTS Content analysis of the conversations indicated that nurse-initiated participation focused on patient's medical condition, treatment plan and education; while patients initiated more small talk. Non-adherence to treatment was significant (Mean = 0.19 h; SD = 0.33). Regression analyses indicated that nurses' attitude towards participation was negatively linked to patient adherence, while patient-nurse-initiated participation was unrelated. Nurses' attitudes towards patient participation moderated the relationship between nurse-patient-initiated participation and patient adherence: the more positive the attitude towards inclusion the more negative the link between patient or nurse-initiated participation and patient adherence. CONCLUSIONS The findings provided paradoxical insights: Nurses' positive attitudes towards participation lead them to accept the patient's position for shortening haemodialysis treatment, so that adherence to care decreases. RELEVANCE TO CLINICAL PRACTICE Nurses require education on negotiating methods to help achieve patient adherence while respecting the patient's opinion. Patients should be educated how to approach nurses, seeking the information they need.
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Affiliation(s)
- Nasra Idilbi
- Department of Nursing, Max Stern Yezreel Valley College, Emek Yezreel, Israel.,Galilee Medical Center, Nahariya, Israel
| | - Zoya Grimberg
- Galilee Medical Center, Nahariya, Israel.,University of Haifa, Haifa, Israel
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Pettersson M, Mattsson E, Bergbom I. Patients' body image after open abdominal surgery of abdominal aortic aneurysm - Perceptions and experiences. Nurs Open 2022; 9:2149-2158. [PMID: 35482535 PMCID: PMC9190703 DOI: 10.1002/nop2.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/17/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2022] Open
Abstract
Aims To explore and gain an understanding of patients’ perceptions and experiences of their body and bodily function in connection with open surgery of abdominal aortic aneurysm. Background After the operation of an abdominal aortic aneurysm (AAA) it may be difficult for the patients to understand what the procedure means. Design The design was descriptive and based on an analysis of 13 audio‐taped consultations with patients undergoing open surgery for AAA at a Swedish university hospital. The patients’ age varied from 57–79 and the mean age was 71 (70.5 female). Methods A hermeneutic approach was used whereby patients were interviewed and draw a picture of their thoughts and experiences of the surgery and what had been done in their bodies. Once patients had finished their drawings, the interviewer asked what thoughts and experiences they had of the AAA. Results Patients described experiences as a process of “going from broken to whole again.”
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Affiliation(s)
- Monica Pettersson
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Deptartment of Hybride and Interventional procedures, Vascular Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erney Mattsson
- Department of Vascular Surgery, St Olavs Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingegerd Bergbom
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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28
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Hope J, Schoonhoven L, Griffiths P, Gould L, Bridges J. 'I'll put up with things for a long time before I need to call anybody': Face work, the Total Institution and the perpetuation of care inequalities. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:469-487. [PMID: 35076086 PMCID: PMC9306934 DOI: 10.1111/1467-9566.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/01/2022] [Accepted: 01/05/2022] [Indexed: 06/01/2023]
Abstract
Failures in fundamental care (e.g. nutrition or pain-relief) for hospitalised patients can have serious consequences, including avoidable deaths. Policy rhetoric of 'shared decision-making' fails to consider how structural constraints and power dynamics limit patient agency in nursing staff-patient interactions. Goffman's concepts of face work, the presentation of self and the Total Institution shaped our analysis of interview and focus group data from hospital patients. Patients avoided threatening 'good' patient and staff face by only requesting missed care when staff face was convincing as 'caring' and 'available' ('engaged'). Patients did not request care from 'distracted' staff ('caring' but not 'available'), whilst patient requests were ignored in Total Institution-like 'dismissive' interactions. This meant patients experienced missed care with both 'distracted' and 'dismissive' staff. Patients with higher support needs were less able to carry out their own missed care to protect staff face, so experienced more serious care omissions. These findings show that many elements of the Total Institution survive in modern healthcare settings despite attempts to support individualised care. Unless nursing staff can maintain face as 'engaged' (despite organisational constraints that can reduce their capacity to do so) patient participation in care decisions will remain at the level of rhetoric.
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Affiliation(s)
- Jo Hope
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Lisette Schoonhoven
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Peter Griffiths
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Lisa Gould
- Department of Surgery and CancerFaculty of MedicineInstitute of Global Health InnovationImperial College LondonLondonUK
| | - Jackie Bridges
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
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Kao HFS, Hung CC, Lee BO, Tsai SL, Moreno O. Patient Participation in Healthcare Activities: Nurses' and Patients' Perspectives in Taiwan. Nurs Health Sci 2021; 24:44-53. [PMID: 34914182 DOI: 10.1111/nhs.12911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
Patient participation in healthcare activities is key in producing successful patient-centered care. However, little is known about both nurses' and patients' perspectives regarding patient participation in East Asia. This paper compared and contrasted perspectives of patient participation in healthcare activities between nurses and patients, using a qualitative study with a purposive sample of 39 nurses and 15 patients. A semi-structured interview was applied to focus groups for nurses, and face-to-face interview for patients. Content analysis was utilized to analyze the data, and common themes and subthemes were identified showing three similarities- authoritative culture, participation behaviors, and obstacles to participation; and two differences- sources of acquiring patient-related health information and responsible party. Nurses and patients did not entirely view participation in healthcare activities congruently. Relevant clinical practices are also suggested, including respecting patients' autonomy, nurses' using layman language to explain, patients' understanding the meaning behind their participation behaviors, recognizing obstacles faced to enhance patient participation with adjusted nursing workload, actively providing needed health information, and leading patients to realize that they will be responsible for their health behaviors after discharge. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Chang-Chiao Hung
- Department of Nursing & Nursing Department, Chang Gung University of Science and Technology & Chia-Yi Chang Gung Memorial Hospital, ChiaYi, Taiwan
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Taiwan
| | - Shu-Ling Tsai
- Department of Nursing, Chang Gung University of Science and Technology, ChiaYi, Taiwan
| | - Oscar Moreno
- School of Nursing, The University of Texas at El Paso, USA
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30
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Bucknall T, Quinney R, Booth L, McKinney A, Subbe CP, Odell M. When patients (and families) raise the alarm: Patient and family activated rapid response as a safety strategy for hospitals. Future Healthc J 2021; 8:e609-e612. [PMID: 34888450 DOI: 10.7861/fhj.2021-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients and those close to them often have an intimate understanding of their condition and can participate in a broad range of clinical processes. During times of deterioration, their concerns might go unheard. Advocacy of family and friends can fulfil an important safety function and can support patients and healthcare professionals looking after them. If concerns by patients are not heard by the patient's primary team in hospital, patient and family activated rapid response systems allow patients and family members to alert critical care outreach teams directly. These types of systems are stipulated by regulators in Australia and in parts of the USA, and there are examples in the UK built around the 'Call for Concern' model championed by the Royal Berkshire Hospital. Implementation is not without its problems and requires a deep understanding of barriers and enablers. Empowering patients to escalate directly might help to change safety culture and have protective effects for patients and staff. Policy makers are urged to consider standardised regulation to aid implementation.
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Affiliation(s)
- Tracey Bucknall
- Alfred Health, Melbourne Australia and director, Centre for Quality and Patient Safety Research, Burwood, Australia
| | - Rett Quinney
- Australian Catholic University, Ballarat, Australia
| | - Lisa Booth
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | | | - Christian P Subbe
- Ysbyty Gwynedd, Bangor, UK, senior clinical lecturer, Bangor University, Bangor, UK and improvement science fellow, The Health Foundation, London, UK
| | - Mandy Odell
- Royal Berkshire NHS Foundation Trust, Reading, UK
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Hung CH, Lee YH, Lee DC, Chang YP, Chow CC. The mediating and moderating effects of shared decision making and medical autonomy on improving medical service satisfaction in emergency observation units. Int Emerg Nurs 2021; 60:101101. [PMID: 34864441 DOI: 10.1016/j.ienj.2021.101101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 09/15/2021] [Accepted: 09/29/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Distinct from other medical settings, the emergency setting is unique and requires flexible and adaptive decision making to provide quality medical services. This study was designed to investigate the mediating and moderating effects of shared decision making (SDM) and patient attitude toward medical autonomy (AMA) on improving medical service satisfaction (MSS) in emergency observation units. METHODS In this cross-sectional study, we collected data via a verified structured questionnaire. A total of 165 participants met the inclusion criteria, and 100% of the questionnaires recovered were valid. RESULTS The results show that SDM had a partial mediating effect (p < 0.01) and that it significantly improved MSS. AMA had a moderating effect on some domains (p < 0.01). Meeting patient needs and increasing their participation in decision making can effectively improve MSS. However, excessive patient participation might not be productive, which is an important finding of this study. CONCLUSION In emergency observation units, SDM-based doctor-patient interactions and cooperation, effective patient-centered communication, and respect for patients' medical autonomy improve the doctor-patient relationship and patients' health literacy. Patients can thus participate in selecting the best treatment plan to achieve expected health outcomes, and ultimately improve MSS.
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Affiliation(s)
- Chun-Hua Hung
- Emergency Department, Changhua Christian Medical Foundation, Erlin Christian Hospital, 558, Sec. 1, Da-Chen Rd., Erlin, Changhua 52665, Taiwan ROC
| | - Yi-Hua Lee
- Department of Administration, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan ROC
| | - De-Chi Lee
- Department of Information Management, Da-Yeh University, 168 University Road, Dacun, Changhua 51591, Taiwan ROC
| | - Yuan-Ping Chang
- Department of Nursing, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City 83102, Taiwan ROC.
| | - Chih-Chung Chow
- Office of the Deputy Superintendent, Changhua Christian Hospital, 135 Nan-Hsiao Street, Changhua 500, Taiwan ROC
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Segevall C, Björkman Randström K, Söderberg S. Meanings of participation in care for older people after hip fracture surgery and nurses working in an orthopaedic ward. Int J Qual Stud Health Well-being 2021; 16:1970302. [PMID: 34431443 PMCID: PMC8405062 DOI: 10.1080/17482631.2021.1970302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The aim of this study was to elucidate meanings of participation in care for older people after hip fracture surgery and nurses working in an orthopaedic ward. METHODS A qualitative phenomenological hermeneutical design was used. We conducted personal interviews with a narrative approach with 11 older people recovering from hip fracture surgery and 12 nurses working in an orthopaedic ward. RESULTS The results show that for older people, participation meant being a co-creator in their own care, founded on being met with sensitivity and support, being told what is going to happen, taking responsibility and asking questions and being able to influence care. For nurses, patient participation meant meeting the patients' needs and requests by being open and allowing them to influence care while at the same time recognizing that the patients' possibility to influence care was limited. CONCLUSION The study shows that for older people and nurses, the phenomenon of participation has similar meanings but also differences. When older people participate in their care, they become a co-creator in care and confirmed as a person. This highlights the importance of a nurse-patient relationship built on trust, connectedness and communication based on a shared understanding.
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Affiliation(s)
- Cecilia Segevall
- Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden
| | | | - Siv Söderberg
- Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden
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33
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Miller PR, Guldager R, Herling SF. Nurses' Perceptions of Patient Participation in the Postanesthesia Care Unit-A Qualitative Focus Group Study. J Perianesth Nurs 2021; 36:656-663. [PMID: 34452815 DOI: 10.1016/j.jopan.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To explore postanesthesia care unit (PACU) nurses' experiences and perception of patient participation during PACU care. DESIGN Qualitative focus group study based on a phenomenological hermeneutic approach. METHODS We conducted three focus group interviews with 18 nurses from three different PACUs. Themes were created based on interpretive theory inspired by Ricoeur. FINDINGS Four themes and 11 subthemes were found. Patients' clinical condition and situation, time management, ethical aspects, and the patient-nurse relationship all had a high impact on postanesthesia nursing practice and conditions for involving patients. CONCLUSIONS PACU nurses want patients to participate in their own treatment and care in the PACU; however, nurses perceive patient participation differently. Nurses experience challenges including patients' impaired autonomy, absence of a holistic approach, and lack of time and resources. Nurses highlight that these barriers should not become an excuse for noninvolvement.
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Affiliation(s)
- Pernille Reck Miller
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Rikke Guldager
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Suzanne F Herling
- Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark; The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Do Falls and Other Safety Issues Occur More Often During Handovers When Nurses Are Away From Patients? Findings From a Retrospective Study Design. J Nurs Care Qual 2021; 36:202-209. [PMID: 33079821 DOI: 10.1097/ncq.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND No studies have assessed the differences in the incidences of falls and other patient safety events (PSEs) during handovers performed away from patients compared with when nurses are on the unit. PURPOSE The primary aim was to explore the incidence of falls and their severity during handovers compared with during nonhandover times; the secondary aim was to explore the occurrence of other PSEs during handover versus nonhandover times. METHODS This was a retrospective study of all PSEs that occurred from 2013 to 2017 in a large Italian academic trust. RESULTS There were 1966 falls and 1523 other PSEs. The incidence of falls per 100 hours was 4.9 during handovers and 4.4 during nonhandover times. The incidences of other PSEs were 2.9 and 3.5, respectively. No significant differences in fall outcome severity emerged. CONCLUSIONS No differences emerged in the occurrence of falls during handovers performed away from patients and when nurses were on the unit. Other PSEs decreased in occurrence during handovers as compared with other times during the shifts.
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Anna S, Catharina F, Ann-Charlotte F. The core of patient-participation in the Intensive Care Unit: The patient's views. Intensive Crit Care Nurs 2021; 68:103119. [PMID: 34391629 DOI: 10.1016/j.iccn.2021.103119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/08/2021] [Accepted: 07/17/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Patient participation is an established concept in public welfare. However, reports of the phenomenon of patient participation during intensive care from the patient's point of view are scarce. Therefore, the aim of this study was to explore the meaning of patient participation in the intensive care unit from the patient's perspective. RESEARCH DESIGN A qualitative design was used for the purpose of the study with a purposive convenient sample of nine adult patients with memories from their intensive care stay. METHOD Data was collected through individual interviews and analysed using a phenomenological hermeneutical method. FINDINGS The results of our study show a variety of meanings and degrees of participation that continuously move on a sliding scale from acting as a captain to feelings of being on an isolated island. Patient participation varied due to individual cognitive abilities and individual preferences, and the caregiver's attention altered between the body and the person through the continuum of care. CONCLUSION Patient participation during ICU care is more than participation in decision-making processes or direct patient care decisions. An understanding of the concept participation from the individual patient is necessary to support person centred care and the patient's relatives play an important role in during the entire care process.
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Affiliation(s)
- Slettmyr Anna
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institute, SE-141 52 Stockholm, Sweden.
| | - Frank Catharina
- School of Health and Caring Sciences, Linnaeus University, SE-351 95 Växjö, Sweden.
| | - Falk Ann-Charlotte
- Department for Health Promoting Science, Sophiahemmet University, SE-114 86 Stockholm, Sweden.
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Chegini Z, Arab-Zozani M, Shariful Islam SM, Tobiano G, Abbasgholizadeh Rahimi S. Barriers and facilitators to patient engagement in patient safety from patients and healthcare professionals' perspectives: A systematic review and meta-synthesis. Nurs Forum 2021; 56:938-949. [PMID: 34339525 DOI: 10.1111/nuf.12635] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 05/19/2021] [Accepted: 07/18/2021] [Indexed: 12/12/2022]
Abstract
AIMS To explore patients' and healthcare professionals' (HCPs) perceived barriers and facilitators to patient engagement in patient safety. METHODS We conducted a systematic review and meta-synthesis from five computerized databases, including PubMed/MEDLINE, Embase, Web of Science, Scopus and PsycINFO, as well as grey literature and reference lists of included studies. Data were last searched in December 2019 with no limitation on the year of publication. Qualitative and Mix-methods studies that explored HCPs' and patients' perceptions of barriers and facilitators to patient engagement in patient safety were included. Two authors independently screened the titles and the abstracts of studies. Next, the full texts of the screened studies were reviewed by two authors. Potential discrepancies were resolved by consensus with a third author. The Mixed Methods Appraisal Tool was used for quality appraisal. Thematic analysis was used to synthesize results. RESULTS Nineteen studies out of 2616 were included in this systematic review. Themes related to barriers included: patient unwillingness, HCPs' unwillingness, and inadequate infrastructures. Themes related to facilitators were: encouraging patients, sharing information with patients, establishing trustful relationship, establishing patient-centred care and improving organizational resources. CONCLUSION Patients have an active role in improving their safety. Strategies are required to address barriers that hinder or prevent patient engagement and create capacity and facilitate action.
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Affiliation(s)
- Zahra Chegini
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Georgia Tobiano
- Nursing and Midwifery Education Research Unit, Gold Coast University Hospital, Gold Coast, Australia
| | - Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, McGill University, Montreal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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Heumann M, Röhnsch G, Hämel K. Primary healthcare nurses' involvement in patient and community participation in the context of chronic diseases: An integrative review. J Adv Nurs 2021; 78:26-47. [PMID: 34288041 DOI: 10.1111/jan.14955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/23/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary healthcare nurses' potential to enable patient and community participation has been increasingly acknowledged. A conceptual understanding of their contributions within a broad range of participation processes is still lacking. AIMS The aims of this study were to develop a conceptual framework that provides information on the role of primary healthcare nurses in shaping participation processes with patients and communities in the context of chronic diseases and to identify conditions that enable or hinder the promotion of patient and community participation by nurses. DESIGN An integrative review was conducted. DATA SOURCES Twenty-three articles published from 2000 to 2019 were included in the analysis: 19 retrieved from PubMed and CHINAL and 4 added through other sources. REVIEW METHODS An inductive data analysis and quality appraisal of studies were conducted. RESULTS The analysis reveals four areas where nurses are involved in facilitating patient and community participation: (1) sharing understanding of health problems and needs, (2) developing resources and facilitating patient education for self-management, (3) raising patients' voices as an advocate in service development and (4) supporting individual and community networks. The conditions affecting nurses' engagement in fostering participation processes are as follows: (1) care priorities and overall workload, (2) nurses' attitudes towards participation and (3) users' acceptance of nurses as partners. CONCLUSIONS Future research can use the framework as a basis for empirical studies investigating nurses' involvement in pursuing patient and community participation. Interventions should focus less on indirect forms of participation, like patient education or advocacy, but should also focus on active forms of participation. Research is needed on nurses' involvement in community participation processes. IMPACT This framework can be used and adapted in future research on patient and community participation in primary healthcare. It describes areas of participation and the facilitators and barriers within the broad range of activities of primary healthcare nurses.
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Affiliation(s)
- Marcus Heumann
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Gundula Röhnsch
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kerstin Hämel
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
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Mixed Methods Study of Nurse Assessment of Patient Preferences for Engagement During Hospitalization. Nurs Res 2021; 70:366-375. [PMID: 34116548 DOI: 10.1097/nnr.0000000000000526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Global health care initiatives emphasize the importance of engaging patients in their health care to improve the patient's experience and outcomes. Assessing patient preferences for engagement is critical, as there are many ways patients can engage in their care and preferences vary across individuals. OBJECTIVE The primary purpose of this study was to evaluate the effect of implementation of the Patient Preferences for Engagement Tool 13-Item Short Form (PPET13) during hospitalization on patient and nurse experience of engagement. Readmissions and emergency department (ED) usage within 30 days postdischarge was also examined. METHODS The mixed methods study was conducted within two medical units in the United States between December 2018 and May 2019. Pre-implementation group patients completed a demographic survey and the Patient Experience of Engagement Survey (PEES) on discharge. Implementation group patients completed the PPET13 within 24 hr of admission with their nurse and the demographic survey and PEES on discharge. A focus group with nurses who implemented the PPET13 was conducted following the implementation period. Data analysis included confirmatory factor analysis, multiple and logistic regression, and qualitative content analysis. RESULTS There was significant improvement in PEES during the implementation phase. The PEES score was a significant predictor of ED visits, but not 30-day readmissions. Nurses were not always certain how to best integrate patient preferences for engagement into their care delivery and suggested integrating the PPET13 into the electronic health record to assist with streamlining the assessment and communicating preferences across the care team. DISCUSSION Assessing patients' preferences for engagement using the PPET13 was associated with an improved experience of engagement, which was found to mediate the relationship between utilization of PPET13 and ED usage within 30 days postdischarge. Use of a PPET, such as the PPET13, can help inform the delivery of individualized engagement strategies to improve patient and family engagement and outcomes; however, nurses need formalized education on how to tailor their care to meet the individual engagement preferences of their patients.
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Eriksson-Liebon M, Roos S, Hellström I. Patients' expectations and experiences of being involved in their own care in the emergency department: A qualitative interview study. J Clin Nurs 2021; 30:1942-1952. [PMID: 33829575 DOI: 10.1111/jocn.15746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To investigate patients' experiences of being involved in their care in the emergency department (ED). BACKGROUND Previous research shows that when patients experience involvement during care visits, this increased their trust in the care, gave a sense of control and promoted their autonomy. DESIGN A qualitative descriptive design with semi-structured interviews, using the "Consolidated criteria for reporting qualitative research" (COREQ) checklist. METHODS Using convenience sampling, semi-structured interviews were conducted with 16 patients in the ED. RESULTS The study identified four categories: attention and inattention; communication and understanding; varying levels of participation; and inefficient and inaccessible care. The results show that patients expected to be treated with respect and to be involved in an open dialogue about their care. Patients' experiences of participation were related to their sense of control. CONCLUSIONS Based on the results of the study, the authors found that factors such as dialogue, information, attention and participation affected the patients' involvement during the ED visit. Experiences of involvement and control were linked to patients' experiences of care and of patients as individuals. RELEVANCE TO CLINICAL PRACTICE Healthcare providers' awareness of the importance of paying attention to the patient as an individual, and of the need for simple, continuous communication could facilitate patient involvement in own care.
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Affiliation(s)
- M Eriksson-Liebon
- Department of Emergency Medicine in Norrköping, Vrinnevi Hospital, Norrköping, Sweden.,Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | - S Roos
- Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | - I Hellström
- Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden.,Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
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Selvin M, Almqvist K, Kjellin L, Schröder A. Patient participation in forensic psychiatric care: Mental health professionals' perspective. Int J Ment Health Nurs 2021; 30:461-468. [PMID: 33098186 PMCID: PMC7984362 DOI: 10.1111/inm.12806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
Patient participation is a central concept in modern health care and an important factor in theories/models such as person-centred care, shared decision-making, human rights approaches, and recovery-oriented practice. Forensic psychiatric care involves the treatment of patients with serious mental illnesses who also have committed a crime, and there are known challenges for mental health staff to create a health-promoting climate. The aim of the present study was to describe mental health professionals' perceptions of the concept of patient participation in forensic psychiatric care. Interviews were conducted with 19 professionals and were analysed with a phenomenographic approach. The findings are presented as three descriptive categories comprising five conceptions in an hierarchic order: 1. create prerequisites - to have good communication and to involve the patient, 2. adapt to forensic psychiatric care conditions - to take professional responsibility and to assess the patient's current ability, and 3. progress - to encourage the patient to become more independent. The findings highlight the need for professionals to create prerequisites for patient participation through good communication and involving the patient, whilst adapting to forensic psychiatric care conditions by taking professional responsibility, assessing the patient's ability, and encouraging the patient to become more independent without adding any risks to the care process. By creating such prerequisites adapted to the forensic psychiatric care, it is more likely that the patients will participate in their care and take more own responsibility for it, which also may be helpful in the patient recovery process.
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Affiliation(s)
- Mikael Selvin
- University Health Care Research CenterFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Kjerstin Almqvist
- Department for Social and Psychological StudiesKarlstad UniversityKarlstadSweden
| | - Lars Kjellin
- University Health Care Research CenterFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Agneta Schröder
- University Health Care Research CenterFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Department of Health ScienceFaculty of Health, Care and NursingNorwegian University of Science and Technology (NTNU)GjövikNorway
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Fotokian Z, Pourhabib A, Navabi N, Ghaffari F. Designing a structural equation model of marital satisfaction based on aging perception and demographic and clinical variables in Iranian elderly patients with coronary artery disease. ARYA ATHEROSCLEROSIS 2021; 16:161-169. [PMID: 33598036 PMCID: PMC7867309 DOI: 10.22122/arya.v16i4.2087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Marital satisfaction is an important variable in maintaining or promoting elderly health. Therefore, identifying the effective factors can increase life expectancy and quality of life. This study aimed to determine the relationship between aging perception and demographic and clinical characteristics with marital satisfaction in the elderly patients with coronary artery disease (CAD). METHODS This was a descriptive-correlational study. The sample size was 480 elderly patients with CAD who were referred to the heart clinics of hospitals in the west of Mazandaran Province, Iran, who were recruited by convenience sampling. Data were collected by a demographic checklist, ENRICH Marital Satisfaction Inventory, and Aging Perceptions Questionnaire (APQ). The data were analyzed by structural equation model (SEM) using Goodness of Fit Index (GFI and chi-square test. P-value less than 0.050 was considered as significant level. RESULTS The mean and standard deviation (SD) of marital satisfaction was 145.16 ± 12.12, and the mean and SD of aging perception was 113.39 ± 12.74. The results of the Pearson's correlation coefficient indicated that the highest correlation was between aging perception and marital satisfaction (r = 0.68, P < 0.001). The model fit indices of the hypothesized model met the criteria, with the GFI = 0.91, Comparative Fit Index (CFI) = 0.93, Normed Fit Index (NFI) = 0.94, and non-Normed Fit Index (NNFI) = 0.91. CONCLUSION Considering the psychological risk factors affecting marital satisfaction such as aging perception and suitable measurement can lead to marital health and improve treatment outcomes by increasing elderly motivation in self-care. Therefore, the elderly patients with CAD need more serious and long-term educational, counseling, and supportive interventions.
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Affiliation(s)
- Zahra Fotokian
- Assistant Professor, Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Pourhabib
- PhD Candidate, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Nasrin Navabi
- Lecturer, Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Ghaffari
- Associate Professor, Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Development and Psychometric Evaluation of the Patient Engagement in Health Care Questionnaire. J Nurs Care Qual 2021; 35:E35-E40. [PMID: 32433156 DOI: 10.1097/ncq.0000000000000439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient engagement in health care can contribute to improving care quality and safety. A valid measurement is essential for promoting it. PURPOSE The purpose was to develop the Patient Engagement in Health Care Questionnaire and test its psychometric properties. METHODS An item pool was generated based on a literature review and qualitative research, and was reviewed by 2 expert panels. Two rounds of survey, with 364 and 433 patients, respectively, were conducted to evaluate psychometric properties of the questionnaire. RESULTS The questionnaire consists of 33 items. Exploratory factor analysis revealed a 6-factor model, explaining 67.16% of the variance, which included communication and information exchange, engaging in treatment and care, engaging in decision-making, giving feedback about care quality, monitoring care safety, and choosing health care providers. Confirmatory factor analysis indicated that the 6-factor model fit the data well. The scale-level content validity index, Cronbach α, and test-retest reliability were 0.935, 0.928, 0.882, respectively. CONCLUSIONS The Patient Engagement in Health Care Questionnaire is a reliable and valid tool to assess patient engagement.
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Roberts S, Chaboyer W, Hopper Z, Marshall AP. Using Technology to Promote Patient Engagement in Nutrition Care: A Feasibility Study. Nutrients 2021; 13:nu13020314. [PMID: 33499271 PMCID: PMC7910973 DOI: 10.3390/nu13020314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 11/24/2022] Open
Abstract
Empowering patients to participate in nutrition care during hospitalisation may improve their dietary intakes and associated outcomes. This study tested the acceptability and feasibility of a technology-based intervention to engage hospital patients in nutrition care at a tertiary teaching hospital in Australia. The hospital used an electronic foodservice system (EFS), by which patients ordered meals via bedside computers. Adults at nutritional risk received the nutrition technology (NUTRI-TEC) intervention, involving nutrition assessment, education on nutrition requirements and training on using the EFS to enter food intakes and monitor nutrition goals. Acceptability was assessed using patient satisfaction and engagement surveys. Feasibility was assessed by evaluating the intervention delivery/fidelity and patient recruitment/retention. Patients’ dietary intakes were observed daily to indicate the intervention’s effects and assess the accuracy of the patient-recorded intakes. Descriptive and inferential statistics were used to analyse the data. Of the 71 patients recruited, 49 completed the study (55% male; median (IQR) age 71 (65–78) years; length of stay 10 (7–14) days). Patient satisfaction with NUTRI-TEC was high. Intervention delivery and fidelity targets were met but recruitment (≥50%) and retention (≥75%) targets were not; only 31% of patients agreed to participate and 69% completed the study (mostly due to unexpected/early discharge). Patient- and researcher-recorded dietary intakes correlated strongly, indicating patients can record food intakes accurately using technology. This study highlights the important role technology is likely to play in facilitating patient engagement and improving care during hospitalisation.
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Affiliation(s)
- Shelley Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD 4222, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (W.C.); (A.P.M.)
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
- Correspondence: ; Tel.: +61-7-5552-9557
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (W.C.); (A.P.M.)
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
| | - Zane Hopper
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
| | - Andrea P. Marshall
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (W.C.); (A.P.M.)
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
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Validação de instrumento de participação da família no cuidado do recém-nascido hospitalizado. ACTA PAUL ENFERM 2020. [DOI: 10.37689/acta-ape/2020ao022855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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van Belle E, Huisman‐De Waal G, Vermeulen H, Heinen M. Feasibility and early effectiveness of the Tell-us Card communication tool to increase in-hospital patient participation: a cluster randomised controlled pilot study. Scand J Caring Sci 2020; 35:911-922. [PMID: 32964468 PMCID: PMC8451905 DOI: 10.1111/scs.12909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/04/2020] [Accepted: 08/12/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Patient participation is fundamental to nursing care and has beneficial effects on patient outcomes. However, it is not well embedded yet and little is known on how nurses could effectively stimulate patient participation in hospital care. The Tell-us Card is a communication tool for inviting patients to talk about their preferences and needs, and to increase patient participation in daily care. OBJECTIVES To assess feasibility and early effectiveness of the Tell-us Card communication tool for enhanced patient participation during hospitalisation. DESIGN AND METHOD A pilot cluster randomised controlled study design was used including four nursing wards. Effectiveness was measured with the Individualized Care Scale (ICS) and the Quality from the Patients' Perspective (QPP) questionnaire. Linear mixed model analysis was used for analysis. Feasibility was assessed with an evaluative questionnaire for patients and nurses and by reviewing the content of Tell-us Cards using the Fundamentals of Care Framework (FOCF) for analysis. Ethical approval was attained. RESULTS Data of 265 patients showed a significant increase at one intervention ward on the ICS (effect size 0.61, p = 0.02) and most ICS subscales. No effect was visible on the QPP. The majority of patients regarded the intervention as beneficial; nurses however experienced barriers with incorporating the Tell-us Card into daily care. Analysis of the Tell-us Card content showed many elements of the FOCF being mentioned, with most patients indicating psychosocial needs like being involved and informed. CONCLUSIONS This pilot study showed a positive early effect of the Tell-us Card communication tool on patient participation, although integration in daily nursing care appeared to be complex and an optimal fit has not yet been reached. Patients were positive about the intervention and wrote meaningful issues on the Tell-us Cards. More research is needed on how to incorporate patient participation effectively in complex hospital care.
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Affiliation(s)
- Elise van Belle
- Radboud Institute for Health SciencesIQ HealthcareRadboud University Medical CenterNijmegenThe Netherlands
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Getty Huisman‐De Waal
- Radboud Institute for Health SciencesIQ HealthcareRadboud University Medical CenterNijmegenThe Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health SciencesIQ HealthcareRadboud University Medical CenterNijmegenThe Netherlands
- Faculty of Health and Social StudiesHAN University of Applied SciencesNijmegenThe Netherlands
| | - Maud Heinen
- Radboud Institute for Health SciencesIQ HealthcareRadboud University Medical CenterNijmegenThe Netherlands
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Stuhlfauth S, Knutsen IR, Foss IC. Guidelines as governance: Critical reflections from a documentary analysis of guidelines to support user involvement in research. Nurs Inq 2020; 28:e12378. [PMID: 32905645 DOI: 10.1111/nin.12378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 01/30/2023]
Abstract
Although guidelines to regulate user involvement in research have been advocated and implemented for several years, literature still describes the process as challenging. In this qualitative study, we take a critical view on guidelines that are developed to regulate and govern the collaboration process of user involvement in research. We adapt a social constructivist view of guidelines and our aim is to explore how guidelines construct the perception of users and researchers and thus the process of involvement. Twenty-two guidelines published between 2006 and 2019 were analyzed iteratively. The analysis focuses on values which are emphasized in the guidelines on the distribution of entities, knowledge, and tasks between users and researchers. The analysis indicates that users and researchers are constructed differently; researchers are mainly constructed as responsible initiators and caretakers, while users are constructed as powerless and vulnerable. The guidelines portray the collaboration process as harmonious and assume a normative perspective. In doing so, challenges described in the literature related to power imbalances are not addressed. Based on these findings, we ask if these guidelines might function to maintain existing power imbalances between users and researchers.
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Affiliation(s)
- Susanne Stuhlfauth
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Ruud Knutsen
- Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Kjeller, Norway
| | - Ingrid Christina Foss
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Mackie BR, Marshall AP, Mitchell ML. Exploring family participation in patient care on acute care wards: A mixed-methods study. Int J Nurs Pract 2020; 27:e12881. [PMID: 32856360 DOI: 10.1111/ijn.12881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient- and family-centred care practices are a recommended part of contemporary care for the acutely ill hospitalized adult patients. However, how patient- and family-centred care is enacted in an adult hospital setting is not well understood. AIMS AND OBJECTIVES The aim of this study is to explore the perceptions of patients, family members and nurses regarding family participation and collaboration in patient care within an acute care setting, including the barriers and facilitators. DESIGN This study used a mixed-methods sequential design. METHODS Observer-as-participant observations and semistructured interviews were undertaken. Integration of the data was achieved through triangulation. RESULTS Triangulation revealed two metathemes. The first metatheme, 'continuum of family involvement', explained the central viewpoint of how family participation and collaboration in the care of acutely ill hospitalized adult patients was enacted. The second metatheme, 'nurses value family involvement', helped to explain and understand the barriers and facilitators to enacting family participation in the acute care setting. CONCLUSION Promoting family participation in the acute care setting requires supporting multiple levels of engagement. Developing a relationship, clear communication and open sharing of information amongst patients, family members and nurses is critical to supporting family involvement.
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Affiliation(s)
- Benjamin R Mackie
- Menzies Health Institute Queensland, School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast and Griffith University, Brisbane, Queensland, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, and Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Southport, Queensland, Australia
| | - Marion L Mitchell
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University and Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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van der Heijden MJE, van Mol MMC, Witkamp EFE, Osse RJ, Ista E, van Dijk M. Perspectives of patients, relatives and nurses on rooming-in for adult patients: A scoping review of the literature. Appl Nurs Res 2020; 55:151320. [PMID: 32868147 DOI: 10.1016/j.apnr.2020.151320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022]
Abstract
AIM To explore the perspectives of patients, their relatives and nurses on rooming-in for adult patients. BACKGROUND The practice of having family stay overnight with an adult patient in hospital is quite new. To support rooming-in programs, the perspectives from all stakeholders should be taken into account. METHODS All types of studies on rooming-in in adult healthcare settings were included in this scoping review. Rooming-in has been defined as the practice where 'family members or trusted others are facilitated to continuously stay with the patient and are provided with facilities to sleep in the patient's room'. RESULTS Seven studies were included: one randomized controlled trial, three qualitative studies, and three correspondence articles. Generally, patients felt safe in the presence of a family member, but could also feel restricted in their freedom and privacy. Family members saw a benefit for the patient, considered rooming-in a moral duty, and were happy to help. Nonetheless, family members reported rooming-in as physically and emotionally stressful. Nurses described that patients were less anxious and more easily adjusted to the hospital environment. CONCLUSIONS The reviewed studies suggest that patients, family members, and nurses have both positive and negative experiences with rooming-in. The concept of rooming-in varies from continuous presence and involvement of relatives to one overnight stay in the patient's room. Each interpretation has its own implications for policy, design, guidelines and feasibility of rooming-in. Nursing staff should be included in decision-making processes for this practice.
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Affiliation(s)
| | - Margo M C van Mol
- Department of Intensive Care Adults, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Erica F E Witkamp
- Faculty of Nursing and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Robert Jan Osse
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Nursing Science, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Nursing Science, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
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Van Humbeeck L, Malfait S, Holvoet E, Vogelaers D, De Pauw M, Van Den Noortgate N, Van Biesen W. Value discrepancies between nurses and patients: A survey study. Nurs Ethics 2020; 27:1044-1055. [DOI: 10.1177/0969733020906595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Patient-centeredness, respect for patient autonomy, and shared decision-making have now made it to center stage in discussions on quality of care. Knowing what actually counts in care and how it should be accomplished from the patients’ and nurses’ perspective seems crucial. Aim To explore how patients and their nurses perceive the importance and enactment of values in their healthcare. Research design An observational, cross-sectional study using a self-developed questionnaire, consisting of 15 items related to seven values (e.g. uniqueness, autonomy, professionalism, compassion, responsiveness, partnership, and empowerment) as described in the taxonomy of Bastemeijer et al. Participants and research context The survey was completed by 384 patients and 81 nurses. Participants were recruited on eight internal medicine wards of a 1000-bed university hospital in Belgium. Ethical considerations This study was approved by the ethical committee of the Ghent University Hospital (B670201836799). Findings (1) Patients and nurses prioritize values of care differently; (2) nurses report not being able to enact the values they prioritize in actual practice as much as one would like to; and (3) there is a gap in experienced delivery of a comprehensible explanation of all treatment options, a conversation based on equality, making shared decisions, and being non-judgmental between nurses and patients. Discussion Our findings challenge nurses’ overemphasis on professional compassion and uniqueness while arguing for increased attention on authentic shared decision-making and empowerment. The first step to a patient-centered culture truly involving patients in their healthcare is communication and information provision, rather than focusing on tangible and normative constructs. Conclusion Our findings revealed differences in prioritization and actual enactment of values in care between patients and nurses. This was especially so for values related to communication, provision of complete unbiased information, and shared decision-making. Nurses should prioritize providing comprehensible information and using conversations based on equality to make decision together with patients.
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Bergman L, Pettersson M, Chaboyer W, Carlström E, Ringdal M. In safe hands: Patients' experiences of intrahospital transport during intensive care. Intensive Crit Care Nurs 2020; 59:102853. [PMID: 32223920 DOI: 10.1016/j.iccn.2020.102853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 02/27/2020] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intrahospital transports are associated with complications and adverse events in intensive care patients. Yet, little is known about how patients' percive these tranfers. Thus, this study aimed to explore patients' experiences of the intrahospital transport process. RESEARCH DESIGN An exploratory qualitative study compromising interviews with twelve patients. Data were analysed using thematic analysis. SETTING Two intensive care units in a university hospital setting. MAIN OUTCOME An understanding of patients' experiences of the intrahospital transport process. FINDINGS The main finding was patients' description of "being in safe hands" during the transport. Patients' experience of transports as feasible and safe was reflected in the first main theme, "feeling prepared and safeguarded". The second theme, "being on the move", described patients' perceptions of the transport; although they were aware of movement, the transport was viewed as a minor event during their stay. The third theme, "entrusting myself to others", revealed how patients handed over control and decision making to the staff, confident that they would look after their best interest. CONCLUSIONS Patients perceived intrahospital transports as an acceptable and safe process. Findings suggest that patients' experience could be improved by being provided with accurate and timely information and preparedness for transport-related events.
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Affiliation(s)
- Lina Bergman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Monica Pettersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Wendy Chaboyer
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Mona Ringdal
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
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