Patients' informational needs and information received do not correspond in hospital

Engaging patients, families and professionals at the bedside using whiteboards

Health-care systems around the world are striving to be patient-centered, and there is growing evidence that engaging patients and families in their care, as well as in efforts to redesign services, contributes to improved outcomes and experiences for patients and providers. This patient-oriented care movement includes efforts to improve the quality of information and communication between health-care professionals and patients as well as families and caregivers. Whiteboards have emerged as a best practice in hospitals to promote engagement and improve information and communication, yet with limited empirical evidence regarding their value to patients, families, or interprofessional teams. We introduced whiteboards on an acute medical unit at a community hospital and conducted an evaluation using a pre-post design collecting both qualitative and quantitative data. Baseline and post-implementation data were collected via qualitative interviews with patients/family and providers and using the Canadian Patient Experience Survey; focus groups were held with staff and members of the care team. Qualitative results highlighted improvements in communication between the care team and patients as well as family members. Implications for practice include attention to patient/family empowerment and safety, adherence to guidance for good communication, and support for regular training and education in the use of communication tools for members of the interprofessional team.

AYAs' online information and eHealth needs: A comparison with healthcare professionals' perceptions

BACKGROUND

Adolescents and young adults (AYAs) diagnosed with cancer fulfill their cancer-related information needs often via the Internet. Healthcare professionals (HCPs) have a crucial role in guiding patients in finding appropriate online information and eHealth sources, a role that is often overlooked. Misperceptions of AYAs' needs by HCPs may lead to suboptimal guidance. We aimed to examine the extent to which AYAs' online information and eHealth needs corresponded with HCPs' perceptions of these needs.

METHODS

Two cross-sectional online surveys (AYAs, n = 299; HCP, n = 80) on online information and eHealth needs were conducted. HCPs provided indications of their perceptions of AYA's needs.

RESULTS

AYAs reported significantly more online information needs compared with HCPs' perceptions regarding: survival rates (AYA = 69%, HCP = 35%, p < 0.001), treatment guidelines (AYA = 65%, HCP = 41%, p < 0.001), return of cancer (AYA = 76%, HCP = 59%, p = 0.004), "what can I do myself" (AYA = 68%, HCP = 54%, p = 0.029), and metastases (AYA = 64%, HCP = 50%, p = 0.040). Significantly more unmet eHealth needs were reported by AYAs compared with HCPs relating to access to own test results (AYA = 25, HCP = 0%, p < 0.001), request tests (AYA = 30%, HCP = 7%, p < 0.001), medical information (AYA = 22%, HCP = 0%, p = 0.001), e-consult with nurses (AYA = 30%, HCP = 10%, p < 0.001), e-consult with physicians (AYA = 38%, HCP = 13%, p = 0.001), and request prescriptions (AYA = 33%, HCP = 21%, p = 0.009).

CONCLUSION

AYAs' online information and eHealth needs are partially discrepant with the impression HCPs have, which could result in insufficient guidance related to AYAs' needs. AYAs and HCPs should get guidance regarding where to find optimal information in a language they understand. This may contribute to AYAs' access, understanding, and satisfaction regarding online information and eHealth.

A quality improvement initiative for patient knowledge comprehension during the discharge procedure using a novel computer-generated patient-tailored discharge document in cardiology

Objective

The duration of hospital admissions has shortened significantly. This challenges healthcare professionals to provide the necessary information and instructions in a limited time. Patient-tailored discharge information may improve the patient's understanding of the discharge information but may also be time-consuming. The objective of this descriptive quality improvement study was to evaluate patient comprehension of discharge information using a novel computer-generated patient-tailored discharge document.

Methods

A prospective pre-post study comparing patient-tailored discharge information with conventional discharge information, for patients undergoing an electrophysiological procedure during two periods of six weeks between January and March 2016.

Group I received conventional discharge information (n  =  55). Group II received a computer-generated, patient-tailored discharge document (n  =  57). Their comprehension of the discharge information was evaluated using a peer-reviewed questionnaire distributed among patients, comparing groups I and II using Likert scales. Nurses and nurse practitioners evaluated the use of personalized discharge information by means of a short survey.

Results

In terms of discharge information, comprehensibility was equivalent; however, an increase in comprehension was observed in patients seeking a telephone consultation with the cardiology department within one-week post-discharge. A reduction in discharge preparation time and an increased uniformity of discharge information were reported by nurses. Nurse practitioners found the web tool easy to use and time-saving.

Conclusions

In this study, computer-generated patient-tailored discharge information was equivalent to conventional discharge information. A more positive trend was seen for patients who initiated teleconsultation with the hospital within one-week post-discharge. This suggests that for this subgroup the patient-tailored discharge web tool might lead to an improvement in care. However, more research with a larger number of participants is needed to confirm this trend.

Undisclosed probing into decision-making capacity: a dilemma in secondary care

BACKGROUND

The assessment of patients' decision-making capacity is ubiquitous in contemporary healthcare. This paper examines the ethics of undisclosed probing of capacity by psychiatrists. The discussion will refer to the law in England and Wales, though the highlighted issues are likely to be relevant in similar jurisdictions.

MAIN TEXT

Decision-making capacity is a private attribute, and patients may not necessarily be aware that one of their personal abilities is being explored. Routine exploration of capacity has not historically been a part of psychiatric examination, but it is now difficult to avoid during psychiatric interview.Ethical practice and shared decision-making require patients to be aware that their decision-making may be evaluated by the doctor at some point, and the potential implications of an objective professional conclusion of incapacity. Case law directs that patients should be informed about any assessment of their decision-making ability, though the extent to which this has translated into practice is unclear. However, explanation about the assessment may cause a patient to react negatively, which may impede therapeutic engagement and constitute an ethical dilemma. It is argued that in the absence of systemic measures, professionals should retain the discretion to decide whether a particular patient should be informed about the impending probe into their decision-making ability, or not. In the latter instance, concealment of information about the assessment or its purpose should be subject to the caveats and safeguards associated with any recourse to therapeutic exception.

CONCLUSION

The necessity to mandatorily inform patients about assessment of their capacity introduces a novel ethical dilemma for psychiatrists. The negotiation of this dilemma should not be the prerogative of the clinician, and requires systemic initiatives to ensure universal awareness of patients about the possibility of their capacity being assessed during their journeys through healthcare systems.

Information needs of people seeking fertility services in Canada: a mixed methods analysis

Background

Infertility is a challenging experience associated with high levels of psychological distress. Many people seeking fertility services use the internet to obtain information about their conditions and treatments.

Objectives

This mixed-methods study aimed to describe the information-seeking experience of people seeking fertility services with respect to the fulfillment of their individually defined information needs and explore relationships between the fulfillment of information needs and psychological outcomes.

Methods

One hundred and four participants completed a survey with close-ended and open-ended questions about their experience using an informational web-based application (app) called ‘Infotility’ and about their mental well-being before and after using the app. The questionnaires administered were the The Mobile Application Rating Scale (uMARS), the Fertility Quality of Life questionnaire (FertiQol), the Patient Empowerment Questionnaire (PEQ) and the General Anxiety Disorder 7-item Scale (GAD-7). Eleven participants completed in-depth qualitative interviews about their experience using the app. A thematic analysis was used to interpret qualitative results and quantitization was used to dichotomize participants into those with met information needs versus those with unmet information needs. Google Analytics was used to compare participants’ reported experience with their actual use of the app.

Results

The results of this study show that there is variability in the amount of information that people seeking fertility services wish to receive. Participants whose information needs were met reported improved psychological outcomes after using the app, while those with unmet needs showed no change in their psychological outcomes.

Conclusions

Our results suggest that fulfilling information needs was associated with improved psychological outcomes in people seeking fertility services. Our results also suggest that individual differences in information needs should be considered when developing health educational materials.

Development and Validation of the Hospital Outpatients' Information Needs Questionnaire (HOINQ)

PURPOSE

The main objective was to develop and validate a "Hospital Outpatients' Information Needs Questionnaire" (HOINQ). Secondly, to identify patients' preferred sources of information. Finally, to establish differences depending on the disease, as well as between sociodemographic and clinical variables.

PATIENTS AND METHODS

This is a transversal study based on a questionnaire. All adult hospital outpatients' who collected their medication at the Pharmacy Service were consecutively recruited, regardless of their diagnosis time, treatment or disease. The Spanish version of the internationally validated European Organization for Research and Treatment Cancer Quality of Life Questionnaire (EORTC QLQ-25) aimed at oncology patients was used as the starting point. In order to be applicable on new target population, it was crucial to make several changes and ensure that it complies with the validity, viability and reliability criteria. The questionnaire prepared for validation was then obtained by a literature review (face validity), submitting the EORTC QLQ-25 to an expert committee (content validity), by piloting (viability) and Cronbach's alpha statistical analysis (reliability). Once the questionnaire was completed, Cronbach's alpha of the final study (reliability) and factor analysis (construct validity) were performed. Then, pertinent modifications were applied to obtain the HOINQ.

RESULTS

A total of 153 outpatients filled the questionnaire, which was widely accepted and required 5-10 min to complete. Cronbach's alpha coefficients met criteria >0.7. Three factors were established by factor analysis: aspects about the disease, pharmacological and no-pharmacological treatment and satisfaction and perception of the information received. Participants felt satisfied (41-52%) with the information amount, quality and usefulness, although 1 out of 3 stated wanting to know more about the different information areas. Younger patients (P-value <0.05) and those who had been attending the Pharmacy Service for a longer time span (P-value <0.01) reported receiving more information. On a 0 to 7 scale, medical specialists (mean = 6.28, SD = 1.38) followed by the rest of health care professionals (mean = 4.23-4.63, SD = 2.25-2.29) were selected as the preferred sources of information. HIV patients reported being more informed, while those with rheumatoid arthritis felt less informed (P-value <0.05).

CONCLUSION

The HOINQ was developed. It is a self-completed questionnaire, composed of three blocks: the 16-item information needs questionnaire, demographic and clinical variables, and patients' preferred sources of information. It is an easy tool to use and replicate, both for patients and professionals.

Assessing patient understanding of their antimicrobial treatment: How are we doing and how might we improve?

BACKGROUND

The Antimicrobial Stewardship Clinical Care Standard states that patients should receive certain information about their antimicrobial therapy. How well the patient communication recommendations of the standard are followed in clinical practice is not well established. The aim of this pilot quality improvement study was to assess current practices around communication with hospitalised patients about their antimicrobial therapy, to determine compliance with current recommendations, and develop and implement quality improvement actions focused on patient communication for antimicrobial stewardship in Australia.

METHODS

Adult inpatients receiving one or more antimicrobials for greater than 72 h were recruited. A survey was conducted to assess rates of compliance with requirements to inform patients about the indication, duration and potential side effects of current antimicrobial therapy; modes of delivery of information; and rates of patient satisfaction with the information provided. A paper-based survey was conducted on the general medical, infectious diseases, geriatric evaluation and management, and rehabilitation wards in a 500-bed tertiary Australian hospital. A sample size of 50 was determined as adequate for a baseline analysis of patient communication practices and the development of quality improvement resources and actions. Responses to categorical questions were analysed quantitatively, with additional feedback from patients was collated and analysed qualitatively.

RESULTS

A total of 54 patients were surveyed. A majority (83%) of patients had been informed that they were taking antimicrobials, and, of these, 96% said they knew the indication, 18% were informed of potential side effects, and 36% knew the duration. Only 22% were informed of the review plan and 27% knew if antimicrobials would be continued on discharge. Written information was given to 11% of patients. Over half (62%) of patients either wanted more information or had concerns about their antimicrobial therapy. Patients reported difficulty in obtaining information. Fifty-eight percent of patients received antimicrobial information from doctors, 13% from nurses and 12% from pharmacists.

CONCLUSIONS

This study identified gaps in communication with patients regarding in-hospital antimicrobial therapy, and highlighted the need for development and delivery of local quality improvement activities to address this gap.

What Do Adult Surgical Patients Speaking Primarily Cantonese, Italian, or Portuguese Really Want to Know About Pain and Pain Management?

BACKGROUND

Surgical patients consider information about pain and pain management to be highly important (Apfelbaum, 2003). At the same time, evidence indicates that members of racial and ethnic minorities are more likely to experience inadequate pain management (Green, Anderson, Baker, Campbell, Decker, Fillingim, & Todd, 2003; Mossey, 2011).

AIMS

This study investigated the needs of general day surgery patients who spoke primarily Cantonese, Italian, or Portuguese at home for information about postoperative pain.

DESIGN

This was a mixed methods, descriptive study.

SETTING

The day surgery unit of a large, quaternary care hospital in downtown Toronto.

PARTIPANTS/SUBJECTS

Inclusion criteria were day patients who were at least 18 years of age or older and spoke primariy Cantonese, Italian or Portugues at home. and were able to read and write in their primary language.

METHODS

Participants who had undergone a day surgery procedure completed a telephone information needs survey in their primary language (Cantonese, Italian, Portuguese) within 72 hours after discharge. Composite mean scores were calculated for each item. Chi-squared analyses were used to probe for intergroup differences and compare with English-fluent participants from phase 1 of this study (Kastanias, Denny, Robinson, Sabo, & Snaith, 2009).

RESULTS

Sixty-three participants in total completed the survey: 21% Cantonese, 41% Italian, and 38% Portuguese. The mean age of the sample was 70 years old; 89% were born outside of Canada, and 52% were male. For the combined group, the average importance rating score range for the information items was 6.2-8.9 out of a possible score of 10. All items were rated as moderate (5-6 out of 10) to high (≥7out of 10) importance. Surgical subtype, health status, and age had no effect on the importance of any information item. There were no significant differences between the three language groups on any of the information items. This lack of difference may have been a result of a lack of power due to the small sample size of the individual language groupings. Overall, the top-ranked information items were "the plan for which drugs to take and when," "what I can do if I still have pain or side effects," and "side effects I was most likely to get."

CONCLUSIONS

Similar to English-fluent participants (Kastanias et al., 2009), participants who primarily spoke either Cantonese, Italian, or Portuguese at home placed moderate to high importance on all of the information items. and neither surgical subtype, health status nor age had any effect on the importance of any item. The multilingual sample in this study placed more importance than English-fluent participants on information regarding help with paying for pain medication (p = .001) and the side effects they were most likely to experience (p < .05). Due to a paucity of literature in this area, further research is warranted. Results may assist with evaluating and improving current approaches to surgical patient pain management education.

Equality as an ethical concept within the context of nursing care rationing

The concept of equality is subject to many different interpretations, and it is closely connected to similar concepts such as equity, justice, fairness, and human rights. As an ideal, equality entails many aspects that are untenable. For instance, genetic and social inequalities may never be extinct, but they can both be ameliorated by proper distribution of society's resources. Likewise, within the context of health care, equality can be promoted by proper rationing of health resources, amongst which nursing care stands out. In the field of nursing, the principle of equality presents itself in various forms of ethical and deontological mandates. However, beyond good intentions and abstract notions, there is a need to examine the ways in which nurses enforce this principle in practice, within the reality of modern health systems. Although there is scarcity of qualitative evidence in the nursing care rationing literature, existing studies suggest that fair treatment pertains to a largely intuitive sense of equality which involves subjective perceptions and judgements about rationing. Nurses' initial predisposition is to view all patients as equal and treat them in an equal manner; yet, on an individual basis, each patient has a different starting point, different needs and different prospects that render rationing decisions complex and uncertain. Equality should be accepted with its unavoidable limitations in practice and be further examined within the context of nursing care rationing, in the hope that it can be advanced in a consistent way, despite the idealistic nature in many of its aspects.

Patientś experiences of patient education on psychiatric inpatient wards; a systematic review

OBJECTIVE

To synthesize the evidence on how patients with serious mental disorders perceived patient education on psychiatric wards and to learn more about the patient perceived benefits and limitations related to patient education and how well patient education meets the perceived needs of inpatients.

METHODS

Quantitative and qualitative data were categorized and synthesized. A systematic literature search was conducted. Articles were validated using validated critical appraisal tools. Data were analyzed using inductive content analysis.

RESULTS

Five articles met the inclusion criteria. The results concerned the specific population with bipolar disorder or schizophrenia. Two explanatory syntheses were aggregated: (I) Benefits and perceived barriers to receiving education and (II) Educational needs of mental health patients. Patients reported mechanical information dissemination and lack of individual and corporative discussions. Patients preferred patient education from different educational sources with respect to individual needs.

CONCLUSION

Patient education were most useful when it could be tailored to an individuaĺs specific needs and match patient preference for how to receive it. The findings did not provide evidence to support any educational methods of preference.

PRACTICE IMPLICATIONS

The findings may contribute to the development of educational interventions that are perceived more helpful for in-patients suffering from serious mental disorders.

Sufficiency and relevance of information for inpatients in general ward settings: A qualitative exploration of information exchange between patients and nurses

BACKGROUND

Information exchange as part of shared decision-making is widely discussed in research and policy literature as a means of improving patient involvement in treatment and care. To date information exchange between patients and nurses has not been explored in ward contexts.

OBJECTIVE

To explore the sufficiency of, and intentions behind, information exchanged by patients and nurses in surgical and medical ward settings using a recognised model of shared decision-making.

DESIGN

A multiple-case study design was used. Data were collected from 19 cases. Each case comprised one patient, the nurses interacting with that patient, the interactions between them, and their perceptions about the interactions.

SETTINGS

The study was undertaken across six surgical, six medical and one rehabilitation ward in a large teaching hospital in the United Kingdom.

PARTICIPANTS

Purposive sampling was used to first recruit nurses and then patients. Inclusion criteria included nurses registered with the Nursing and Midwifery Council, and patients who had been in hospital for more than 24h and who could consent to participating. Twenty-two nurses and 19 patients participated.

METHODS

Interactions from 19 cases were observed and audio-recorded. Individual interviews with patients and nurses followed, and were related to, the observed interactions.

RESULTS

Patients and nurses perceived they had exchanged sufficient information for their own needs including patient involvement, due to: information being shared previously and on an ongoing basis; having asked all their questions; therapeutic patient/nurse relationships; and, nurses speaking in lay terms. In contrast, the observational data suggested that insufficient information was exchanged between patients and nurses due to: lost opportunities for sharing information; paternalistic practice; and withholding information.

CONCLUSION

The elements of information exchange within a recognised model of shared decision-making do not adequately fit with patient/nurse interactions in ward settings. Participants generally perceived they had given and received enough information for their own needs. Therefore, the ways in which patients and nurses currently interact, could remain as they are. Policymakers should be aware of the varying contexts where healthcare staff work, and should promote information exchange and shared decision-making more strategically. Due to the complexities of patient/nurse interactions, consideration should be given to situation and context when applying these findings to practice.

Moving from theory to practice: experience of implementing a learning supporting model designed to increase patient involvement and autonomy in care

BACKGROUND

In implementing new programs of care, such as person-centered care, there is a risk that the focus will be at an organizational level, instead of a level that describes what happens in the personal development among staff. The aim of this study was to describe experiences of the implementation process of a learning supporting model designed to increase patient involvement and autonomy in care. The project, which lasted 2 years, involved training sessions, supervision and reflective meetings. Over the period, the staff who participated focused on developing their dialogues with patients to make the patients aware of their own capabilities and to encourage them to be fully involved in the treatment. A reflective lifeworld approach was used. Data were collected through interviews, notes and written stories, and analyzed using hermeneutic analysis with a focus on meanings.

RESULTS

At the beginning of the project, the participants perceived the model as abstract and difficult to understand but supervision and reflection sessions enabled understanding and changed the participants' approach to caring. The participants described the model as an approach used in challenging patients to become involved in their care and to take charge of their lives when living with a chronic life-threatening disease. The participants' experience of implementing the model has not been easy but has led to increased self-confidence and feelings of improved competence in dialogue with patients.

CONCLUSIONS

Using the PARISH model when critically examining the results shows that in the implementation process there were some difficulties, e.g. the context was supportive and facilitating but there was no appointed facilitator. By making participation in improvement work voluntary, the impact of such work becomes less efficient, less cost-effective and probably less sustainable. Furthermore, implementation needs encouragement since changing approaches takes time and requires patience. Group supervision sessions seem an appropriate way to translate research into practice; systematic scheduled and mandatory group supervision sessions would, therefore, probably make implementation more robust and sustainable. In addition, a well-trained facilitator would be able to motivate staff to undertake daily reflection and participate in group supervision sessions. Reflection seems to be a key component in the personal learning necessary to change work routines and approaches.

HOW DO PATIENTS EXPERIENCE A KIDNEY BIOPSY?

BACKGROUND

Guidelines for care before, during and after a kidney biopsy vary nationally and internationally. A literature search has shown few studies about the care before, during and after a kidney biopsy and we found one study from the patients' perspective.

OBJECTIVES

The aim of the study is to gain knowledge about patients' experiences before, during and after a kidney biopsy.

METHODS

A qualitative study with a phenomenological and hermeneutic approach using 'observiews' of seven patients before, during and after a kidney biopsy. Data were analysed using Malterud's principles of systematic text condensation.

RESULTS

Three themes were found: The patients' basic needs, the patient's needs for information and the patients use humour as a coping strategy.

CONCLUSION AND APPLICATION TO PRACTICE

The patients' experiences were characterised by their need to fulfill self-care requirements, because they had to lie down for four to six hours after the biopsy procedure. There is a need to find evidence for the time the patient need to be bedbound to avoid bleeding complications. The patients' needs for information were different, which explains why information should be individualised. There is particular need for more information after discharge.

Determination of Patient Learning Needs after Thyroidectomy

The purpose of this study was to determine discharge learning needs of patients undergoing thyroidectomy. The population of this descriptive study consisted of patients undergoing thyroidectomy in the Endocrine Surgery Unit of a university hospital between February and December 2013. The study included 251 patients who were discharged after thyroidectomy. Data obtained using the data collection form and the Patient Leaning Needs Scale (PLNS) were analyzed by frequency, mean, standard deviation, Kruskal Wallis and student-t tests. The mean age of the patients was 47.91±13.05 and 76.1% were females. The PLNS total mean score was 208.38±34.91, with the maximum score of 39.23±6.80 on the subscale of treatment and complications and the minimum score of 19.45±4.70 on the subscale of feelings related to condition. It was found that the PLNS total score of the patients was not influenced by age, gender, marital status (p>0.05). This study demonstrated that patients had high learning needs after thyroidectomy.

Reasons for middle-aged women in Taiwan to choose hysterectomy: a qualitative study using the bounded rationality perspective

AIMS AND OBJECTIVES

To explore women's perspectives on deciding to undergo hysterectomy for benign conditions based on physicians' recommendations and the women's own judgement.

BACKGROUND

Hysterectomy is the second most common surgical procedure worldwide. Although most hysterectomies are elective, physicians may recommend treatment that involves a loss of sexuality or ovary removal, creating a difficult choice for women.

DESIGN

Qualitative, in-depth interview

METHODS

A purposive sample of 17 women was recruited. The women had decided to undergo hysterectomy after the diagnosis of uterine fibroids. All these women had already decided not to have more children. Data were collected by in-depth interviewing, and content analysis was used to analyse the data.

RESULTS

Our study revealed five themes: release from stress, inescapable fate, positive support, hoping for peace of mind and sense of trust.

CONCLUSIONS

The participants felt that mental and physical health were the most important considerations, noting that when women no longer want children, a uterus is useless. The women believed that they retained their womanhood, even without a uterus, and were satisfied with the outcomes of their hysterectomy decisions.

RELEVANCE TO CLINICAL PRACTICE

Our findings might serve as educational and counselling reference materials for healthcare providers, ensuring that women receive appropriate care quality and have their needs met. Healthcare providers can then maximise women's empowerment, deepen their awareness of body image and their concept of self-care and help them to clearly perceive their own concerns and needs so that they can make suitable decisions.

Information on antidepressants for psychiatric inpatients: the divide between patient needs and professional practice

BACKGROUND

Medicine information is an integral part of patient care and a patient right. In particular, patients with a mental health diagnosis have a need for information on medicines.

OBJECTIVE

This study aims to describe the current practice on information provision on antidepressants to inpatients in psychiatric hospitals.

METHODS

A qualitative study was conducted consisting of semi-structured interviews with health care professionals (n=46) and patients (n=17) in 11 Flemish psychiatric hospitals. Two topic guides were designed for conducting the interviews with these respective stakeholders. The issues addressed in the topic guides related to: organization of information provision in the hospital, information on demand of the patient, information provision by health care professionals, information for relatives, evaluation of provided information, interdisciplinary contacts on information provision and satisfaction on current practice of information provision. The interviews were analysed according to the five stages of the framework analysis.

RESULTS

Psychiatrists and nurses are the key players to provide information on antidepressants. Their approach depends on patient characteristics and mental state. Information is provided mainly orally. Health care professionals consider non-verbal cues of patients to verify if information has been understood. Health care professionals reported lack of time and lack of interdisciplinary contacts as negative aspects. Patients indicated that health care professionals take too little initiative to provide medicine information.

CONCLUSIONS

Patients are informed about their antidepressants through various pathways. Although the awareness is present of the importance of the individual approach and efforts are done to tailor information to the individual patient, improvement is still possible. Tailoring communication; assessing patient needs and preferences; matching of health care professional style and patient needs; and achieving concordance, is a complex and challenging task for health care professionals in mental health care.

Factors associated with nurses’ opinions and practices regarding information and consent

This cross-sectional survey aimed to investigate nurses’ opinions and practices regarding information and consent in the context of a large Italian teaching hospital and to explore potential influences of gender, age, university education, length of professional experience, and care setting. A questionnaire was administered to 282 nurses from six different care settings (Emergency Room, Emergency Medicine, Surgery, Hematology–Oncology, Geriatrics, and Internal Medicine). Overall, 84% (n = 237) of nurses returned the questionnaire (men: 24%; mean age: 36.2 ± 8 years; university degree: 35%; mean length of professional experience: 12 ± 8.2 years). Most respondents regularly informed patients about medications and nursing procedures and asked for consent prior to invasive procedures, but some provided information to relatives instead of patients. Lack of time or opportunity was the main difficulty in informing patients. The work setting was the foremost factor significantly associated with participants’ opinions and practices. Further investigations are needed to confirm these findings in similar and other care settings.

Root Cause Analysis: Using Theory of Constraints Application to Measure the Impact of Employee Demographics on the Adoption of Information Technology Equipment

This paper uses Theory of Constraints (TOC) improvement questions to measure how employees' demographics influence their adoption of various Information Technology Equipments (ITEs) in organisations. Survey questions in the form of a Likert scale are prepared to address these possible effects. The number of total participants was 216 and they were from two universities: Argosy University, Atlanta campus; and Brigham Young University, Provo campus. The research question for this study asked how the factors of age, gender, race, and education level positively or negatively influence employees' attitudes toward ITE adoption at their place of employment. A Pearson product-moment correlation coefficient was computed to assess the relationships and the Kruskal–Wallis and the Mann–Whitney U tests were used to compare the independent groups. The results suggested that there was a correlation among age, race and education level and indicated that age negatively correlates with employees' level of comfort with ITE use. There was a statistically significant difference at the 0.01 level between White and Black participants.

Information needs of cancer patients: a comparison of nurses' and patients' perceptions

This study aimed to identify nurses' and patients' perceptions and compare them in terms of the information needs of cancer patients. Another aim is to identify the association between the demographic and situational characteristics of patients'/nurses' and information needs. A total of 305 patients and 130 nurses participated in this descriptive and comparative study. Data was collected with a study-specific questionnaire developed for this study. Descriptive statistics, Pearson Chi-square and RIDIT analyses were used to analyze the data. Results indicated that there was incongruence between patients' and nurses' perceptions regarding information provision (p < 0.05), both congruence regarding how much information was needed (eight out of 16 information items), but also significant incongruence on the remaining items(p < 0.05). The other finding was that patients residing out of Ankara city needed to obtain more information rather than the others. No relationship was found between demographic and situational characteristics and nurses' perceptions regarding information need of patients.

Perceived information after surgery for colorectal cancer--an explorative study

AIM

With fast track surgery and shorter hospital stay, discharge from hospital after cancer surgery is becoming more challenging for the individual patient. The aim of this study was to explore how patients perceive information after surgery for colorectal cancer, what their information needs are and to determine factors affecting received information.

METHOD

A hundred patients filled in the questionnaires QLQ-C30, CR38 and INFO25 created by the European Organization for Research and Treatment of Cancer, the Eastern Cooperative Oncology Group (ECOG) instrument and the SOC (sense of coherence) instrument and provided written comments within the first 2 weeks after discharge following surgery for colorectal cancer. The questionnaires were analysed using hierarchical cluster analysis and a multiple linear regression analysis. The written comments were analysed using content analysis.

RESULTS

In all, 49% of the patients expressed a need for more information. In the written comments they specified these areas of information: they lacked information concerning their surgery, how to handle symptoms and problems at home, someone to contact after discharge and prognostic information about their future. Patients reported most received information in areas of medical tests and disease but less on other services and support in outpatient care. The variation in INFO25 was best explained by gender (P = 0.045) and preoperative health status (American Society of Anesthesiologists score 3, P = 0.022).

CONCLUSION

The results from this study indicate that women and patients with a poorer preoperative health status scored less on information received and would need more time and support to prepare for discharge. The patients expressed a desire for more information about the surgery, how to handle symptoms at home and prognostic information about their future.

Reliability of the Cardiac Patients Learning Needs Inventory (CPLNI) for use in Portugal

AIMS AND OBJECTIVES

To perform the semantic validation and to evaluate the reliability and the presence of ceiling and floor effects of the Cardiac Patients Learning Needs Inventory in Portuguese patients with coronary artery disease.

BACKGROUND

Information should be selected based on what patients know and need to learn, which means that the teaching process should be based on each person's needs. The Cardiac Patients Learning Needs Inventory is aimed at identifying the cardiac patients' individual learning needs.

DESIGN

Methodological research design.

METHODS

Two hundred patients hospitalised at the coronary intensive care unit or at the cardiothoracic surgery unit of a public hospital in Lisbon answered the adapted version of the Cardiac Patients Learning Needs Inventory. Internal consistency was estimated based on Cronbach's alpha. Scores above 0·50 were considered acceptable. Stability was measured through test-retest and calculated using student's t test. Significance was set at 0·05.

RESULTS

Patients' mean age was 65 years (SD = 11·8), and most were men (152; 76%). Cronbach's alpha for the total scale was high in the first and second measurement (0·91), and for seven domains, it was acceptable in the first and second measurement (range from 0·50-0·89). No statistically significant difference was found between mean scores on the first and second measurement. Lower diversity was observed in the answers, most of which ranged between important and very important (ceiling-effect).

CONCLUSION

The adapted version for use in Portugal maintained the conceptual, semantic and idiomatic equivalences of the original version and showed adequate reliability. RELEVANCE TO CLINICAL PRACTICES: Owing to the lack of validated instruments translated into Portuguese, to measure cardiac patients' learning needs, this study entails important clinical and theoretical implications.

[Semantic validation of the Cardiac Patients Learning Needs Inventory for Brazilians and Portuguese]

The Cardiac Patients Learning Needs Inventory (CPLNI) was constructed to assess the learning needs of patients with cardiac disease. This study aimed to compare the results of semantic validations of the CPLNI version adapted to Portuguese, involving 40 Brazilian and 16 Portuguese patients hospitalized for coronary artery disease treatment. The participants were individually interviewed and answered to sociodemographic and clinic characterization instrument, to the adapted CPLNI, and to the semantic validation instrument. In CPLNI's general assessment, most patients, both Brazilians and Portuguese, considered the instrument adequate, easy to understand and complete. The semantic validation of the CPLNI showed the need for some changes in its writing with a view to the semantic adaptation of the instrument for use in Portugal and Brazil.

Patient education practices in psychiatric hospital wards: a national survey in Finland

BACKGROUND

Despite the fact that patients' receiving of information is one of the fundamental rights of patients, there is still limited information available on how patient education is carried out in psychiatric healthcare organizations.

AIMS

The aim of this study was to describe patient education practices in adult acute psychiatric hospitals.

METHODS

A descriptive questionnaire survey was administered in all adult acute psychiatric wards in Finland. Data was analysed using descriptive statistics and qualitative content analysis.

RESULTS

A total of 55 head nurses participated in the study (response rate 60%). The content of patient education covered almost all investigated informational areas and patient education was mostly carried out orally and with leaflets. However, patients' individual needs for certain communication methods were not met. Moreover, staff rarely received adequate on-the-job training. In the study wards, there were only few systematic procedures and instructions regarding patient education. Problems relating to the delivery of patient education were described in four themes: patients' poor condition, lack of staff resources, discrepancies in procedures and poor operational conditions.

CONCLUSION

Patient education in psychiatric hospitals covers the informational areas investigated. However, there are numerous quality gaps in the realization of patient education in psychiatric hospitals. The results of this study suggest that to ensure patients' right to receive information, specific guidelines and instructions are needed for psychiatric patients. These guidelines and instructions should thoroughly consider different domains of patient education including content, communication methods, definition of patient's individual needs and delivery personnel.

The information needs of people attending for computed tomography (CT): what are they and how can they be met?

OBJECTIVE

To establish patients' knowledge of CT, their views of information provided and explore the role of information in imaging.

METHODS

A sample of 150 first-time outpatients attending for CT scanning at a Scottish hospital. The study had three phases: a questionnaire survey; structured interviews pre-scan and face-to-face interviews post-scan.

RESULTS

One hundred and twelve questionnaires were returned with 82 deemed usable. Sixty and 53 respondents participated in the pre-scan and post-scan interviews, respectively. Thirty percent of questionnaire respondents and 57.4% of pre-scan interviewees identified accurately the type of scan to be received. Scores on the knowledge test improved by the time of the pre-scan interview. During all stages of the study family members were described as a source of information. Patients reported clinicians as providing few details about the scan, and there was confusion about how results were communicated. Most interviewees thought the leaflet had prepared them for the procedure.

CONCLUSION

The study revealed a lack of familiarity with CT scanning, diverse informational needs, and the importance of personal contact in information giving.

PRACTICE IMPLICATIONS

The study raised wide-ranging issues and highlights the key role of information in the provision of diagnostic health services.

Transition of care: experiences and preferences of patients across the primary/secondary interface - a qualitative study

BACKGROUND

Coordination between care providers of different disciplines is essential to improve the quality of care, in particular for patients with chronic diseases. The way in which general practitioners (GP's) and medical specialists interact has important implications for any healthcare system in which the GP plays the role of gatekeeper to specialist care. Patient experiences and preferences have proven to be increasingly important in discussing healthcare policy. The Dutch government initiated the development of a special website with information for patients on performance indicators of hospitals as well as information on illness or treatment.In the present study we focus on the transition of care at the primary - secondary interface with reference to the impact of patients' ability to make choices about their secondary care providers. The purpose of this study is to (a) explore experiences and preferences of patients regarding the transition between primary and secondary care, (b) study informational resources on illness/treatment desired by patients and (c) determine how information supplied could make it easier for the patient to choose between different options for care (hospital or specialist).

METHODS

We conducted a qualitative study using semi-structured focus group interviews among 71 patients referred for various indications in the north and west of The Netherlands.

RESULTS

Patients find it important that they do not have to wait, that they are taken seriously, and receive adequate and individually relevant information. A lack of continuity from secondary to primary care was experienced. The patient's desire for free choice of type of care did not arise in any of the focus groups.

CONCLUSION

Hospital discharge information needs to be improved. The interval between discharge from specialist care and the report of the specialist to the GP might be a suitable performance indicator in healthcare. Patients want to receive information, tailored to their own situation. The need for information, however, is quite variable. Patients do not feel strongly about self-chosen healthcare, contrary to what administrators presently believe.

Patients' Perceptions of Hospital Discharge Informational Content

Ensuring that patients' informational needs have been met prior to hospital discharge sets the stage for successful self-management of recovery at home. This secondary analysis study aims to identify differences in the amount of discharge teaching content needed and received by adult medical-surgical patients on the basis of their sociodemographic characteristics and hospitalization-related factors. The Quality of Discharge Teaching Scale (QDTS) is used to measure patients' perceptions of the amount of discharge-related informational content they needed and received. Eighty-nine percent of patients receive more informational content than they perceived they needed. Nonwhite patients report more content needed than White patients. Patients with prior hospitalizations and cardiac patients report greater amounts of content received. The QDTS content subscales provide a mechanism for assessing patient perceptions of discharge informational needs and discharge content received that can be used for clinical practice and quality monitoring.

Mental health: patients' experiences of patient education during inpatient care

AIMS AND OBJECTIVES

This study aimed to explore psychiatric patients' experiences of patient education on psychiatric inpatient wards.

BACKGROUND

Patient education seems to be an effective way to support psychiatric patients' capacity for independent living, compliance and insight. Despite the development of various patient education interventions there is still a lack of coherent information on how to improve patient education in the field of psychiatric care, especially from patients' own perspectives.

DESIGN AND METHOD

Data were collected through interviews with 51 inpatients during their discharge process. This exploratory study employs a mixed methods design in data collection and analysis. The structured questions were analysed using descriptive statistics (percentages, frequencies, Mann-Whitney U-test, t-test). Open-ended questions were analysed using inductive content analysis.

RESULTS

Patients perceived different informational areas to be important for them, although some variation was found. However, patient education was not realized in these same areas. Problems related to patient education described by patients were lack of information, problems in patient-staff interaction and a lack of prerequisite knowledge among patients and staff. Patients' suggestions for future development of patient education were more innovative methods in patient education, paying attention to patient-staff interaction and personnel's professional knowledge. A majority of patients wanted to receive information through discussions with staff. However, other patient education methods were also suggested.

CONCLUSIONS

Patient education in psychiatric hospitals is an important area to be developed, therefore, more innovative methods should be developed and their effectiveness should be tested.

RELEVANCE TO CLINICAL PRACTICE

Development of patient education can be implemented through tailoring patient education to patients' individual needs and provide patient education using more innovative methods.

Registered nurses' perceptions of educational preparation for professional work and development in their profession

There is a lack of knowledge regarding graduate nurses' experiences of preparation in nursing education for their work in health care. The aim was to describe registered nurses' (RNs) perceptions of preparation in nursing education for their professional work and development in the nursing profession. The sample consisted of 339 RNs with 3 years experience taken from Swedish class registers for graduation in nursing education. A questionnaire was sent by post to 327 RNs. The response rate was 70.3%. The results (n=219) show that the most important domains of knowledge for RNs' work were biological science, medical science and nursing, whereas humanities and social science were less important. The importance of medical science was significantly lesser in community care and nursing in emergency care. Research methodology was of little importance for RNs' work. RNs could not make use of or conduct research in their work but research planning was significantly higher for those with extensive university education. This study mainly indicates that RNs need a stimulating work environment, including mentoring and support to enable continuous professional development in health care.

Information needs following a diagnosis of oesophageal cancer; self-perceived information needs of patients and family members compared with the perceptions of healthcare professionals: a pilot study

This pilot study was undertaken to describe patients' and family members' information needs following a diagnosis of oesophageal cancer and healthcare professionals' (HCP) perceptions concerning patients' and family members' information needs. Another aim was to describe patients' and family members' satisfaction with information provided. Data were collected by means of a self-report questionnaire. A total of 15 patients, 16 family members and 34 HCP participated. Patients and family members consider most information to be important. The high rating for information about tests/treatment and self-care means that both patients and family members consider this to be the most important areas of information. Healthcare professionals tend to underestimate both patients' and family members' needs for information. Patients and family members were only partly satisfied with the information received, with patients in general more satisfied with information given compared with family members. Patients' and family members' needs for information following a diagnosis of oesophageal cancer are substantial and have not been adequately met by HCP. A qualitative study might be helpful to complete the description of patients' and family members' needs. If a questionnaire is employed, it ought to be less extensive.

The process of developing audiovisual patient information: challenges and opportunities

AIM

The aim of this project was to produce audiovisual patient information, which was user friendly and fit for purpose. The purpose of the audiovisual patient information is to inform patients about randomized controlled trials, as a supplement to their trial-specific written information sheet.

BACKGROUND

Audiovisual patient information is known to be an effective way of informing patients about treatment. User involvement is also recognized as being important in the development of service provision. The aim of this paper is (i) to describe and discuss the process of developing the audiovisual patient information and (ii) to highlight the challenges and opportunities, thereby identifying implications for practice. A future study will test the effectiveness of the audiovisual patient information in the cancer clinical trial setting.

METHODS

An advisory group was set up to oversee the project and provide guidance in relation to information content, level and delivery. An expert panel of two patients provided additional guidance and a dedicated operational team dealt with the logistics of the project including: ethics; finance; scriptwriting; filming; editing and intellectual property rights.

RESULTS

Challenges included the limitations of filming in a busy clinical environment, restricted technical and financial resources, ethical needs and issues around copyright. There were, however, substantial opportunities that included utilizing creative skills, meaningfully involving patients, teamworking and mutual appreciation of clinical, multidisciplinary and technical expertise.

CONCLUSION

Developing audiovisual patient information is an important area for nurses to be involved with. However, this must be performed within the context of the multiprofessional team. Teamworking, including patient involvement, is crucial as a wide variety of expertise is required.

RELEVANCE TO CLINICAL PRACTICE

Many aspects of the process are transferable and will provide information and guidance for nurses, regardless of specialty, considering developing this format of patient information.