Impact of Satisfaction, Nurse–Patient Interactions and Perceived Benefits on Health Behaviors Following a Cardiac Event

A pilot study of an emotional intelligence training intervention for a paediatric team

OBJECTIVE

Emotional intelligence (EI) is the individual's ability to perceive, understand and manage emotion and to understand and relate effectively to others. We examined the degree to which EI training may be associated with a change in EI among different medical personnel and patient satisfaction.

DESIGN, SETTING AND PARTICIPANTS

The EI of 17 physicians and 10 nurses in paediatric ward was prospectively evaluated with Bar-On's EI at baseline and after 18 months. 11 physicians who did not undergo the intervention served as controls.

INTERVENTIONS

The intervention consisted of a training programme comprising group discussions, simulations and case studies.

MAIN OUTCOMES AND MEASURES

Pre-emotional quotient inventory (EQ-i) and post-EQ-i scores and patient satisfaction surveys of nurse and physicians pre-intervention and post-intervention were analysed.

RESULTS

The mean overall EI score of the study sample rose from 99.0±9.6 (both plus and minus mathematical operations standing for SD) at baseline to 105.4±10 (p<0.000) after 18 months, with the most robust increase (nearly 6%; p<0.003) manifested among physicians. In contrast, the control group's EI scores did not change over this period. Within the intervention group, physicians displayed a statistically significant increase in three of the five EI dimensions, compared with only one of the five EI dimensions for nurses. Patient satisfaction scores relating to physician care rose from 4.4 pre-intervention to 4.7 post-intervention (p=0.03).

CONCLUSION

An EI intervention led to an overall increase in EI scores, with a significant improvement in patient satisfaction. These findings suggest important potential benefits for both staff and their patients.

Results of a survey of client satisfaction with outpatient physiotherapy care

The purpose of this study was to use a questionnaire based on the discrepancy model to assess the factors contributing to satisfaction and dissatisfaction with private outpatient physiotherapy services in Sydney; to test the applicability of the "consumer model" to physiotherapy practice, and to identify the criteria used to assess quality. The following information was collected: client demographics and history; expectations, and perceptions of 12 dimensions relating to the service received; satisfaction with previous care providers; reasons for seeking therapy; causes of previous dissatisfaction; the criteria used to assess quality; and a global assessment of satisfaction. The response rate was 69.3%. Overall satisfaction was best correlated with the therapist's willingness to discuss positive and negative aspects of treatment (r = 0.71). The findings indicate that dissatisfied clients change health care providers, as predicted by the consumer model. This calls into question the value of surveys administered to clients during therapy, as the continuation of treatment implies a degree of satisfaction. The highest expectations were recorded in the six dimensions related to the client-therapist interaction. The measurement of expectations in the domains assessed added little value as expectations were universally high. Criteria related to outcomes and the client-therapist interaction were the most frequently reported contributors to previous dissatisfaction.

A National Health Service Hospital's cardiac rehabilitation programme: a qualitative analysis of provision

AIM

This paper reports a study examining the effectiveness of a London National Health Service Trust Hospital's cardiac rehabilitation programme, from the perspectives of healthcare professionals and patients.

BACKGROUND

Cardiovascular disease is the world's leading cause of death and disability. Substantial research has reported that, following a cardiac event, cardiac rehabilitation can promote recovery, improve exercise capacity and patient health, reduce various coronary artery disease risk factors and subsequently reduce hospitalization costs. Despite these findings and the introduction of the National Service Framework for Coronary Heart Disease, there is wide variation in the practice, management and organization of cardiac rehabilitation services.

METHODS

A purposeful sample of three postmyocardial infarction patients registered on the selected hospital's cardiac rehabilitation programme, coupled with 11 healthcare professionals were selected. The patients acted as individual case studies. The authors followed all three patients through phase III of their cardiac rehabilitation programme. The research attempted to explore the roles and procedures of a London hospital's cardiac rehabilitation programme through an interpretative framework involving qualitative research methods. Participant observation and in-depth semi-structured interviews were the instruments used to collect data.

FINDINGS

Whilst the healthcare professionals were enthusiastic about coronary heart disease prevention, the London NHS trust hospital's cardiac rehabilitation programme had several barriers, which reduced the programme's success and prevented it from achieving National Service Framework targets. The barriers were complex and mainly included service-related factors, such as lack of professional training, weak communication between primary and secondary care and confused roles and identities.

CONCLUSION

Although the study has immediate relevance for the local area, it highlighted issues of more general relevance to cardiac rehabilitation and secondary prevention programme development, such as communication and role and identity perceptions in a multi-professional working environment and the need to develop a formal training programme for cardiac rehabilitation healthcare professionals.

RELEVANCE TO CLINICAL PRACTICE

The results of this study highlight the need for increased investment, improved planning and the introduction of a comprehensive training programme for healthcare practitioners in cardiac rehabilitation. Implementation of these actions may reduce many of the service limitations and barriers that currently surround cardiac rehabilitation programmes.

Does self-care agency change between hospital admission and discharge? An Orem-based investigation

AIMS

To assess whether nursing care improved patients' self-care agency between admission to hospital care and discharge.

METHODS

A pre-test-post-test comparative research design with random subject selection was used. One hundred and sixty patients and 52 nurses rated identical self-care agency assessment forms, based on Orem's framework, both at admission and discharge. Patient satisfaction with nursing care and nurse satisfaction with working conditions were also assessed. Repeated measures ancova as well as paired and independent t-tests were used to test differences at both time points. Level of significance was set at 0.05 in this study.

RESULTS

Patients in general reported high self-care agency pre- and post-test. Compared with a reference group of elderly residents, the study sample showed significantly lower levels of self-care agency. We found no difference between patient and nurse assessments of self-care agency on admission and discharge. Better patient-nurse relationships were associated with greater self-care agency reported by patients.

CONCLUSIONS

Authors found no change in patient self-care agency between hospital admission and discharge. Outcomes may have been due to the inappropriate choice of the conceptual framework applied for acute care settings or to the insufficient length of the study. A longitudinal approach to observe long-term improvement of self-care capabilities is recommended.

Access to the World After Myocardial Infarction: Experiences of the Recovery Process

Myocardial infarction (MI) is a traumatic health event and at the same time a transition of vital importance in human life. The purpose of this study was to elucidate recovery patterns after myocardial infarction with regard to the content of patients' experiences. The study used a descriptive design and a qualitative method. Interviews with 16 men and women were performed, and data were subjected to a thematic content analysis. The recovery process had a pattern of ability, restraints, and reorientation. Through self-help and help from others, the mutual sharing of burdens, and clarifying restraints to recovery, the recovery process progressed toward reorientation. New values and motivation for change, as well as a new balance within the self and relationships were found. The MI had been integrated into life and, through the recovery process, patients' attitudes were better focused, leading to an enhanced quality of life.

Physical Activity Patterns in Heart Transplant Women

Maintaining regular, long-term physical activity is critical to achieve favorable effects of heart transplantation. Yet, at present, little is known about the physical activity patterns of transplant recipients, especially women. The study was conducted to (1) describe levels and types of physical activity using actigraphy and self-report, (2) determine the association between physical activity and sociodemographic variables, and (3) assess the relationship between physical activity, quality of life (QOL), and relevant health indicators (hypertension, hyperlipidemia, and obesity) among female heart transplant recipients. Twenty-seven women (average age, 57 +/- 13 years, primarily Caucasian [82%], retired [89%], married [67%], average time since transplant 2.1 +/- 1.3 years) from a single heart transplant facility were asked to report amount and types of physical activity and overall QOL and wear an actigraph for 1 week to measure physical activity level. Physical activity levels by actigraphy averaged 280,320 +/- 52,416 counts for the week (range, 206,784-354,144); self-reported physical activity level on a 0 to 10 scale was 4.3 +/- 0.37 (range, 0-7). The actigraph and self-reported measures were significantly correlated (r = 0.661, P = .000). It was found that women were more likely to engage in household tasks and family activities than occupational activities or sports. Significant differences in physical activity (F = 6.319, P = .006) were observed in participants who reported fair (n = 13), good (n = 9), and very good (n = 5) overall QOL. The only demographic factor associated with physical activity was age; younger women were more active than older women (r = -0.472, P = .013). A negative correlation was found between levels of physical activity and presence of hypertension, hyperlipidemia, and obesity. It was found that a majority of female transplant recipients remains sedentary. Given the association between physical activity and overall QOL and relevant health indicators, measures to enhance physical activity need to be developed and tested; these strategies may be beneficial in improving overall outcomes.

Attitudes toward HIV Health Care Providers scale: development and validation

Patient attitudes toward their health care providers can play an important role in determining health behavior change. The frequency of contact with health care professionals and disease stigma makes assessing patients' perception of this relationship of particular interest in an HIV medical population. While past general satisfaction and attitude tools have been used to assess this construct, there is a need for an assessment tool specific to patient attitudes in an HIV setting. This study was designed to validate the Attitudes toward HIV Health Care Provider scale (AHHCP) in an HIV medical population. Principal components analysis of the AHHCP yielded a two-factor structure accounting for 53.3% of the total variance in attitudes toward health care providers. The two factors represented items concerning Professionalism and Emotional Support. The AHHCP was found to have good internal consistency (0.92) and convergent validity with a measure of patient satisfaction (r = 0.59). The results of the present study suggest that the AHHCP is a reliable and valid instrument for use in assessing patient attitudes toward their health care providers.