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Melby L, Nair RD. 'We have no services for you… so you have to make the best out of it': A qualitative study of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients' dissatisfaction with healthcare services. Health Expect 2023; 27:e13900. [PMID: 37905602 PMCID: PMC10726260 DOI: 10.1111/hex.13900] [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: 08/25/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION People should have access to healthcare services that are effective, safe and secure, patient-centred, and coordinated and continuous. One group that has consistently reported negative experiences and feels dissatisfied with services are patients with Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS). The objective of this study was to develop a deeper understanding of the experiences of dissatisfaction among ME/CFS patients and explore the reasons for such dissatisfaction. METHODS We conducted in-depth interviews with 48 people from 24 households (comprising patients and family members), providing insight into the experiences of 37 ME/CFS sufferers in Norway. The participants were purposively sampled and included persons of different ages, genders, time since having the condition (3-30 years), and severity. RESULTS Four main themes were developed: (1) 'Nonexistent services' cover patients' experience that healthcare services had nothing to offer them after receiving their ME/CFS-diagnosis. (2) 'Nonpersonalised services' documents experiences where patients did receive services, which in theory was appropriate for relieving a specific health problem, but in practice were experienced as inappropriate because they were not adapted to the patient's need. (3) 'Slow services' address patients' experience of getting services too late (or too little) to be useful. (4) 'Wrong services' comprise patients' experiences of being offered and/or 'forced' to accept services that they felt were inappropriate for their health problems. CONCLUSIONS Providers' lacking knowledge of the condition and lack of precise recommendations for follow up may partly explain unsatisfactory experiences. Providers' belief (or disbelief) in the condition could furthermore influence caregiving. Also, systemic issues in the healthcare sector, like high workloads and bureaucracy, can negatively affect care provision. Finally, users' unsatisfactory experiences may also be due to a lack of patient involvement in the design of such services. Further research should investigate how patients can be involved in service design, and also providers' perspectives on caregiving and the barriers they experience for providing high-quality care. PATIENT OR PUBLIC CONTRIBUTION The ME-patient organisation suggested research topics to the call from which this study got funding. Patients and caregivers provided feedback during analysis and interpretation of data.
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Affiliation(s)
- Line Melby
- SINTEF, Department of Health ResearchTrondheimNorway
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2
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What do bereaved relatives of cancer patients dying in hospital want to tell us? Analysis of free-text comments from the International Care of the Dying Evaluation (i-CODE) survey: a mixed methods approach. Support Care Cancer 2023; 31:81. [PMID: 36562882 PMCID: PMC9788999 DOI: 10.1007/s00520-022-07490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE We conducted an international survey of bereaved relatives of cancer patients dying in hospitals in seven countries, with the aim to assess and improve the quality of care. The survey used the i-CODE (International Care of the Dying Evaluation) questionnaire. Here, we report findings from the free-text comments submitted with the questionnaires. We explored for topic areas which would potentially be important for improving the quality of care. Further, we examined who reported free-texts and in what way, to reduce bias without ignoring the function the free-texts may have for those contributing. METHODS We used a combined qualitative-quantitative approach: logistic regression analysis to study the effect of respondents' socio-demographic characteristics on the probability of free-texts contributions and thematic analysis to understand the free-text meaning. The primary survey outcomes, (1) how frequently the dying person was treated with dignity and respect and (2) support for the relative, were related to free-text content. RESULTS In total, 914 questionnaires were submitted; 457/914 (50%) contained free-text comments. We found no socio-demographic differences between the respondents providing free-texts and those who did not. We discovered different types of free-texts ("feedback," "narrative," "self-revelation") containing themes of which "continuity of care," "the one person who can make a difference," and "the importance of being a companion to the dying" represent care dimensions supplementing the questionnaire items. A free-text type of grateful feedback was associated with well perceived support for the relative. CONCLUSION Bereaved relatives used the free-texts to report details related to i-CODE items and to dimensions otherwise not represented. They highlighted the importance of the perceived support from human interaction between staff and the dying patient and themselves; and that more than professional competence alone, personal, meaningful interactions have profound importance.
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Dust G, Schippel N, Stock S, Strupp J, Voltz R, Rietz C. Quality of care in the last year of life: adaptation and validation of the German “Views of Informal Carers’ Evaluation of Services – Last Year of Life – Cologne”. BMC Health Serv Res 2022; 22:1433. [DOI: 10.1186/s12913-022-08700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 10/19/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
To inform quality improvement and strengthen services provided in the last year of life, measuring quality of care is essential. For Germany, data on care experiences in the last year of life that go beyond diagnoses and care settings are still rare. The aim of this study was to develop and validate a German version of the ‘Views of Informal Carers’ Evaluation of Services – Short Form (VOICES-SF)’ suitable to assess the quality of care and services received across settings and healthcare providers in the German setting in the last year of life (VOICES-LYOL-Cologne).
Methods
VOICES-SF was adapted and translated following the ‘TRAPD’ team approach. Data collected in a retrospective cross-sectional survey with bereaved relatives in the region of Cologne, Germany were used to assess validity and reliability.
Results
Data from 351 bereaved relatives of adult decedents were analysed. The VOICES-LYOL-Cologne demonstrated construct validity in performing according to expected patterns, i.e. correlation of scores to care experiences and significant variability based on care settings. It further correlated with the PACIC-S9 Proxy, indicating good criterion validity. The newly added scale “subjective experiences of process and outcome of care in the last year of life” showed good internal consistency for each given care setting, except for the homecare setting. Test-retest analyses revealed no significant differences in satisfaction ratings according to the length of time since the patient’s death. Overall, our data demonstrated the feasibility of collecting patient care experiences reported by proxy-respondents across multiple care settings.
Conclusion
VOICES-LYOL-Cologne is the first German instrument to analyse care experiences in the last year of life in a comprehensive manner and encourages further research in German-speaking countries. This instrument enables the comparison of quality of care between settings and may be used to inform local and national quality improvement activities.
Trial registration
This study was registered in the German Clinical Trials Register (DRKS00011925; Date of registration: 13/06/2017).
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Voltz R, Dust G, Schippel N, Hamacher S, Payne S, Scholten N, Pfaff H, Rietz C, Strupp J. Improving regional care in the last year of life by setting up a pragmatic evidence-based Plan-Do-Study-Act cycle: results from a cross-sectional survey. BMJ Open 2020; 10:e035988. [PMID: 33234614 PMCID: PMC7689073 DOI: 10.1136/bmjopen-2019-035988] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To set up a pragmatic Plan-Do-Study-Act cycle by analysing patient experiences and determinants of satisfaction with care in the last year of life. DESIGN Cross-sectional postbereavement survey. SETTING Regional health services research and development structure representing all health and social care providers involved in the last year of life in Cologne, a city with 1 million inhabitants in Germany. PARTICIPANTS 351 bereaved relatives of adult decedents, representative for age and gender, accidental and suspicious deaths excluded. RESULTS For the majority (89%) of patients, home was the main place of care during their last year of life. Nevertheless, 91% of patients had at least one hospital admission and 42% died in hospital. Only 60% of informants reported that the decedent had been told that the disease was leading to death. Hospital physicians broke the news most often (58%), with their communication style often (30%) being rated as 'not sensitive'. Informants indicated highly positive experiences with care provided by hospices (89% 'good') and specialist palliative home care teams (87% 'good'). This proportion dropped to 41% for acute care hospitals, this rating being determined by the feeling of not being treated with respect and dignity (OR=23.80, 95% CI 7.503 to 75.498) and the impression that hospitals did not work well together with other services (OR=8.37, 95% CI 2.141 to 32.71). CONCLUSIONS Following those data, our regional priority for action now is improvement of care in acute hospitals, with two new projects starting, first, how to recognise and communicate a limited life span, and second, how to improve care during the dying phase. Results and further improvement projects will be discussed in a working group with the city of Cologne, and repeating this survey in 2 years will be able to measure regional achievements. TRIAL REGISTRATION NUMBER DRKS00011925.
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Affiliation(s)
- Raymond Voltz
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Clinical Trials Center(ZKS), University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Health Services Research, University of Cologne, Cologne, Germany
| | - Gloria Dust
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Nicolas Schippel
- Faculty of Human Sciences and Faculty of Medicine, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Stefanie Hamacher
- Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Sheila Payne
- Faculty of Health and Medicine, Division of Health Research, University of Lancaster, Lancaster, UK
| | - Nadine Scholten
- Faculty of Human Sciences and Faculty of Medicine, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Faculty of Human Sciences and Faculty of Medicine, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Christian Rietz
- Faculty of Educational and Social Sciences, Department of Educational Science, Heidelberg University of Education, Heidelberg, Germany
| | - Julia Strupp
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
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Bradby H, Lindenmeyer A, Phillimore J, Padilla B, Brand T. 'If there were doctors who could understand our problems, I would already be better': dissatisfactory health care and marginalisation in superdiverse neighbourhoods. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:739-757. [PMID: 32020646 PMCID: PMC7318273 DOI: 10.1111/1467-9566.13061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
How people in community settings describe their experience of disappointing health care, and their responses to such dissatisfaction, sheds light on the role of marginalisation and underlines the need for radically responsive service provision. Making the case for studying unprompted accounts of dissatisfaction with healthcare provision, this is an original analysis of 71 semi-structured interviews with healthcare users in superdiverse neighbourhoods in four European cities. Healthcare users spontaneously express disappointment with services that dismiss their concerns and fail to attend to their priorities. Analysing characteristics of these healthcare users show that no single aspect of marginalisation shapes the expression of disappointment. In response to disappointing health care, users sought out alternative services and to persuade reluctant service providers, and they withdrew from services, in order to access more suitable health care and to achieve personal vindication. Promoting normative quality standards for diverse and diversifying populations that access care from a range of public and private service providers is in tension with prioritising services that are responsive to individual priorities. Without an effort towards radically responsive service provision, the ideal of universal access on the basis of need gives way to normative service provision.
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Affiliation(s)
| | | | - Jenny Phillimore
- Institute for Research into Superdiversity (IRiS)School of Social PolicyUniversity of BirminghamBirminghamUK
| | - Beatriz Padilla
- Department of SociologyUniversity of South FloridaTampaUSA
- Instituto Universitario de Lisboa (ISCTE‐IUL)LisbonPortugal
| | - Tilman Brand
- Department Prevention and EvaluationLeibniz Institute for Prevention Research and Epidemiology – BIPSBremenGermany
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Ó Coimín D, Prizeman G, Korn B, Donnelly S, Hynes G. Dying in acute hospitals: voices of bereaved relatives. BMC Palliat Care 2019; 18:91. [PMID: 31672137 PMCID: PMC6824032 DOI: 10.1186/s12904-019-0464-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 09/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background Internationally there is an increasing concern about the quality of end-of-life care (EoLC) provided in acute hospitals. More people are cared for at end of life and die in acute hospitals than in any other healthcare setting. This paper reports the views of bereaved relatives on the experience of care they and the person that died received during their last admission in two university adult acute tertiary hospitals. Methods Relatives of patients who died were invited to participate in a post-bereavement postal survey. An adapted version of VOICES (Views of Informal Carers - Evaluation of Services) questionnaire was used. VOICES MaJam has 36 closed questions and four open-ended questions. Data were gathered in three waves and analysed using SPSS and NVivo. 356 respondents completed the survey (46% response rate). Results The majority of respondents (87%: n = 303) rated the quality of care as outstanding, excellent or good during the last admission to hospital. The quality of care by nurses, doctors and other staff was highly rated. Overall, care needs were well met; however, findings identified areas of care which could be improved, including communication and the provision of emotional and spiritual support. In addition, relatives strongly endorsed the provision of EoLC in single occupancy rooms, the availability of family rooms on acute hospital wards and the provision of bereavement support. Conclusions This research provides a powerful snapshot in time into what works well and what could be improved in EoLC in acute hospitals. Findings are reported under several themes, including the overall quality of care, meeting care needs, communication, the hospital environment and support for relatives. Results indicate that improvements can be made that build on existing good practice that will enhance the experience of care for dying persons and their relatives. The study adds insights in relation to relative’s priorities for EoLC in acute hospitals and can advance care providers’, policy makers’ and educationalists’ priorities for service improvement.
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Affiliation(s)
- Diarmuid Ó Coimín
- End-of-Life Care, Mater Misericordiae University Hospital, Quality and Patient Safety Directorate, Eccles Street, Dublin 7, Ireland.
| | - Geraldine Prizeman
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Bettina Korn
- End-of-Life Care, Hospice Friendly Hospital Programme, 1st Floor CEO Building, St. James's Hospital, James Street, Dublin 8, Ireland
| | - Sarah Donnelly
- Social Work, School of Social Policy, Social Work and Social Justice, University College, Dublin, Ireland
| | - Geralyn Hynes
- Palliative Care, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Stajduhar KI. Examining the Perspectives of Family Members Involved in the Delivery of Palliative Care at Home. J Palliat Care 2019. [DOI: 10.1177/082585970301900106] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This ethnographic study examined the social context of home-based palliative caregiving. Data were composed of observation field notes, interviews, and textual documents, and were analyzed using constant comparative methods. Findings show that home-based palliative caregiving resulted in life-enriching experiences for many caregivers. However, assumptions about dying at home and health care reforms resulted in some caregivers feeling “pressured” to provide home care, and consequently, left them feeling their obligations to care were exploited by the health care system. Shifts toward providing care closer to home not only changed caregivers, but also changed the home setting where palliative care was provided. Findings indicate a need for interventions designed to improve support for caregivers at home, and to explore how assumptions influence and sometimes drive the provision of home health care.
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Affiliation(s)
- Kelli I. Stajduhar
- Centre on Aging, University of Victoria, and Vancouver Island Health Authority, Victoria, British Columbia, Canada
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8
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Preisler M, Rohrmoser A, Goerling U, Kendel F, Bär K, Riemer M, Heuse S, Letsch A. Early palliative care for those who care: A qualitative exploration of cancer caregivers’ information needs during hospital stays. Eur J Cancer Care (Engl) 2019; 28:e12990. [DOI: 10.1111/ecc.12990] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 10/08/2018] [Accepted: 12/16/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Martina Preisler
- Medical Department, Division of Hematology and Oncology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Amy Rohrmoser
- Medical Department, Charité Comprehensive Cancer Center; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Ute Goerling
- Medical Department, Charité Comprehensive Cancer Center; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Friederike Kendel
- Institute of Medical Psychology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - Konrad Bär
- Medical Department, Division of Hematology and Oncology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Manuel Riemer
- Wilfrid Laurier University; Department of Psychology; Waterloo Ontario Canada
| | - Silke Heuse
- Institute of Medical Psychology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - Anne Letsch
- Medical Department, Division of Hematology and Oncology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
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9
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Centeno C, Arantzamendi M, Rodríguez B, Tavares M. Letters from Relatives: A Source of Information Providing Rich Insight into the experience of the Family in Palliative Care. J Palliat Care 2018. [DOI: 10.1177/082585971002600305] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies on the effectiveness and efficiency of palliative care (PC) services that use a methodology similar to that used by studies in other medical specialties face serious limitations, since the goals of PC are substantially different. Qualitative research methods can make an important contribution to our understanding of the features of palliative care (PC) that are most relevant to patients and their relatives. The goal of this study was to understand the reasons behind the gratitude shown in letters from bereaved relatives sent to two PC units, one in Spain and one in Portugal. A thematic analysis of the content of the letters was independently carried out by three researchers, who later collaborated to write up the results. Relatives appeared grateful primarily for the humane attitude, professional treatment, and emotional support that their loved ones received from the PC team; they thanked the team for creating a special atmosphere and offering holistic care, and they talked about the contrast between PC and other forms of care. The unsolicited gratitude expressed in their letters constitutes a valid and particularly rich source of information about the contribution that a PC team can make.
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Affiliation(s)
- Carlos Centeno
- M Arantzamendi (corresponding author): Escuela de Enfermería, Universidad de Navarra, Irunlarrea 1, 31008 Pamplona,
| | - María Arantzamendi
- C Centeno: Unidad de Medicina Paliativa y Control de Síntomas, Clínica Universidad de Navarra, Pamplona, Spain
| | - Belén Rodríguez
- B Rodríguez: Unidad de Cuidados Paliativos, Hospital Los Montalvos, Complejo Hospital Universitario de Salamanca, Salamanca, Spain
| | - Miguel Tavares
- M Tavares: Serviço de Cuidados Paliativos, Instituto Português de Oncologia, Porto, Portugal
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Stajduhar KI, Funk L, Cohen SR, Williams A, Bidgood D, Allan D, Norgrove L, Heyland D. Bereaved Family Members’ assessments of the quality of End-Of-Life Care: What is Important? J Palliat Care 2018. [DOI: 10.1177/082585971102700402] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Families of patients are well poised to comment on the end-of-life (EOL) care received by those patients and can provide feedback to care providers and decision makers. To better understand family-member evaluations of the quality of in-patient EOL care, this study draws on qualitative interview data (n=24) to identify core aspects of EOL care that are important for family members. Based on this analysis, a conceptual framework of family members’ assessments of their experiences with EOL health care services is developed. Findings suggest the need to distinguish between perceived substantive or tangible features of received care, interpretations of the causes and symbolic meanings of that care, and personal and affective outcomes. Practitioners are encouraged to reflect on how behaviours and communications may be interpreted by families. Attention also needs to be given to the changes in practice and organizational decision making that can facilitate more positive experiences for families and patients.
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Affiliation(s)
- Kelli I. Stajduhar
- KI Stajduhar (corresponding author) School of Nursing and Centre on Aging, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia, Canada V8W 2Y2
| | - Laura Funk
- Centre on Aging, University of Victoria, Victoria, British Columbia, Canada
| | - S. Robin Cohen
- Jewish General Hospital, Montreal, Quebec, Canada; A Williams: School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Allison Williams
- Jewish General Hospital, Montreal, Quebec, Canada; A Williams: School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Darcee Bidgood
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Diane Allan
- Saanich Peninsula Hospital, Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Leah Norgrove
- Department of Community Health and Epidemiology, Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - Daren Heyland
- Saanich Peninsula Hospital, Vancouver Island Health Authority, Victoria, British Columbia, Canada
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11
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Gourdji I, Mcvey L, Purden M. A Quality end of Life from A Palliative Care Patient's Perspective. J Palliat Care 2018. [DOI: 10.1177/082585970902500105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study explored the meaning of quality of life (QOL) from the perspective of palliative care patients by examining their lived experiences and their perceptions of what contributes to their QOL. Ten in-patients — five women and five men — took part in in-depth, semi-structured interviews. When asked about their QOL, they spoke about three distinct aspects: the meaning of a quality life at this stage in their illness trajectory, the experience of living with the illness, and factors that contributed to their QOL. Patients’ approach to life, illness life, and ideal quality life were found to create a sphere of influence that shaped their end-of-life experience. At the heart of living a quality end of life for these patients was their ability to “do the things that I usually do,” “be helpful to others,” and “live in a caring environment,” The findings highlight the importance of understanding each of these factors: patients’ approach to life, illness life, and ideal quality of life, and what they mean to patients in order to tailor interventions to enhance their QOL.
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Affiliation(s)
- Iris Gourdji
- Sir Mortimer B. Davis-Jewish General Hospital and School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Lynne Mcvey
- Sir Mortimer B. Davis-Jewish General Hospital and School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Margaret Purden
- Sir Mortimer B. Davis-Jewish General Hospital and School of Nursing, McGill University, Montreal, Quebec, Canada
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Heyland DK, Frank C, Tranmer J, Paul N, Pichora D, Jiang X, Day AG. Satisfaction with End-Of-Life Care: A Longitudinal study of Patients and Their Family Caregivers in the Last months of Life. J Palliat Care 2018. [DOI: 10.1177/082585970902500402] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To determine whether and how ratings of satisfaction with end-of-life (EOL) care change over time and across settings, we administered a satisfaction questionnaire to patients 55 years and older with advanced medical disease and their family caregivers (FCGs). We re-interviewed approximately every two months for a maximum of four visits. Overall, 97 patients and 68 FCGs completed a baseline interview; 57 and 40 completed two interviews, 35 and 22 completed three, and 15 and 10 completed four. Patient satisfaction increased over time and in three of the six questionnaire domains, but this was largely confounded with the location of interview. Satisfaction scores were greater among patients whose baseline interviews occurred at home. FCGs reported increased satisfaction over time; members of the subgroup that cared for patients who died during the study were less satisfied in the spirituality domain during bereavement than prior to their relative's death. Satisfaction with care tends to vary based on location of interview and may vary across time with respect to certain aspects of EOL care.
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Affiliation(s)
- Daren K. Heyland
- D Heyland (corresponding author): Clinical Evaluation Research Unit, Angada 4, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, Canada K7L 2V7
| | - Christopher Frank
- N Paul, X Jiang, A Day: Clinical Evaluation Research Unit, Kingston General Hospital
| | - Joan Tranmer
- D Heyland: Department of Medicine, Kingston General Hospital
| | - Nancy Paul
- D Heyland, J Tranmer, D Pichora: Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Deborah Pichora
- C Frank: Department of Medicine, Division of Geriatric Medicine, St. Mary's of the Lake Hospital, Queen's University
| | - Xuran Jiang
- J Tramer, D Pichora: School of Nursing, Kingston General Hospital
| | - Andrew G. Day
- N Paul, X Jiang, A Day: Clinical Evaluation Research Unit, Kingston General Hospital
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13
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Langegård U, Ahlberg K, Fransson P, Johansson B, Sjövall K, Bjork-Eriksson T, Ohlsson-Nevo E. Evaluation of quality of care in relation to health-related quality of life of patients diagnosed with brain tumor: a novel clinic for proton beam therapy. Support Care Cancer 2018; 27:2679-2691. [PMID: 30484013 PMCID: PMC6541566 DOI: 10.1007/s00520-018-4557-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/15/2018] [Indexed: 12/31/2022]
Abstract
Purpose Patients with brain tumors constitute a vulnerable group, and it is important that they receive the highest quality of care (QoC). The study aim was to describe the perceptions of QoC and its association with health-related quality of life in brain tumor patients undergoing proton beam therapy in a newly established clinic. Method Data were collected at the start of treatment and after 3 and 6 weeks. Adult patients (≥ 18 years old) with brain tumors (n = 186) completed two self-administered questionnaires: a modified Quality from the Patients’ Perspective, which measures perceived reality and subjective importance of care, and the EORTC QLQ-C30. Data were analyzed using parametric and non-parametric statistical tests. Results The perceived QoC was highest for treatment information and lowest for dietician and smoking information, whereas interaction with doctors and nurses was rated as the most important aspect of quality of care. Subjective importance ratings were significantly higher than perceived reality ratings for 60% of items. A better global health was moderately correlated with a higher perceived support for fatigue. Conclusions A need for quality improvement was identified for several aspects of patient care. Greater symptom distress during the treatment period led to greater perceived importance of symptom support. Ensuring QoC is complex and collaboration with other health care professionals is essential. Relevance to clinical practice The clinic could improve QoC regarding information about possible symptoms, adjust care according to patient perceptions of importance, and involve patients in care decisions. Electronic supplementary material The online version of this article (10.1007/s00520-018-4557-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulrica Langegård
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, Box 457, 405 30, Göteborg, Sweden.
| | - Karin Ahlberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, Box 457, 405 30, Göteborg, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden.,Cancercentrum, Norrlands University Hospital, Umeå, Sweden
| | - Birgitta Johansson
- Experimental Oncology, Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Katarina Sjövall
- Department of Oncology, Skane University Hospital, Scania, Sweden.,Department of Oncology, Lund University, Lund, Sweden
| | - Thomas Bjork-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,The Skandion Clinic, Uppsala, Sweden.,Regional Cancer Center West, Gothenburg, Sweden
| | - Emma Ohlsson-Nevo
- University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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14
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Donnelly S, Prizeman G, Coimín DÓ, Korn B, Hynes G. Voices that matter: end-of-life care in two acute hospitals from the perspective of bereaved relatives. BMC Palliat Care 2018; 17:117. [PMID: 30340568 PMCID: PMC6195738 DOI: 10.1186/s12904-018-0365-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background End-of-life care (EoLC) is an experience that touches the lives of everyone. Dying in an acute hospital is a common occurrence in developed countries across the world. Previous studies have shown that there is wide variation in EoLC and at times is experienced as being of poor quality. Assessing and measuring the quality of care provided is a key component of all healthcare systems. This paper reports on the qualitative analysis of open-ended free text questions that were asked as part of a post-bereavement survey conducted in two adult acute hospitals in Ireland. Methods This was a quantitative descriptive post-bereavement postal survey, gathering data retrospectively from relatives or friends of patients who died, utilising an adapted version of the VOICES (Views of Informal Carers - Evaluation of Services) questionnaire. VOICES MaJam has 29 core questions, seven questions requesting personal demographic information and four open-ended questions gathering descriptive data about the care experience during the patient’s last admission to hospital. A total of 356 valid questionnaires were returned. Qualitative data were managed, coded and analysed with NVivo 10, using a template analysis framework approach. Results Three quarters (75%: n = 268) responded to at least one of the open-ended questions. Several key themes emerged, indicating areas that require particular attention in EoLC. Two themes relate to how care needs are met and how the hospital environment has a critical influence on EoLC experiences. The remaining three themes relate more to the interpersonal context including whether patients are treated with dignity and respect, the psychological, emotional and spiritual needs of patients and their family members and communication. Conclusions Acute hospitals need to ensure that patients and their relatives receive high quality EoLC. Seeking the views of bereaved relatives should be considered by all hospitals and healthcare settings to ascertain the quality of care at end of life. This study contributes to our understanding and knowledge of what good EoLC looks like and where care can be improved, thus enabling hospitals to direct and inform quality improvement.
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Affiliation(s)
- Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Geraldine Prizeman
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02 T283, Ireland
| | - Diarmuid Ó Coimín
- Mater Misericordiae University Hospital, Quality and Patient Safety Directorate, Eccles Street, Dublin 7, Ireland
| | - Bettina Korn
- 1st Floor CEO Building, St. James's Hospital, James Street, Dublin 8, Ireland
| | - Geralyn Hynes
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02 T283, Ireland
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15
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Funk LM, Peters S, Roger KS. Caring about dying persons and their families: Interpretation, practice and emotional labour. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:519-526. [PMID: 29462841 DOI: 10.1111/hsc.12559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 06/08/2023]
Abstract
The importance of emotional support for dying persons and their families has been well established, yet we know less about how care workers understand emotional processes related to death and dying, or how these understandings are connected to care practices and emotional labour at the end of life. The aim of this study was to explore how healthcare workers interpret and respond to emotional needs of dying persons and their families. Qualitative data were collected between 2013 and 2014 through in-depth, in-person interviews with 14 nurses and 12 healthcare aides in one Western Canadian city. Transcripts were analysed using an inductive, interpretive thematic coding approach and the analytic lens of emotional labour. Dominant interpretive frames of a "good death" informed participants' emotionally supportive practice. This included guiding patients and families to "open up" about their emotions to activate the grief process. There was concern that incomplete grieving would result in anger being directed towards care staff. The goal of promoting emotional sharing informed the work of "caring about." Although palliative philosophies opened up moral and professional space for "caring about" in the context of organisational norms which often discouraged these practices, the tension between the two, and the lack of time for this work, may encourage surface expressions rather than authentic emotional care.
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Affiliation(s)
- Laura M Funk
- Department of Sociology, University of Manitoba, Winnipeg, MB, Canada
| | - Sheryl Peters
- School of Nursing, University of Manitoba, Winnipeg, MB, Canada
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16
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Ross L, Neergaard MA, Petersen MA, Groenvold M. Measuring the quality of end-of-life care: Development, testing, and cultural validation of the Danish version of Views of Informal Carers' Evaluation of Services-Short Form. Palliat Med 2018; 32:804-814. [PMID: 29130380 DOI: 10.1177/0269216317740274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The perspectives of patients and relatives are important in the improvement of the quality of health care. However, the quality of end-of-life care has not been systematically evaluated in Scandinavia. AIM To develop or adapt and subsequently validate a questionnaire assessing the quality of end-of-life care in Denmark. The questionnaire was intended for bereaved relatives in order to assess the quality of care in the last 3 months of the patient's life and the circumstances surrounding death. DESIGN AND DATA SOURCES Based on the literature and interviews with 15 bereaved relatives and 17 healthcare professionals, relevant topics to include in a questionnaire were identified. The topics were prioritized by 100 bereaved relatives and subsequently compared to existing questionnaires. The chosen questionnaire was tested by cognitive interviews with 36 bereaved relatives. RESULTS Most of the important topics were covered by the Views of Informal Carers' Evaluation of Services-Short Form, but not all Danish settings (e.g. home care by a palliative team) were covered. These settings were added to the Views of Informal Carers' Evaluation of Services-Short Form, and a few adaptations were made before a Danish version of the Views of Informal Carers' Evaluation of Services-Short Form was tested by cognitive interviews. This cultural validation showed that the slightly adapted Danish version was perceived as relevant, understandable, and acceptable. Furthermore, the cognitive interviews gave insight in the comprehension and interpretation of Views of Informal Carers' Evaluation of Services-Short Form items. CONCLUSION With a few adaptations, the British Views of Informal Carers' Evaluation of Services-Short Form was relevant in a Danish setting.
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Affiliation(s)
- Lone Ross
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - Mette Asbjoern Neergaard
- 2 The Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | - Morten Aagaard Petersen
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - Mogens Groenvold
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark.,3 Department of Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
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17
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Virdun C, Luckett T, Lorenz K, Davidson PM, Phillips J. Dying in the hospital setting: A meta-synthesis identifying the elements of end-of-life care that patients and their families describe as being important. Palliat Med 2017; 31:587-601. [PMID: 27932631 DOI: 10.1177/0269216316673547] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite most expected deaths occurring in hospital, optimal end-of-life care is not available for all in this setting. AIM To gain a richer and deeper understanding of elements of end-of-life care that consumers consider most important within the hospital setting. DESIGN A meta-synthesis. DATA SOURCES A systematic search of Academic Search Complete, AMED, CINAHL, MEDLINE, EMBASE, PsycINFO, PubMed, Google, Google Scholar and CareSearch for qualitative studies published between 1990 and April 2015 reporting statements by consumers regarding important elements of end-of-life hospital care. Study quality was appraised by two independent researchers using an established checklist. A three-stage synthesis approach focusing on consumer quotes, rather than primary author themes, was adopted for this review. RESULTS Of 1922 articles, 16 met the inclusion criteria providing patient and family data for analysis. Synthesis yielded 7 patient and 10 family themes including 6 common themes: (1) expert care, (2) effective communication and shared decision-making, (3) respectful and compassionate care, (4) adequate environment for care, (5) family involvement and (6) financial affairs. Maintenance of sense of self was the additional patient theme, while the four additional family themes were as follows: (1) maintenance of patient safety, (2) preparation for death, (3) care extending to the family after patient death and (4) enabling patient choice at the end of life. CONCLUSION Consumer narratives help to provide a clearer direction as to what is important for hospital end-of-life care. Systems are needed to enable optimal end-of-life care, in accordance with consumer priorities, and embedded into routine hospital care.
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Affiliation(s)
- Claudia Virdun
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
| | - Tim Luckett
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
| | - Karl Lorenz
- 2 Center for Innovation to Implementation, VA Palo Alto Health Care System, USA.,3 The RAND Corporation, USA.,8 Stanford School of Medicine, USA
| | - Patricia M Davidson
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia.,4 School of Nursing, Johns Hopkins University (JHU), Baltimore, MD, USA.,5 St. Vincent's Hospital, Sydney, NSW, Australia
| | - Jane Phillips
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia.,2 Center for Innovation to Implementation, VA Palo Alto Health Care System, USA.,6 School of Nursing, Sydney, The University of Notre Dame Australia, Sydney, NSW, Australia.,7 Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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18
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Measuring Family Members' Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4621592. [PMID: 28706945 PMCID: PMC5494554 DOI: 10.1155/2017/4621592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/28/2017] [Accepted: 04/20/2017] [Indexed: 11/17/2022]
Abstract
RATIONALE Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families' satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families' perceptions of the EOLC experience and to be self-administered. METHODS AND RESULTS Phase 1. A literature review identified key domains of satisfaction with EOLC in LTC, and original survey items were assessed for inclusiveness and relevance. Items were modified, and one item was added. PHASE 2 The revised questionnaire was administered to 118 LTC family members and cognitive interviews were conducted. Further modifications were made including reformatting to be self-administered. PHASE 3 The new instrument was pilot-tested with 134 family members. Importance ratings indicated good content and face validity. Cronbach's alpha coefficients (range: .88-.94) indicated internal consistency. CONCLUSION This research adapted and pilot-tested the CANHELP for use in LTC. This paper introduces the new, valid, internally consistent, self-administered tool (CANHELP Lite Family Caregiver LTC) that can be used to measure families' perceptions of and satisfaction with EOLC. Future research should further validate the instrument and test its usefulness for quality improvement and care planning.
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19
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Khademi M, Mohammadi E, Vanaki Z. On the violation of hospitalized patients' rights: A qualitative study. Nurs Ethics 2017; 26:576-586. [PMID: 28604227 DOI: 10.1177/0969733017709334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Nurses have always been known as an advocate for the rights of patients. The recognition of what is perceived as the violation of patients' rights can help nurses to understand patients' concerns and priorities. Thus, it helps nurses play their supportive roles more effectively. OBJECTIVE: The aim of this study was to explore different dimensions of the violation of patients' rights. RESEARCH DESIGN: Data were collected utilizing unstructured interviews and field notes. Data analysis was conducted using the qualitative content analysis approach. Prolonged engagement, maximum variation sampling, and member check were among the factors which enriched the research. PARTICIPANTS AND RESEARCH CONTEXT: The sample consisted of 18 patients and 11 members of their families. They were purposively selected from two hospitals in Tehran during 2009-2012. ETHICAL CONSIDERATIONS: The research was approved by the Ethics Committee of the university and hospitals. FINDING: The patients' rights were violated in a variety of ways. There were three main dimensions to this issue: (a) care recession including deprivation of the caregiver's presence and the delay/lack of needed responses; (b) receiving mechanical care including superficiality, lack of emotion, and failure to understand the situation; and (c) being disrespected including humility and aggression. CONCLUSION: The patients and their families consider any shortcomings in relation to the patient and the quality of care as the violation of the rights. The findings of the study imply sensitizing managers toward providing appropriate conditions as well as educating nurses to observe patients' rights. It is suggested that the processes leading to the violation of patients' rights be discovered and prevented in the future.
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Affiliation(s)
- Mojgan Khademi
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Iran; Tarbiat Modares University, Iran
| | | | - Zohreh Vanaki
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Iran
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20
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Schwei RJ, Johnson TP, Matthews AK, Jacobs EA. Perceptions of negative health-care experiences and self-reported health behavior change in three racial and ethnic groups. ETHNICITY & HEALTH 2017; 22:156-168. [PMID: 27748134 PMCID: PMC5548094 DOI: 10.1080/13557858.2016.1244621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Our two study objectives were: (1) to understand the relationship between the perception of a previous negative health-care experience and race/ethnicity, and how socio-demographic, access-to-health-care, and self-reported health variables modified this relationship; and (2) to assess how many behaviors participants reported changing as a result of experiencing a perceived negative health-care experience, which behaviors they changed, and if there were differences in patterns of change across racial/ethnic groups. DESIGN We conducted a cross-sectional survey of a convenience sample of 600 African-American, Mexican-Hispanic, and white adults in socioeconomically diverse neighborhoods in Chicago, IL. We used multivariable logistic regression to analyze the relationship between a perceived negative health-care experience in the last 5 years and race/ethnicity. We summed and then calculated the percentage of people who changed each of the 10 behaviors and evaluated whether or not there were differences in behavior change across racial/ethnic groups. PRINCIPAL FINDINGS More than 32% of participants reported a perceived negative health-care experience in the past 5 years. Participants who had a bachelor's degree or above (OR: 2.95, 95%CI: 1.01-8.63), avoided needed care due to cost (OR: 1.84, 95%CI: 1.11-3.06), or who reported fair/poor health (OR: 3.58, 95%CI: 1.66-7.80) had significantly increased odds of reporting a negative health-care experience. Of these people, 88% reported 'sometimes/always' changing at least one health-seeking behavior. There were no racial/ethnic differences in reporting negative experiences or in patterns of behavior change. CONCLUSIONS Race/ethnicity was not related to reporting a perceived negative health-care experience or reported patterns of behavior change in response to that experience. However, those who avoided care due to cost were more highly educated, or who indicated poorer health status reported having a negative experience more often. Our findings suggest that the perception of a previous negative experience may influence subsequent health-care-seeking behaviors.
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Affiliation(s)
- Rebecca J Schwei
- a Department of Medicine , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Timothy P Johnson
- b Institute for Health Research and Policy, University of Illinois at Chicago , Chicago , IL , USA
| | - Alicia K Matthews
- b Institute for Health Research and Policy, University of Illinois at Chicago , Chicago , IL , USA
| | - Elizabeth A Jacobs
- c Departments of Medicine & Population Health Sciences , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
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21
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Bailey C, Hewison A, Karasouli E, Staniszewska S, Munday D. Hospital care following emergency admission: a critical incident case study of the experiences of patients with advanced lung cancer and Chronic Obstructive Pulmonary Disease. J Clin Nurs 2016; 25:2168-79. [PMID: 27139373 DOI: 10.1111/jocn.13170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and lung cancer, their carers and healthcare professionals following emergency admission to acute care hospital. BACKGROUND Emergency admissions of people with lung cancer and COPD have increased and there is global concern about the number of patients who die in hospital. The experience of patients with advanced lung cancer and COPD admitted to hospital as an emergency when nearing the end of life has not previously been investigated. DESIGN Qualitative critical incident case study. METHODS Semistructured interviews were conducted with 39 patients (15 with COPD and 24 with lung cancer), 20 informal carers and 50 healthcare professionals, exploring patients' experiences of emergency hospital admission. Interviews took place after admission and following discharge. Participants nominated relatives and healthcare professionals for interview. Data were analysed thematically. RESULTS Patients were satisfied with their 'emergency' care but not the care they received once their initial symptoms had been stabilised. The poorer quality care they experienced was characterised by a lack of attention to their fundamental needs, lack of involvement of the family, poor communication about care plans and a lack of continuity between primary and secondary care. A conceptual model of 'spectacular' and 'subtacular' trajectories of care was used to relate the findings to the wider context of health care provision. CONCLUSION The complex nature of illness for patients with advanced respiratory disease makes emergency hospital admissions likely. Whilst patients (with COPD and lung cancer) were satisfied with care in the acute 'spectacular' phase of their admission, more attention needs to be given to the continuing care needs of patients in the 'subtacular' phase. RELEVANCE TO CLINICAL PRACTICE This is the first study to explore the patient experience of acute care following an emergency admission and identifies where there is potential for care to be improved.
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Affiliation(s)
- Cara Bailey
- Nursing, Health and Population Sciences, Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alistair Hewison
- Nursing, Health and Population Sciences, Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Eleni Karasouli
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sophie Staniszewska
- RCN Research Institute, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Daniel Munday
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Reilly CC, Bausewein C, Pannell C, Moxham J, Jolley CJ, Higginson IJ. Patients' experiences of a new integrated breathlessness support service for patients with refractory breathlessness: Results of a postal survey. Palliat Med 2016; 30:313-22. [PMID: 26311570 PMCID: PMC4778380 DOI: 10.1177/0269216315600103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We developed a new single point of access to integrated palliative care, respiratory medicine and physiotherapy: the breathlessness support service for patients with advanced disease and refractory breathlessness. This study aimed to describe patients' experiences of the service and identify the aspects valued. DESIGN We attempted to survey all patients who had attended and completed the 6-week breathlessness support service intervention by sending them a postal questionnaire to self-complete covering experience, composition, effectiveness of the BSS and about participation in research. Data were analysed using descriptive statistics and thematic analysis of free text comments. RESULTS Of the 70 postal questionnaires sent out, 25 (36%) returned. A total of 21 (84% (95% confidence interval: 69%-98%)) responding patients reported that they definitely found the breathlessness support service helpful and 13 (52% (95% confidence interval: 32%-72%)) rated the breathlessness support service as excellent. A total of 21 (84% (95% confidence interval: 69%-98%)) patients reported that the breathlessness support service helped with their management of their breathlessness along with additional symptoms and activities (e.g. mood and mobility). Four key themes were identified: (1) personalised care, (2) caring nature of the staff, (3) importance of patient education to empower patients and (4) effectiveness of context-specific breathlessness interventions. These were specific aspects that patients valued. CONCLUSION Patients' satisfaction with the breathlessness support service was high, and identified as important to this was a combination of personalised care, nature of staff, education and empowerment, and use of specific interventions. These components would be important in any future breathlessness service.
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Affiliation(s)
- Charles C Reilly
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Claudia Bausewein
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK Department for Palliative Medicine, Munich University Hospital, Munich, Germany
| | - Caty Pannell
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - John Moxham
- Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK
| | - Caroline J Jolley
- Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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Hill H, Evans JM, Forbat L. Nurses respond to patients' psychosocial needs by dealing, ducking, diverting and deferring: an observational study of a hospice ward. BMC Nurs 2015; 14:60. [PMID: 26582969 PMCID: PMC4650322 DOI: 10.1186/s12912-015-0112-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosocial support is considered a central component of nursing care but it remains unclear as to exactly how this is implemented in practice. The aim of this study was to provide a descriptive exploration of how psychosocial needs (PNs) of patients in a hospice ward are expressed and met, in order to develop an understanding of the provision of psychosocial support in practice. METHODS An embedded mixed-methods study was conducted in one hospice ward. Data collection included observations of patients' expressions of PNs and nurses' responses to those expressed PNs, shift hand-overs and multi-disciplinary meetings. Interviews about the observed care were conducted with the patients and nurses and nursing documentation pertaining to psychosocial care was collated. Descriptive statistical techniques were applied to quantitative data in order to explore and support the qualitative observational, interview and documentary data. RESULTS During the 8-month period of observation, 227 encounters within 38 episodes of care were observed among 38 nurses and 47 patients. Within these encounters, 330 PNs were expressed. Nurses were observed immediately responding to expressed PNs in one of four ways: dealing (44.2 %), deferring (14.8 %), diverting (10.3 %) and ducking (30.7 %). However, it is rare that one type of PN was clearly expressed on its own: many were expressed at the same time and usually while the patient was interacting with the nurse for another reason, thus making the provision of psychosocial support challenging. The nurses' response patterns varied little according to type of need. CONCLUSIONS The provision of psychosocial support is very complex and PNs are not always easily recognised. This study has allowed an exploration of the actual PNs of patients in a hospice setting, the way in which they were expressed, and how nurses responded to them. The nurses faced the challenge of responding to PNs whilst carrying out the other duties of their shift, and the fact that nurses can provide psychosocial support as an inherent component of practice was verified. The data included in this paper, and the discussions around the observed care, provides nurses everywhere with an example against which to compare their own practice.
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Affiliation(s)
- Hazel Hill
- School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Josie Mm Evans
- School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Liz Forbat
- Australian Catholic University and Calvary Health Care, Canberra, 2600 Australia
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24
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Exploring information provision in reconstructive breast surgery: A qualitative study. Breast 2015; 24:732-8. [PMID: 26422125 DOI: 10.1016/j.breast.2015.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 02/12/2015] [Accepted: 09/07/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Women considering reconstructive breast surgery (RBS) require adequate information to make informed treatment decisions. This study explored patients' and health professionals' (HPs) perceptions of the adequacy of information provided for decision-making in RBS. METHODS Semi-structured interviews with a purposive sample of patients who had undergone RBS and HPs providing specialist care explored participants' experiences of information provision prior to RBS. RESULTS Professionals reported providing standardised verbal, written and photographic information about the process and outcomes of surgery. Women, by contrast, reported varying levels of information provision. Some felt fully-informed but others perceived they had received insufficient information about available treatment options or possible outcomes of surgery to make an informed decision. CONCLUSIONS Women need adequate information to make informed decisions about RBS and current practice may not meet women's needs. Minimum agreed standards of information provision, especially about alternative types of reconstruction, are recommended to improve decision-making in RBS.
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Pringle J, Johnston B, Buchanan D. Dignity and patient-centred care for people with palliative care needs in the acute hospital setting: A systematic review. Palliat Med 2015; 29:675-94. [PMID: 25802322 DOI: 10.1177/0269216315575681] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A core concept behind patient-centred approaches is the need to treat people with, and preserve, dignity in care settings. People receiving palliative care are one group who may have particularly sensitive needs in terms of their condition, symptoms and life expectancy. Dignity is more likely to be violated in hospital settings. Given the high percentage of people with palliative care needs who are admitted to hospital during their last year of life, the provision of dignity enhancing and preserving care in that setting is of vital importance. AIM To examine international evidence relating to dignity and person-centred care for people with palliative care needs in the acute hospital setting. DESIGN A systematic literature review was conducted, incorporating data extraction, analysis and quality appraisal of included papers. DATA SOURCES MEDLINE, CINAHL, PsycINFO, ASSIA, EMBASE, Cochrane Database and Web of Science. Inclusion dates: 1 January 2000-1 April 2014. ELIGIBILITY CRITERIA Adult palliative care, acute care setting, dignity or person-centred care. RESULTS In all, 33 papers met the inclusion criteria for the review. Papers highlighted the many and varied potential threats to dignity for people with palliative care needs in acute settings, including symptom control and existential distress, approaches and models in care provision and healthcare settings and design. CONCLUSION Acute hospital staff require adequate training, including symptom control, and the correct environment in which to deliver dignified and person-centred end-of-life care. Specific models/approaches to care can be beneficial, if adequate training regarding implementation is given. The needs of family members also require consideration, particularly following bereavement.
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Affiliation(s)
- Jan Pringle
- School of Education, Social Work and Community Education, University of Dundee, Dundee, UK
| | - Bridget Johnston
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, The University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Rasouli O, Zarei MH. Monitoring and reducing patient dissatisfaction: a case study of an Iranian public hospital. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2015. [DOI: 10.1080/14783363.2015.1016869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Watts T. Final-year nursing undergraduates' understandings of palliative care: a qualitative study in Wales, UK. Int J Palliat Nurs 2014; 20:285-93. [PMID: 25040864 DOI: 10.12968/ijpn.2014.20.6.285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND With worldwide population ageing and the increasing prevalence of chronic conditions, government policies promoting palliative care, and evidence of disparate or even blurred conceptions of palliative care, it is important for educators and practitioners who support undergraduate nurses to establish how these students conceptualise palliative care. Today's students are tomorrow's nurses, and their understanding will shape the ways in which palliative care is integrated into their professional practice. AIM The aim of this work was to explore nursing undergraduates' understandings of palliative care. METHODS As part of a larger qualitative study of palliative care for people with advanced dementia, 11 final-year adult-field nursing undergraduates' understandings of palliative care were explored through in-depth individual interviews. The data was subject to thematic content analysis. FINDINGS The analysis revealed that the participants were cognisant of the broad scope of palliative care. Moreover, they valued and appreciated compassionate comfort care and emotional support. However, their understanding was rather superficial and focused on the imminently dying phase. CONCLUSION The findings are positive as they indicate that the participants appreciated and valued compassionate person- and family-centred care. However, they also illuminate where undergraduate nurse education could be further enhanced.
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Affiliation(s)
- Tessa Watts
- Associate Professor in Nursing, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, Wales
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Bogetz JF, Ullrich CK, Berry JG. Pediatric hospital care for children with life-threatening illness and the role of palliative care. Pediatr Clin North Am 2014; 61:719-33. [PMID: 25084720 DOI: 10.1016/j.pcl.2014.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Under increasing pressure to contain costs, hospitals are challenged to provide high-quality care to an increasingly complex group of children with life-threatening illness (LTI) that often worsen over time. Pediatric palliative care is an essential component of optimal hospital care delivery for these children and their families. This article describes (1) the current landscape of pediatric hospital care for children with LTI, (2) the connection between palliative care and hospital care for such children, and (3) the relationship between health care reform and palliative care for children with LTI.
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Affiliation(s)
- Jori F Bogetz
- Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, 770 Welch Road, Suite 100, Palo Alto, CA 94304, USA.
| | - Christina K Ullrich
- Pediatric Palliative Care and Pediatric Hematology/Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Jay G Berry
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Room 212.2, 21 Autumn Street, Boston, MA 02115, USA
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O'Brien MR, Preston H. Family carer perspectives of acute hospital care following a diagnosis of motor neuron disease: a qualitative secondary analysis. BMJ Support Palliat Care 2014; 5:503-9. [PMID: 24681558 DOI: 10.1136/bmjspcare-2013-000627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/28/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The multifaceted nature of the problems faced by someone with motor neuron disease requires a knowledgeable multidisciplinary team approach. Where available, generally, such services are only provided on an outpatient basis, meaning that hospitalised patients are frequently admitted to non-specialist wards where understanding of their needs is limited. Little is known regarding the inpatient care received by patients. Our objective was to address this by exploring the experience of hospitalisation following a diagnosis of motor neuron disease from the perspective of family carers of those diagnosed with the illness. METHOD This was a qualitative secondary analysis of pre-existing data from two previously published, separately conducted, qualitative studies. The study involved interview data from 18 bereaved carers and 3 current carers of family members diagnosed with motor neuron disease in Northwest England. RESULTS The findings reveal dissatisfaction with the inpatient care received, which impacted negatively not only on patient and carer enthusiasm for future hospital admissions but also on carer bereavement. CONCLUSIONS Patients with motor neuron disease have specialist needs that are not always met during hospital admission, particularly to non-specialist units. The inpatient care provided for these patients must be improved as must the knowledge and understanding of the illness among healthcare professionals who treat them.
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Affiliation(s)
- Mary R O'Brien
- Faculty of Health & Social Care, Evidence-based Practice Research Centre (EPRC), Edge Hill University, Ormskirk, Lancashire, UK
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Thompson J, Brown J, Davies A. An evaluation of routine specialist palliative care for patients on the Liverpool Care Pathway. Int J Palliat Nurs 2014; 20:23-5. [PMID: 24464170 DOI: 10.12968/ijpn.2014.20.1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION This report describes a service evaluation of the 'added value' of routine specialist palliative care team (SPCT) involvement with patients on the Liverpool Care Pathway for the Dying Patient (LCP). METHODS In the authors' hospital, patients that are commenced on the LCP are routinely referred to the SPCT. They are reviewed on the day of referral and then at least every other day, depending on the clinical situation. The data for this report was obtained by reviewing the SPCT's clinical database and the patients' LCP proformas. RESULTS The SPCT intervened in the care of 80% of 158 newly referred patients, e.g. for alteration of continuous subcutaneous infusion (23%) or alteration of use of non-pharmacological interventions (21%). Furthermore, 11% of patients were taken off the LCP, around one quarter of whom were later put back on. CONCLUSIONS The authors' model of care could overcome many of the issues relating to the LCP and would ameliorate the developing vacuum of care for patients at the end of life.
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Affiliation(s)
- Jo Thompson
- Clinical Nurse Specialists in Palliative Care, Department of Palliative Care, Royal Surrey County Hospital, Guildford, England
| | - Jayne Brown
- Clinical Nurse Specialists in Palliative Care, Department of Palliative Care, Royal Surrey County Hospital, Guildford, England
| | - Andrew Davies
- Consultant in Palliative Medicine, Department of Palliative Care, Royal Surrey County Hospital, Guildford, England
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Crutzen R, Beekers N, van Eenbergen M, Becker M, Jongen L, van Osch L. E-loyalty towards a cancer information website: applying a theoretical framework. Psychooncology 2014; 23:685-91. [PMID: 24408565 DOI: 10.1002/pon.3471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 11/26/2013] [Accepted: 12/05/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To provide more insight into user perceptions related to e-loyalty towards a cancer information website. This is needed to assure adequate provision of high quality information during the full process of cancer treatment-from diagnosis to after care-and an important first step towards optimizing cancer information websites in order to promote e-loyalty. METHODS Participants were cancer patients (n = 63) and informal caregivers (n = 202) that visited a website providing regional information about cancer care for all types of cancer. Subsequently, they filled out a questionnaire assessing e-loyalty towards the website and user perceptions (efficiency, effectiveness, active trust and enjoyment) based on a theoretical framework derived from the field of e-commerce. A structural equation model was constructed to test the relationships between user perceptions and e-loyalty. RESULTS Participants in general could find the information they were looking for (efficiency), thought it was relevant (effectiveness) and that they could act upon it (active trust) and thought the visit itself was pleasant (enjoyment). Effectiveness and enjoyment were both positively related with e-loyalty, but this was mediated by active trust. Efficiency was positively related with e-loyalty. The explained variance of e-loyalty was high (R(2) = 0.70). CONCLUSIONS This study demonstrates that the importance of user perceptions is not limited to fields such as e-commerce but is also present within the context of cancer information websites. The high information need among participants might explain the positive relationship between efficiency and e-loyalty. Therefore, cancer information websites need to foster easy search and access of information provided.
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Affiliation(s)
- Rik Crutzen
- Maastricht University/CAPHRI, Maastricht, The Netherlands
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Robinson J, Gott M, Ingleton C. Patient and family experiences of palliative care in hospital: what do we know? An integrative review. Palliat Med 2014; 28:18-33. [PMID: 23670719 DOI: 10.1177/0269216313487568] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In most developed countries, acute hospitals play a significant role in palliative care provision and are the setting in which most people die. They are often the setting where a life-limiting diagnosis is made and where patients present when symptoms develop or when they are not well managed. Understanding the experiences of hospital admissions for people with a life-limiting illness and their families is essential in understanding the role acute hospitals play in providing palliative care. AIM The aim of this review is to synthesise current evidence regarding the experience of palliative care in an acute hospital setting from the perspectives of patient and family. DESIGN An integrative review was completed using standard processes followed by a process of data extraction and synthesis. DATA SOURCES Using predefined search terms, literature was sourced from five electronic databases including MEDLINE (EBSCO), CINAHL, EMBASE, Cochrane and PsycINFO between January 1990 and November 2011. Reference lists from relevant articles were cross-checked and pertinent journals hand searched for articles. RESULTS In total, 32 articles were included in the review. Five recurring themes were identified from the synthesised data: symptom control and burden, communication with health professionals, decision-making related to patient care and management, inadequate hospital environment and interpersonal relationships with health professionals. CONCLUSION This review has identified that, largely as a result of study design, our knowledge of patient and family experiences of palliative care in an acute hospital remains limited to discrete aspects of care. Further research is required to explore the total patient and family experience taking into account all aspects of care including the potential benefits of hospital admissions in the last year of life.
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Seymour J. Needs and preferences of patients with diseases other than cancer: the UK experience. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/096992607x196042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Shin IS, Kim JH. The effect of problem-based learning in nursing education: a meta-analysis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2013; 18:1103-20. [PMID: 23283571 DOI: 10.1007/s10459-012-9436-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/02/2012] [Indexed: 05/21/2023]
Abstract
Problem-based learning (PBL) has been identified as an approach that improves the training of nurses by teaching them how to apply theory to clinical practice and by developing their problem-solving skills, which could be used to overcome environmental constraints within clinical practice. A consensus is emerging that there is a need for systematic reviews and meta-analyses regarding a range of selected topics in nursing education. The purpose of this study was to conduct a meta-analysis of the available literature in order to synthesize the effects of PBL in nursing education. Using a number of databases, we identified studies related to the effectiveness of PBL in nursing. An analysis was conducted on a range of outcome variables, including overall effect sizes and effects of evidence and evaluation levels, learning environment, and study characteristics. We found that the effect of PBL in nursing education is 0.70 standard deviations (medium-to-large effect size). We also found that PBL has positive effects on the outcome domains of satisfaction with training, clinical education, and skill course. These results may act as a guide for nurse educators with regard to the conditions under which PBL is more effective than traditional learning strategies.
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Affiliation(s)
- In-Soo Shin
- Department of Education, College of Education, Jeonju University, Jeonju, Republic of Korea
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Exploring inequalities in access to care and the provision of choice to women seeking breast reconstruction surgery: a qualitative study. Br J Cancer 2013; 109:1181-91. [PMID: 23928662 PMCID: PMC3778305 DOI: 10.1038/bjc.2013.461] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/16/2013] [Accepted: 07/21/2013] [Indexed: 12/03/2022] Open
Abstract
Background: Breast reconstruction (BR) may improve psychosocial and cosmetic outcomes after mastectomy for breast cancer but currently, few women opt for surgery. Reasons for this are unclear. The aim of this qualitative study was to explore access to care and the provision of procedure choice to women seeking reconstructive surgery. Methods: Semi-structured interviews with a purposive sample of patients who had undergone BR and professionals providing specialist care explored participants' experiences of information provision before BR. Interviews were transcribed verbatim and analysed using the constant comparative technique of grounded theory. Sampling, data collection and analysis were performed concurrently and iteratively until data saturation was achieved. Results: Both patients and professionals expressed concerns about the provision of adequate procedure choice and access to care. Lack of information and/or time, involvement in decision making and issues relating to the evolution and organisation of reconstructive services, emerged as potential explanations for the inequalities seen. Interventions to improve cross-speciality collaboration were proposed to address these issues. Conclusion: Inequalities in the provision of choice in BR exist, which may be explained by a lack of integration between surgical specialities. Pathway restructuring, service reorganisation and standardisation of training may enhance cross-speciality collaboration and improve the patient experience.
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Stocker R, Close H. Assessing the uptake of the Liverpool Care Pathway for dying patients: a systematic review. BMJ Support Palliat Care 2013; 3:399-404. [PMID: 24950519 DOI: 10.1136/bmjspcare-2012-000406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Improving the care of the dying is regarded as a national priority and current guidelines stipulate the need to provide holistic palliative care. Despite this, many dying patients and carers report low levels of comfort and satisfaction with care. Reasons include poor coordination of care, variability in communication and crisis-driven interventions. Integrated care pathways aim to support care coordination and open communication with patients and carers. One example is the Liverpool Care Pathway (LCP). Using the LCP entails assessment of eligibility criteria which requires skills, knowledge and clinical judgement about its timing. This can be problematic, and little is known about actual uptake, characteristics of assessed patients and reasons for inclusion/exclusion. A comprehensive systematic review was conducted for papers published between January 1990 and July 2012 providing information on LCP uptake. 17 papers met inclusion criteria. A total of 18 052 patients were placed on the LCP, in a variety of inpatient and primary care settings, and cancer and non-cancer diagnoses. 47.4% of dying patients identified were placed on the LCP. Although the LCP is widely recommended, it is only used for around half of dying patients. Reasons may include lack of knowledge, high staff turnover and concerns about applicability particularly for unpredictable dying trajectories. The proportion of patients who meet the eligibility criteria and the reasons surrounding low uptake remain unclear. Research is urgently required to further quantify the variable use of the LCP, and to investigate whether alternative approaches should be developed for non-cancer groups.
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Affiliation(s)
- Rachel Stocker
- School of Medicine, Pharmacy and Health, Wolfson Research Institute, Durham University, Thornaby, Stockton-on-Tees, UK
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Weber M, Claus M, Zepf KI, Fischbeck S, Escobar Pinzon LC. Dying in Germany--unfulfilled needs of relatives in different care settings. J Pain Symptom Manage 2012; 44:542-51. [PMID: 22771131 DOI: 10.1016/j.jpainsymman.2011.10.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 10/05/2011] [Accepted: 10/10/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT The integration of family members in the dying process and the recognition of their special needs are important factors for the development of high-quality palliative care. OBJECTIVES This study aimed to explore important needs and personal experiences of relatives at the end of life, and to detect differences in these needs and experiences for various care settings. METHODS Our cross-sectional survey was based on a random sampling of 5000 inhabitants of Rhineland-Palatinate (Germany) who died between May 25 and August 24, 2008. Relatives of these randomly drawn deceased persons were interviewed by a written survey. RESULTS A total of 1378 questionnaires were completed (response rate 36.0%), with 1337 eligible for our analyses; 81.5% of the bereaved totally/partially agreed that the information received from physicians was comprehensive and sufficient; 7.5% neither agreed nor disagreed; and 11.0% partially/totally disagreed. Of the respondents, 54.1% totally/partially agreed to having received emotional support by physicians, 14.2% neither agreed nor disagreed, and 31.7% partially/totally disagreed. Physicians in nursing homes and standard hospital wards were rated less favorably. Whereas the professionals' lack of time was strongly associated with the unfulfilled needs for emotional support, many relatives also lacked this type of care when physicians seemed to have enough time. CONCLUSION The high rates of unfulfilled needs of relatives across all care settings and all types of diseases reinforce the necessity of a comprehensive palliative care approach. An increased awareness of the psychological vulnerability of caregivers should lead to dedicated efforts to improve deficits in the German health care system.
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Affiliation(s)
- Martin Weber
- Interdisciplinary Palliative Care Unit, III, Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, ObereZahlbacher Strasse 67, Mainz, Germany
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Thompson GN, McClement SE, Menec VH, Chochinov HM. Understanding bereaved family members' dissatisfaction with end-of-life care in nursing homes. J Gerontol Nurs 2012; 38:49-60. [PMID: 22998093 DOI: 10.3928/00989134-20120906-94] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 04/03/2012] [Indexed: 12/31/2022]
Abstract
With increasing numbers of older adults identifying a nursing home (NH) as their final place of care, it is important to assess the quality of dying in this setting and understand factors that impact family members' dissatisfaction with end-of-life care. A retrospective bereaved family member survey (N = 208) was conducted in 21 NHs located in urban areas of central Canada. Bereaved family members who were dissatisfied with care identified significantly more concerns in all domains assessed and were more likely to have problems with: (a) receiving confusing information from nursing staff about the resident's care, including medical treatments; (b) receiving inadequate information from nursing staff; and (c) feeling that end-of-life care was different than they had expected. Since the quality of communication between nurses, residents, and family members is the main factor that determines families' dissatisfaction with care, strategies and interventions aimed at reducing unmet information needs will be vital to improving end-of-life care in NHs.
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Funk LM, Stajduhar KI, Robin Cohen S, Heyland DK, Williams A. Legitimising and rationalising in talk about satisfaction with formal healthcare among bereaved family members. SOCIOLOGY OF HEALTH & ILLNESS 2012; 34:1010-1024. [PMID: 22384989 DOI: 10.1111/j.1467-9566.2011.01457.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
While there is a fair amount of knowledge regarding substantive features of end of life care that family members desire and appreciate, we lack full understanding of the process whereby family members formulate care evaluations. In this article we draw on an analysis of interview data from 24 bereaved family members to explicate how they interpret their experiences and formulate evaluations of end of life care services. Most participants wove between expressing and legitimising dissatisfaction, and qualifying or diffusing it. This occurred through processes of comparisons against prior care experiences and expectations, personalising (drawing on personal situations and knowledge), collectivising (drawing on conversations with and observations of others) and attempting to understand causes for their negative care experiences and to attribute responsibility. The findings suggest that dissatisfaction might be diffused even where care is experienced negatively, primarily through the acknowledgement of mitigating circumstances. To a lesser extent, some participants attributed responsibility to the 'system' (policy and decision-makers) and individual staff members. The findings are discussed in relation to the theoretical understanding of satisfaction and evaluation processes and how satisfaction data might inform improvements to care quality.
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Affiliation(s)
- Laura M Funk
- Department of Sociology, University of Manitoba, Winnipeg, Canada.
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Abstract
AIMS To discuss the intricacies of the decision-making process about initiating end-of-life care pathways. BACKGROUND Internationally, enhancing the quality of end-of-life care has become a central concern in governments' health policies. Despite limited empirical evaluation, end-of- life care pathways have been championed and widely adopted as complex interventions to enhance end-of-life care worldwide. DATA SOURCES A literature search of established electronic databases was conducted for published articles in English addressing decision-making and end-of-life care pathways between 1997-2010. Manual searches of relevant journals and internet sites were also undertaken. DISCUSSION The initiation of an end-of-life care pathway marks the transition to the terminal phase of care. Although guidance for commencing these pathways exists, this may not overcome the complexities of the decision-making process, which must be viewed in context, namely: marking the transition to terminal care, dealing with ambiguity, reaching professional consensus and engaging patients and families. Implications for nursing. Nurses in all care settings have an important role in easing the transition to end-of- life care. Accordingly, nurses need not only an appreciation of end-of-life care pathways, but the complexities surrounding the decision to commence a pathway and their role within. CONCLUSION The initiation of an end-of-life care pathway is contingent on the outcome of a complex decision-making process which is rarely explored and poorly understood.
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Affiliation(s)
- Tessa Watts
- Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, UK.
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Being present in hospital when the patient is dying - A grounded theory study of spouses experiences. Eur J Oncol Nurs 2011; 15:382-9. [DOI: 10.1016/j.ejon.2010.11.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 10/28/2010] [Accepted: 11/09/2010] [Indexed: 11/19/2022]
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Watts T. End-of-life care pathways as tools to promote and support a good death: a critical commentary. Eur J Cancer Care (Engl) 2011; 21:20-30. [PMID: 22066609 DOI: 10.1111/j.1365-2354.2011.01301.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This paper calls into question whether and how end-of-life care pathways facilitate the accomplishment of a 'good death'. Achieving a 'good death' is a prominent social and political priority and an ideal which underpins the philosophy of hospice and palliative care. End-of-life care pathways have been devised to enhance the care of imminently dying patients and their families across care settings and thereby facilitate the accomplishment of a 'good death'. These pathways have been enthusiastically adopted and are now recommended by governments in the UK as 'best practice' templates for end-of-life care. However, the literature reveals that the 'good death' is a nebulous, fluid concept. Moreover, concerns have been articulated regarding the efficacy of care pathways in terms of their impact on patient care and close analysis of two prominent end-of-life pathways reveals how biomedical aspects of care are privileged. Nonetheless drawing on a diverse range of evidence the literature indicates that end-of-life care pathways may facilitate a certain type of 'good death' and one which is associated with the dying process and framed within biomedicine.
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Affiliation(s)
- T Watts
- Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, UK.
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Abstract
Good encounters within healthcare are important for the manner in which ill people facilitate their health and their perception of quality of care. Research about quality of care are important, but point out that dissatisfaction with healthcare may in the future be even more common regarding the demands for a more effective healthcare. The aim of this study was therefore to describe experiences of dissatisfaction with encounters in healthcare among men who personally filed a complaint to the Patients' Advisory Committee in the county council. Qualitative data were collected in semi-structured interviews with a purposive sample of nine men who have filed a complaint to the Patients' Advisory Committee. The analysis resulted in two categories: being met with a disrespectful manner and not receiving a personal apology. The results in the first category describe that the men were treated with disrespect and suspicions by healthcare professionals. This was related to lack of communication which made the men sensitive to negative attitudes on the part of professionals. The results in the second category show that the men expected amends to be made in form of a personal apology about the dissatisfaction. The men were given no opportunities to influence the encounters and the professionals were unconscious of their behaviour in form of bad treatment. In conclusion, the results indicate the importance of meeting patients and their relatives with respect and dignity, listening to their experiences and proceeding with the treatment without insulting anyone as a person.
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Affiliation(s)
- Lisa Skär
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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Affiliation(s)
- Maria Parry
- Faculty of Health, Sport … Science, University Of Glamorgan, Pontypridd, CF37 1DL, Wales
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Abstract
The aim of this article is to investigate the concept of care in contemporary medical practice and medical ethics. Although care has been hailed throughout the centuries as a crucial ideal in medical practice and as an honourable virtue to be observed in codes of medical ethics, I argue that contemporary medicine and medical ethics suffer from the lack of a theoretically sustainable concept of care and then discuss possible reasons that may help to explain this absence. I draw on the empirical studies of Carol Gilligan on care and connectedness as ontologically situated realities in human life. Based on a philosophical elaboration of her findings on the ethics of care emphasizing relationality, I try to show how the notion of 'relational ontology' originating from this stream of thought may be of help in developing a medical ethics that acknowledges care as a perspective to be observed in all interactions between physicians and patients.
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Affiliation(s)
- Elin Martinsen
- Section for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, PO BOX 1130, Blindern, 0318 Oslo, Norway.
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Madden P, Coupland V, Møller H, Davies E. Using maps and funnel plots to explore variation in place of death from cancer within London, 2002-2007. Palliat Med 2011; 25:323-32. [PMID: 21398346 DOI: 10.1177/0269216311398700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
London has a high proportion of hospital deaths, which health policy seeks to reduce. We explore variation and trends in place of death from cancer within London between 2002 and 2007. Mortality data based on death certificates were used to define deaths from cancer at home, hospice, hospital and nursing home and examine trends over time for London. Proportions of deaths in each place were presented in maps for 31 London primary care trusts (PCTs). Funnel plots were used to identify consistent performance outside the control limits of three standard deviations. There was little overall change in place of death for London, but consistent variation between PCTs. Outer London PCTs had higher proportions of home deaths and inner London PCTs higher proportions of hospice deaths. Funnel plots identified consistent high outlying performance for home, hospice and hospital deaths. No PCT showed a change of 10% or more in home deaths, but five showed decreasing hospital deaths and three increasing hospice deaths. Maps and funnel plots appear useful for identifying areas with differing performance for home, hospital, nursing home and hospice deaths. These methods may help further investigation of how local services may successfully support deaths outside hospital.
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Affiliation(s)
- P Madden
- King's College London, Thames Cancer Registry, London, UK
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Swahnberg K, Wijma B. Staff's awareness of abuse in health care varies according to context and possibilities to act. J Psychosom Obstet Gynaecol 2011; 32:65-71. [PMID: 21391861 DOI: 10.3109/0167482x.2011.555021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore awareness of abuse in health care (AHC) from a staff perspective. Patient evaluation studies often focus on patient satisfaction, and serious negative experiences might therefore be obscured. In our research, we have found that abuse in health care (AHC) is commonly reported by male and female patients, when asked for in a strait way, but so far no intervention studies against AHC have been published. Investigating staff's awareness of AHC is our first step toward developing interventions against AHC. STUDY DESIGN Data were collected at a Swedish clinic of obstetrics and gynecology. Qualitative interviews with 21 informants were analysed with constant comparative analyses. RESULTS The core category - 'Staff's awareness of AHC varies according to context and possibilities to act' - was derived from the interaction between five categories; Moral imagination, Relativism, Explanations, Dissociation from AHC and Acting against AHC. Awareness of AHC was not a permanent state that did/did not exist as all participants displayed both high and low awareness; depending on the context. CONCLUSION Staff's awareness depends on more than personal characteristics; therefore, AHC interventions have to target individual behavior as well as cultures and structures in health care.
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Affiliation(s)
- Katarina Swahnberg
- Department of Clinical and Experimental Medicine, Division of Gender and Medicine, Linköping University, Linköping, Sweden.
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Fröjd C, Swenne CL, Rubertsson C, Gunningberg L, Wadensten B. Patient information and participation still in need of improvement: evaluation of patients' perceptions of quality of care. J Nurs Manag 2011; 19:226-36. [PMID: 21375626 DOI: 10.1111/j.1365-2834.2010.01197.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS To identify areas in need of quality improvement by investigating inpatients' perceptions of quality of care, and to identify differences in perceptions of care related to patient gender, age and type of admission. BACKGROUND Nursing managers play an important role in the development of high-quality care. METHODS Quality of care was assessed using the Quality from the Patients' Perspective (QPP). In all, 2734 inpatients at a Swedish university hospital completed the QPP. RESULTS Inadequate quality was identified for 15 out of 24 items, e.g. information given on treatment and examination results, opportunities to participate in decisions related to care and information on self-care. Patients with emergency admissions reported lower scores for quality of information and doctors' care than did patients with planned admissions. CONCLUSION Results from the present survey identified areas in need of quality improvement and differences in perceived care quality between patients. Quality of care must be developed in close collaboration with other healthcare professionals; in this respect, nursing managers could play an important role. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers could play a more active part in measuring quality of care, and in using results from such measurements to develop and improve quality of care.
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Affiliation(s)
- Camilla Fröjd
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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