1
|
Elina H, Sofia E, Tricia CS, Jaana-Maija K, Katariina K, Anu SJ. Patients Receiving Palliative Care and Their Experiences of Encounters With Healthcare Professionals. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:497-513. [PMID: 35235482 PMCID: PMC11100268 DOI: 10.1177/00302228221077486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The study aimed to explore experiences of encounters with health care professionals among patients receiving palliative cancer care in specialist palliative care inpatient units. A qualitative explorative study design was conducted in a specialist palliative care inpatient setting. Data collection was implemented using semi-structured individual interviews (20 palliative care cancer patients) and analysed with inductive content analysis. Palliative care patients experienced both meaningful and disrespectful encounters with healthcare professionals. The meaningful encounters encompassed authentic and supportive experiences, while the disrespectful encounters included indifferent and inadequate experiences. Caring for a patient receiving palliative care requires care beyond tending to a patient's physical needs. Patients should be encountered holistically and as equal human beings without highlighting their roles as patients. The healthcare professionals and the organisations should also acknowledge the importance of time and effort spent for encounters and conversations with the patients instead of concentrating resources mainly on physical care.
Collapse
Affiliation(s)
- Haavisto Elina
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Finland
- Department of Nursing Science, University of Turku, Finland
- Satakunta Central Hospital, Pori, Finland
| | - Eriksson Sofia
- Finno-Ugrian and Scandinavian Studies, Faculty of Arts, University of Helsinki, Finland
| | | | | | | | - Soikkeli-Jalonen Anu
- Finno-Ugrian and Scandinavian Studies, Faculty of Arts, University of Helsinki, Finland
| |
Collapse
|
2
|
Barrett D, Sibalija J, Kim RB. Patients' Experiences of a Precision Medicine Clinic. J Patient Exp 2024; 11:23743735241229384. [PMID: 38313864 PMCID: PMC10836129 DOI: 10.1177/23743735241229384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
The purpose of this study is to provide an overview of patients' experiences using a precision medicine (PM) clinic that conducts pharmacogenomics-based (PGx) testing for adverse drug reactions. The study aimed to identify the features of the clinic valued most by patients and areas for improvement. A paper survey was used to collect data. Survey questions focused on patients' perceptions of the PM testing and the overall clinic experience. Sixty-seven patients completed the survey. Quantitative data were analyzed using SPSS and frequencies were reported. Open-ended responses were coded and organized thematically. Patients reported that the clinic services increased confidence in their medication usage. Feeling respected by staff, receiving education, and quick appointments were highly valued by patients. Suggested areas for improvement included better communication from the clinic to patients, expansion of clinic services, and education for other healthcare providers. The findings demonstrate that patient experience goes beyond the clinical care provided. Current and potential future providers of PM should invest the time and energy to configure their care delivery system to enhance the patient experience.
Collapse
Affiliation(s)
- David Barrett
- Ivey Business School, Western University, London, Canada
| | - Jovana Sibalija
- Faculty of Health Sciences, Western University, London, Canada
| | - Richard B Kim
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| |
Collapse
|
3
|
Kao HFS, Hung CC, Lee BO, Tsai SL, Moreno O. Patient Participation in Healthcare Activities: Nurses' and Patients' Perspectives in Taiwan. Nurs Health Sci 2021; 24:44-53. [PMID: 34914182 DOI: 10.1111/nhs.12911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
Patient participation in healthcare activities is key in producing successful patient-centered care. However, little is known about both nurses' and patients' perspectives regarding patient participation in East Asia. This paper compared and contrasted perspectives of patient participation in healthcare activities between nurses and patients, using a qualitative study with a purposive sample of 39 nurses and 15 patients. A semi-structured interview was applied to focus groups for nurses, and face-to-face interview for patients. Content analysis was utilized to analyze the data, and common themes and subthemes were identified showing three similarities- authoritative culture, participation behaviors, and obstacles to participation; and two differences- sources of acquiring patient-related health information and responsible party. Nurses and patients did not entirely view participation in healthcare activities congruently. Relevant clinical practices are also suggested, including respecting patients' autonomy, nurses' using layman language to explain, patients' understanding the meaning behind their participation behaviors, recognizing obstacles faced to enhance patient participation with adjusted nursing workload, actively providing needed health information, and leading patients to realize that they will be responsible for their health behaviors after discharge. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Chang-Chiao Hung
- Department of Nursing & Nursing Department, Chang Gung University of Science and Technology & Chia-Yi Chang Gung Memorial Hospital, ChiaYi, Taiwan
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Taiwan
| | - Shu-Ling Tsai
- Department of Nursing, Chang Gung University of Science and Technology, ChiaYi, Taiwan
| | - Oscar Moreno
- School of Nursing, The University of Texas at El Paso, USA
| |
Collapse
|
4
|
de Jong Y, van der Willik EM, Milders J, Meuleman Y, Morton RL, Dekker FW, van Diepen M. Person centred care provision and care planning in chronic kidney disease: which outcomes matter? A systematic review and thematic synthesis of qualitative studies : Care planning in CKD: which outcomes matter? BMC Nephrol 2021; 22:309. [PMID: 34517825 PMCID: PMC8438879 DOI: 10.1186/s12882-021-02489-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022] Open
Abstract
RATIONALE & OBJECTIVE Explore priorities related to outcomes and barriers of adults with chronic kidney disease (CKD) regarding person centred care and care planning. STUDY DESIGN Systematic review of qualitative studies. SEARCH STRATEGY & SOURCES In July 2018 six bibliographic databases, and reference lists of included articles were searched for qualitative studies that included adults with CKD stages 1-5, not on dialysis or conservative management, without a previous kidney transplantation. ANALYTICAL APPROACH Three independent reviewers extracted and inductively coded data using thematic synthesis. Reporting quality was assessed using the COREQ and the review reported according to PRISMA and ENTREQ statements. RESULTS Forty-six studies involving 1493 participants were eligible. The period after diagnosis of CKD is characterized by feelings of uncertainty, social isolation, financial burden, resentment and fear of the unknown. Patients show interest in ways to return to normality and remain in control of their health in order to avoid further deterioration of kidney function. However, necessary information is often unavailable or incomprehensible. Although patients and healthcare professionals share the predominant interest of whether or not dialysis or transplantation is necessary, patients value many more outcomes that are often unrecognized by their healthcare professionals. We identified 4 themes with 6 subthemes that summarize these findings: 'pursuing normality and control' ('pursuing normality'; 'a search for knowledge'); 'prioritizing outcomes' ('reaching kidney failure'; 'experienced health'; 'social life'; 'work and economic productivity'); 'predicting the future'; and 'realising what matters'. Reporting quality was moderate for most included studies. LIMITATIONS Exclusion of non-English articles. CONCLUSIONS The realisation that patients' priorities do not match those of the healthcare professionals, in combination with the prognostic ambiguity, confirms fatalistic perceptions of not being in control when living with CKD. These insights may contribute to greater understanding of patients' perspectives and a more person-centred approach in healthcare prioritization and care planning within CKD care.
Collapse
Affiliation(s)
- Ype de Jong
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Esmee M van der Willik
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Jet Milders
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| |
Collapse
|
5
|
Ania-González N, Olano-Lizarraga M, Vázquez-Calatayud M. Interventions to empower cardiorenal patients: A systematic review. J Adv Nurs 2021; 78:363-376. [PMID: 34363636 DOI: 10.1111/jan.15007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/02/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
AIMS To identify the most effective interventions to empower cardiorenal patients. DESIGN A systematic review of the literature has been carried out. DATA SOURCES The PubMed, CINAHL, PsycINFO and Cochrane databases were reviewed, and journals in the field were manually searched between January and February 2020. REVIEW METHODS Five randomized clinical trials and quasi-experimental studies that met the selection and CONSORT & TREND methodological quality criteria were selected. RESULTS The evidence supports that there are no existing interventions aimed at empowering cardiorenal patients. However, the interventions to empower people with chronic kidney disease and heart failure suggest that their integration should address seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life. CONCLUSION A gap has been revealed in the literature regarding the empowerment of cardiorenal patients. This review provides relevant information to help design, implement and evaluate interventions to empower these patients by describing the strategies used to empower people experiencing both chronic conditions and the tools used for their assessment. IMPACT There is a need for further research to design, implement and evaluate a multidimensional intervention that favours the empowerment of cardiorenal patients by using valid and reliable instruments that measure the domains that constitute it in an integrated manner. Interventions aimed at empowering the cardiorenal patient should include seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life.
Collapse
Affiliation(s)
| | - Maddi Olano-Lizarraga
- School of Nursing, Universidad de Navarra, Pamplona, Spain.,Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Universidad de Navarra, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Mónica Vázquez-Calatayud
- Clínica Universidad de Navarra, Pamplona, Spain.,School of Nursing, Universidad de Navarra, Pamplona, Spain.,Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Universidad de Navarra, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| |
Collapse
|
6
|
Chang FH, Fields BE, Kersey JM, Wu CY, Shih M, Skidmore ER. How does culture influence the implementation of strategy training in stroke rehabilitation? A rapid ethnographic study of therapist perspectives in Taiwan and the United States. Disabil Rehabil 2021; 44:5612-5622. [DOI: 10.1080/09638288.2021.1946604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Beth E. Fields
- Occupational Therapy Program, Department of Kinesiology, University of Wisconsin–Madison, Madison, MI, USA
| | - Jessica M. Kersey
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chao-Yi Wu
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA
| | - Minmei Shih
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
7
|
Rydmark Kersley Å, Berterö C. Women's experiences of an enhanced recovery after surgery program: A qualitative study. Nurs Health Sci 2021; 23:263-272. [PMID: 33404177 DOI: 10.1111/nhs.12810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
The Enhanced Recovery After Surgery Program aims to transfer much of the responsibility for postoperative recovery to the patient and their next of kin. The aim of the study was to identify and describe women's experiences of care within this program in relation to gynecological abdominal surgery. A qualitative approach was used where 16 women were interviewed within 1 to 2 weeks of their surgery. A thematic analysis focusing on interpretation of latent content was performed. Three themes were identified: Empowerment, Self-care, and Participation. Empowerment represents aspects of the recovery program that strengthen self-efficacy, such as being seen, being given information, and continuity of care. Self-care identifies the practical implications of empowerment, namely internal resources, knowledge, and external resources. These two themes were identified as separate but interlinked through the theme Participation. Preoperative information, postoperative encouragement, and follow-up empowered the women in their recovery. Early discharge from hospital was beneficial for recovery if accompanied by social support and sufficient self-care ability. A desire for a person-centered approach in the preoperative meeting and in postoperative care was identified.
Collapse
Affiliation(s)
- Åsa Rydmark Kersley
- Department of Obstetrics and Gynaecology, Linköping University, Linköping, Sweden
| | - Carina Berterö
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
8
|
Stelwagen M, van Kempen A, Westmaas A, Vet E, Scheele F. Parents' Experiences With a Model of Integrated Maternity and Neonatal Care Designed to Empower Parents. J Obstet Gynecol Neonatal Nurs 2021; 50:181-192. [PMID: 33428875 DOI: 10.1016/j.jogn.2020.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore the experiences of parents with an integrated maternity and neonatal ward designed to empower parents by providing family-integrated care (FICare) to mother-newborn couplets in single-family rooms. DESIGN A qualitative analysis with a contextual constructivist approach. SETTING An integrated maternity and neonatal level 2 ward designed to empower parents in a teaching hospital in Amsterdam, the Netherlands. Maternity and neonatal care, up to and including highly complex care, is provided to mother-newborn couplets in single-family rooms according to the principles of FICare. PARTICIPANTS Twenty-seven mothers and nine fathers of newborns who were hospitalized for at least 7 days. METHODS We held four focus group discussions and eight semistructured interviews 1 to 3 months after discharge of the newborn to explore which experiences (mechanisms) facilitated or impeded aspects of parent empowerment (outcomes) under which specific conditions of the integrated infrastructure (contexts). We used the realist evaluation model to analyze the data. RESULTS Our analysis revealed five themes of parent empowerment (outcomes): Feeling Respected, Gaining Self-Management Tools, Insights Into the Newborn's Condition, Perceived Control, and Self-Efficacy. For each theme, participants reported facilitating and impeding experiences (mechanisms) that were initiated and influenced by the combination of single-family rooms, couplet care, rooming-in, and FICare (contexts). Unrestricted physical proximity to their newborns, 24 hours per day, in a safe private environment offered parents intensive learning experiences through active participation in care. It helped them to achieve independent parenthood at the time of discharge, but it also generated challenges such as power conflicts with the staff; prioritizing care for themselves, siblings, or the newborn; feelings of isolation; and lack of sleep. CONCLUSION Providing FICare to mother-newborn couplets in single-family rooms offers parents an intensive learning context for independent parenthood at the time of discharge. Health care professionals should be aware of the challenges and facilitators experienced by parents in the context of close physical proximity to their newborns 24 hours per day in single-family rooms. This awareness will allow them to better support parents in their empowerment process toward independent parenthood at the time of discharge.
Collapse
|
9
|
Abelsson A, Falk P, Sundberg B, Nygårdh A. Empowerment in the perioperative dialog. Nurs Open 2021; 8:96-103. [PMID: 33318816 PMCID: PMC7729678 DOI: 10.1002/nop2.607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 01/10/2023] Open
Abstract
Aim To describe how the nurse anaesthetist empowers the patient in the perioperative dialogue. Design A qualitative descriptive design with interviews with 12 nurse anaesthetist (NA). Method A hermeneutic text interpretation with a foundation in Gibson's empowerment model. Result The results highlight Gibson's nursing domain: Helper, Supporter, Counsellor, Educator, Resource Consultant, Resource Mobilizer, Facilitator, Enabler and Advocate. The overall understanding is revealed as a relationship can be built through closeness between the patient and the NA. The NA helps the patient master the situation by talking to and touching the patient. The patient is helped to find their own strengths and to cope with their fears. The patients decide over their own bodies. When the patients do not want to or cope with protecting themselves, the NA protects and represents the patient.
Collapse
Affiliation(s)
- Anna Abelsson
- Department of Nursing ScienceSchool of Health SciencesJönköping UniversityJönköpingSweden
| | - Peter Falk
- Department of Nursing ScienceSchool of Health SciencesJönköping UniversityJönköpingSweden
- Surgical and Intensive care ClinicsVärnamo County HospitalRegion Jönköping countySweden
| | - Bengt Sundberg
- Department of Nursing ScienceSchool of Health SciencesJönköping UniversityJönköpingSweden
- Surgical and Intensive care ClinicsRyhov County HospitalRegion Jönköping countySweden
| | - Annette Nygårdh
- Department of Nursing ScienceSchool of Health SciencesJönköping UniversityJönköpingSweden
| |
Collapse
|
10
|
Baumgart A, Manera KE, Johnson DW, Craig JC, Shen JI, Ruiz L, Wang AYM, Yip T, Fung SKS, Tong M, Lee A, Cho Y, Viecelli AK, Sautenet B, Teixeira-Pinto A, Brown EA, Brunier G, Dong J, Scholes-Robertson N, Dunning T, Mehrotra R, Naicker S, Pecoits-Filho R, Perl J, Wilkie M, Tong A. Meaning of empowerment in peritoneal dialysis: focus groups with patients and caregivers. Nephrol Dial Transplant 2020; 35:1949-1958. [PMID: 32712672 PMCID: PMC7824999 DOI: 10.1093/ndt/gfaa127] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/21/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND While peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-management and improve treatment outcomes. We aimed to describe patients' and caregivers' perspectives on the meaning and role of patient empowerment in PD. METHODS Adult patients receiving PD (n = 81) and their caregivers (n = 45), purposively sampled from nine dialysis units in Australia, Hong Kong and the USA, participated in 14 focus groups. Transcripts were thematically analyzed. RESULTS We identified six themes: lacking clarity for self-management (limited understanding of rationale behind necessary restrictions, muddled by conflicting information); PD regimen restricting flexibility and freedom (burden in budgeting time, confined to be close to home); strength with supportive relationships (gaining reassurance with practical assistance, comforted by considerate health professionals, supported by family and friends); defying constraints (reclaiming the day, undeterred by treatment, refusing to be defined by illness); regaining lost vitality (enabling physical functioning, restoring energy for life participation); and personal growth through adjustment (building resilience and enabling positive outlook, accepting the dialysis regimen). CONCLUSIONS Understanding the rationale behind lifestyle restrictions, practical assistance and family support in managing PD promoted patient empowerment, whereas being constrained in time and capacity for life participation outside the home undermined it. Education, counseling and strategies to minimize the disruption and burden of PD may enhance satisfaction and outcomes in patients requiring PD.
Collapse
Affiliation(s)
- Amanda Baumgart
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Karine E Manera
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jenny I Shen
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor, University of California, Los Angeles Medical Center, Torrance, CA, USA
| | - Lorena Ruiz
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor, University of California, Los Angeles Medical Center, Torrance, CA, USA
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Terence Yip
- Department of Medicine, Tung Wah Hospital, Hong Kong, China
| | - Samuel K S Fung
- Division of Nephrology, Department of Medicine and Geriatrics, Jockey Club Nephrology and Urology Centre, Princess Margaret Hospital, Kowloon, Hong Kong, China
| | - Matthew Tong
- Department of Medicine and Geriatrics, Pok Oi Hospital, Yuen Long, Hong Kong, China
| | - Achilles Lee
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, China
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Benedicte Sautenet
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Department of Nephrology-Hypertension, Kidney Transplantation, Dialysis, Tours Hospital, SPHERE-INSERM 1246, University of Tours and Nantes, Tours, France
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Gillian Brunier
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Tony Dunning
- South Bank Technical and Further Education, Brisbane, Australia
| | - Rajnish Mehrotra
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Jeffrey Perl
- Division of Nephrology, Department of Medicine, St Michael’s Hospital Unity Health, University of Toronto, Toronto, Ontario, Canada
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| |
Collapse
|
11
|
van Belle E, Huisman‐De Waal G, Vermeulen H, Heinen M. Feasibility and early effectiveness of the Tell-us Card communication tool to increase in-hospital patient participation: a cluster randomised controlled pilot study. Scand J Caring Sci 2020; 35:911-922. [PMID: 32964468 PMCID: PMC8451905 DOI: 10.1111/scs.12909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/04/2020] [Accepted: 08/12/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Patient participation is fundamental to nursing care and has beneficial effects on patient outcomes. However, it is not well embedded yet and little is known on how nurses could effectively stimulate patient participation in hospital care. The Tell-us Card is a communication tool for inviting patients to talk about their preferences and needs, and to increase patient participation in daily care. OBJECTIVES To assess feasibility and early effectiveness of the Tell-us Card communication tool for enhanced patient participation during hospitalisation. DESIGN AND METHOD A pilot cluster randomised controlled study design was used including four nursing wards. Effectiveness was measured with the Individualized Care Scale (ICS) and the Quality from the Patients' Perspective (QPP) questionnaire. Linear mixed model analysis was used for analysis. Feasibility was assessed with an evaluative questionnaire for patients and nurses and by reviewing the content of Tell-us Cards using the Fundamentals of Care Framework (FOCF) for analysis. Ethical approval was attained. RESULTS Data of 265 patients showed a significant increase at one intervention ward on the ICS (effect size 0.61, p = 0.02) and most ICS subscales. No effect was visible on the QPP. The majority of patients regarded the intervention as beneficial; nurses however experienced barriers with incorporating the Tell-us Card into daily care. Analysis of the Tell-us Card content showed many elements of the FOCF being mentioned, with most patients indicating psychosocial needs like being involved and informed. CONCLUSIONS This pilot study showed a positive early effect of the Tell-us Card communication tool on patient participation, although integration in daily nursing care appeared to be complex and an optimal fit has not yet been reached. Patients were positive about the intervention and wrote meaningful issues on the Tell-us Cards. More research is needed on how to incorporate patient participation effectively in complex hospital care.
Collapse
Affiliation(s)
- Elise van Belle
- Radboud Institute for Health SciencesIQ HealthcareRadboud University Medical CenterNijmegenThe Netherlands
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Getty Huisman‐De Waal
- Radboud Institute for Health SciencesIQ HealthcareRadboud University Medical CenterNijmegenThe Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health SciencesIQ HealthcareRadboud University Medical CenterNijmegenThe Netherlands
- Faculty of Health and Social StudiesHAN University of Applied SciencesNijmegenThe Netherlands
| | - Maud Heinen
- Radboud Institute for Health SciencesIQ HealthcareRadboud University Medical CenterNijmegenThe Netherlands
| |
Collapse
|
12
|
Stømer UE, Wahl AK, Gøransson LG, Urstad KH. Exploring health literacy in patients with chronic kidney disease: a qualitative study. BMC Nephrol 2020; 21:314. [PMID: 32727397 PMCID: PMC7392653 DOI: 10.1186/s12882-020-01973-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022] Open
Abstract
Background Patients with chronic kidney disease make day-to-day decisions about how to self-manage their disease. Chronic kidney disease (CKD) includes a risk for progression towards end-stage renal disease and the development of comorbidities, such as cardiovascular disease, which represents the leading cause of death among these patients. To reduce these risks, CKD patients are recommended to follow a healthy lifestyle with physical activity, food and fluid restrictions, and adherence to complex medication regimes throughout all phases of the disease. To manage the complexity of this health situation, health literacy (HL) is considered essential. The current prevailing understanding is that HL is a multidimensional concept and comprises a range of cognitive, affective, social, and personal skills that determine the motivation and ability to gain access to, understand, and use health information. Recently, we investigated multiple aspects of HL in CKD patients in a quantitative cross-sectional study utilizing the Health Literacy Questionnaire (HLQ) and observed that finding good health information and appraising health information were the most challenging aspects of HL. This study aimed to explore CKD patients’ lived experiences of different dimensions of HL presented in the HLQ. Methods This qualitative study utilized in-depth semistructured interviews. Twelve patients with different levels of HL were included. The interviews were analyzed using thematic analysis as described by Braun and Clarke. Results We identified three main themes that were significant for CKD patients’ HL: 1. Variation in people’s attitudes and behavior as health information seekers, 2. The problem of fragmented healthcare in the context of multimorbidity makes the healthcare system challenging to navigate, and 3. The value of a good relationship with healthcare providers. Conclusion CKD patients take different approaches to health information. Limiting or avoiding health information may be a strategy used by some individuals to cope with the disease and does not necessarily mean that health information is inaccessible or difficult to understand. Comorbidity and a fragmented healthcare system can make the healthcare system challenging to navigate. A good and trusting relationship with healthcare providers seems to promote several aspects of HL and should be promoted to optimize CKD patients’ HL.
Collapse
Affiliation(s)
- Une Elisabeth Stømer
- Faculty of Health Science, University of Stavanger, Stavanger, Norway. .,Department of Nephrology, Stavanger University Hospital, Stavanger, Norway.
| | | | - Lasse Gunnar Gøransson
- Department of Nephrology, Stavanger University Hospital, Stavanger, Norway.,Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | |
Collapse
|
13
|
Clair C, Engström Å, Strömbäck U. Strategies to Relieve Patients' Preoperative Anxiety Before Anesthesia: Experiences of Nurse Anesthetists. J Perianesth Nurs 2020; 35:314-320. [DOI: 10.1016/j.jopan.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/13/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
|
14
|
Pálsdóttir AM, Gudmundsson M, Grahn P. Equine-Assisted Intervention to Improve Perceived Value of Everyday Occupations and Quality of Life in People with Lifelong Neurological Disorders: A Prospective Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072431. [PMID: 32260047 PMCID: PMC7177295 DOI: 10.3390/ijerph17072431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 12/03/2022]
Abstract
People with neurological disorders suffer from poor mobility, poor balance, fatigue, isolation and monotonous everyday activities. Studies show that equine-assisted interventions can improve their mobility and balance, but could these kinds of interventions also increase participants’ activity repertoire and self-assessed health, and reduce their fatigue? The study was conducted as a prospective, controlled study with three cohorts followed for one year: intervention group (n = 14), control group Passive (n = 29), and control group Active (n = 147). Participants in the study were affected by neurological disease or injury that limited their opportunities for an active everyday life. The intervention group lacked regular activities outside the home before the intervention, which consisted of riding once a week, led by a certified therapist. Control group Passive lacked regular activities outside the home, while control group Active had several activities outside the home per week. Primary outcome measures were activity repertoire measured with Occupational Value Assessment questionnaire. Secondary outcome measures were global self-assessed health measured with EuroQol-VAS and fatigue measured with Shirom-Melamed Burnout Questionnaire. The intervention group’s activity repertoire and self-assessed health increased significantly compared to both baseline and the control groups. Equine-assisted interventions could help to improve the perceived value of everyday occupations and quality of life, as well as break isolation and increase the activity repertoire of people with neurological disorders.
Collapse
Affiliation(s)
- Anna María Pálsdóttir
- The Department of Work Science, Business Economics and Environmental Psychology, Swedish University of Agricultural Sciences, P.O. Box 88, SE-230 53 Alnarp, Sweden;
- Correspondence: ; Tel.: +46-40-415-425; Fax: +46-40-415-010
| | - Marie Gudmundsson
- Nature and Health, Region Dalarna, P.O. Box 712, SE-791 29 Falun, Sweden;
| | - Patrik Grahn
- The Department of Work Science, Business Economics and Environmental Psychology, Swedish University of Agricultural Sciences, P.O. Box 88, SE-230 53 Alnarp, Sweden;
| |
Collapse
|
15
|
Gervais C, Verdon C, deMontigny F, Leblanc L, Lalande D. Creating a space to talk about one's experience of suffering: families' experience of a family nursing intervention. Scand J Caring Sci 2019; 34:446-455. [PMID: 31487072 DOI: 10.1111/scs.12748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/08/2019] [Indexed: 12/14/2022]
Abstract
STUDY RATIONALE The impacts of health problems on individual and family functioning, as well as the influence of family on health, are well documented. However, health care and services in the West are mostly oriented towards individuals, and the needs of families often receive little consideration. The Family Support Service (FSS) was developed to address this situation. Its aim is to improve the education of nursing students and contribute to the health of the community by offering family conversations to families whose members have a health problem or who have difficulty adjusting to certain transitions. AIMS AND OBJECTIVES The objective of this study was to explore families' experience of the family conversations in which they participated and their satisfaction with the FSS. METHODOLOGICAL DESIGN AND JUSTIFICATION This study used a descriptive qualitative design based on semi-structured interviews and thematic analysis. The study followed ethical codes of conduct and conformed to the Canadian Tri-Council Policy Statement (TCPS). RESEARCH METHODS Qualitative interviews were conducted with 22 participants who had participated in family conversations as interventions, to evaluate their experience of those family conversations and their satisfaction with the FSS. RESULTS The families reported a very positive experience of the family conversations. Three themes emerged from their statements and explained this satisfaction: (i) the nurse's attitudes and skills as the foundation for meaningful encounters; (ii) a family systems intervention where families feel recognised; and (iii) a structure adapted to the needs of families. CONCLUSIONS This study adds to the existing body of knowledge on families' experience of family system nursing and invites nurses to develop attitudes that are conducive to meaningful encounters with families.
Collapse
Affiliation(s)
- Christine Gervais
- Centre for Studies and Research on Family Intervention, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Chantal Verdon
- Centre for Studies and Research on Family Intervention, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Francine deMontigny
- Centre for Studies and Research on Family Intervention, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Lori Leblanc
- Centre for Studies and Research on Family Intervention, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Dominique Lalande
- Centre for Studies and Research on Family Intervention, Université du Québec en Outaouais, Gatineau, QC, Canada
| |
Collapse
|
16
|
Reprint of: Patient participation in nursing bedside handover: A systematic mixed-methods review. Int J Nurs Stud 2019; 97:63-77. [PMID: 31181413 DOI: 10.1016/j.ijnurstu.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 08/30/2017] [Accepted: 10/22/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous reviews of nursing handover have been undertaken, but none have focused on the patient's role. OBJECTIVES To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. DESIGN Systematic mixed- methods review. DATA SOURCES Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. REVIEW METHODS Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. RESULTS Segregated synthesis of research of patients' perceptions revealed two contrasting categories; patient-centred handover and nurse-centred handover. Segregated synthesis of research of nurses' perceptions included three categories: viewing the patient as an information resource; dealing with confidential and sensitive information; and enabling patient participation. The segregated synthesis of QI projects included two categories: nurse barriers to enacting patient participation in bedside handover; and involving patients in beside handover. Once segregated findings were configured, we discovered that the patient's role in bedside handover involves contributing clinical information related to their care or progress, which may influence patient safety. Barriers related to nurses' discomfort encouraging patient participation and worries for sharing confidential and sensitive information. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and increasing the interpersonal approach during handover. CONCLUSIONS Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses to achieve this and prepare patients to do this. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects.
Collapse
|
17
|
Almeida OAED, Santos WS, Rehem TCMSB, Medeiros M. Envolvimento da pessoa com doença renal crônica em seus cuidados: revisão integrativa. CIENCIA & SAUDE COLETIVA 2019; 24:1689-1698. [DOI: 10.1590/1413-81232018245.04332019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 02/19/2019] [Indexed: 11/21/2022] Open
Abstract
Resumo A doença renal crônica (DRC) acarreta ao indivíduo uma sobrecarga de cuidados indispensáveis ao alcance das metas terapêuticas e qualidade de vida. O controle nutricional, o regime medicamentoso e as terapias de substituição renal são exemplos que requerem participação ativa. Assim, foi realizada revisão integrativa de artigos científicos para identificar os que versam sobre envolvimento e participação do paciente em seus cuidados na DRC. Os descritores “Chronic kidney disease”; “Self-Care” and “Patient Participation” foram aplicados nas bases CINHAL, Bireme e Medline. Selecionamos 21 publicações entre 2012 e 2016. A entrevista semiestruturada destacou-se como método de coleta de dados, com a aplicação da análise temática fenomenológica. Conforme a predominância do assunto tratado, os manuscritos foram alocados em quatro eixos temáticos: Manejo da doença renal e seu tratamento; Envolvimento na tomada de decisão; Plano avançado de cuidados; e, Diálise peritoneal domiciliar. Verificamos que abordagens envolvendo pessoas transplantadas ou nos primeiros estágios da doença são pouco explorados com a aplicação do método qualitativo e, ainda, consideramos que pessoas com DRC devem ser instigadas no envolvimento ativo de seus próprios cuidados, necessitando de conhecimento, motivação e suporte dos profissionais de saúde.
Collapse
|
18
|
Roberti J, Cummings A, Myall M, Harvey J, Lippiett K, Hunt K, Cicora F, Alonso JP, May CR. Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies. BMJ Open 2018; 8:e023507. [PMID: 30181188 PMCID: PMC6129107 DOI: 10.1136/bmjopen-2018-023507] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER CRD42014014547.
Collapse
Affiliation(s)
- Javier Roberti
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kate Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Cicora
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| |
Collapse
|
19
|
Lambert K, Mansfield K, Mullan J. Qualitative exploration of the experiences of renal dietitians and how they help patients with end stage kidney disease to understand the renal diet. Nutr Diet 2018; 76:126-134. [PMID: 29968271 DOI: 10.1111/1747-0080.12443] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 10/28/2022]
Abstract
AIM Dietary modification is integral to the management of end stage kidney disease. However, adherence to the renal diet is poor. Few studies have explored the perspectives of renal dietitians and how they work with patients to facilitate dietary change. The objectives of this study were to explore the experiences of renal dietitians about educating patients with end stage kidney disease; and to describe the strategies perceived to help patients understand the renal diet. METHODS Semi-structured interviews based on Sensemaking theory were conducted with renal dietitians (n = 27) working in Australia and New Zealand from a range of metropolitan, regional and remote areas. RESULTS Five major themes across two categories were derived from the data. The renal dietitians in this study experienced feelings of frustration, frequently worked in practice environments with limited or inadequate resources and perceived that establishing trust and demonstrating empathy were important to sense making. Renal dietitians helped patients make sense of and understand the diet by clarifying ambiguities and conflicting information; and simplifying complexity by using simple explanations, individualised advice and practical support. These strategies were considered critical to the renal diet sense making process. CONCLUSIONS The experience of providing renal diet advice to adults with end stage kidney disease was emotionally and professionally challenging. Alternative approaches to patient education may help dietitians to empower patients to better understand the renal diet. Further research exploring the experiences of learning about the renal diet from the patient and carer perspective would also help to inform future alternative approaches.
Collapse
Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Kylie Mansfield
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Judy Mullan
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
20
|
Johnsson A, Wagman P, Boman Å, Pennbrant S. What are they talking about? Content of the communication exchanges between nurses, patients and relatives in a department of medicine for older people-An ethnographic study. J Clin Nurs 2018; 27:e1651-e1659. [PMID: 29493840 DOI: 10.1111/jocn.14315] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Anette Johnsson
- Department of Health Sciences; University West; Trollhättan Sweden
- School of Health and Welfare; Jönköping University; Jönköping Sweden
| | - Petra Wagman
- Department of Rehabilitation; School of Health and Welfare; Jönköping University; Jönköping Sweden
| | - Åse Boman
- Department of Health Sciences; University West; Trollhättan Sweden
| | - Sandra Pennbrant
- Department of Health Sciences; University West; Trollhättan Sweden
| |
Collapse
|
21
|
Prato L, Lindley L, Boyles M, Robinson L, Abley C. Empowerment, environment and person-centred care: A qualitative study exploring the hospital experience for adults with cognitive impairment. DEMENTIA 2018; 18:2710-2730. [DOI: 10.1177/1471301218755878] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is acknowledged that there are many challenges to ensuring a positive hospital experience for patients with cognitive impairment. The study (‘Improving hospital care for adults with cognitive impairment’) aimed to explore the positive and negative experiences of older adults with cognitive impairment (dementia and delirium) and their relatives and/or carers, during an acute hospital stay, from admission to discharge, using a qualitative, case study methodology. Six participants with cognitive impairment, eight relatives and 59 members of the health care team were recruited. Data was collected via ethnographic, observational periods at each stage of the hospital journey and through the use of semi-structured interviews with relatives, carers and health care staff including: medical staff; nursing staff; physiotherapists and ward managers. Interpretive phenomenological analysis was used to facilitate data analysis. 52 hours 55 minutes of ethnographic observations and 18 interviews with ward staff and relatives were undertaken. Three superordinate themes emerged from the data as crucial in determining the quality of the hospital experience: valuing the person; activities of empowerment and disempowerment and the interaction of environment with patient well-being. Whether the patient’s hospital experience was positive or negative was powerfully influenced by family involvement and ward staff actions and communication. Participants identified a requirement for a ward based activity service for patients with cognitive impairment. Further research must be undertaken focusing on the development of ward based activities for patients with cognitive impairment, alongside a move towards care which explores measures to improve and expand relative involvement in hospital care.
Collapse
Affiliation(s)
- Laura Prato
- Newcastle University, Campus for Ageing and Vitality (former Newcastle General Hospital), Newcastle Upon Tyne, UK
| | - Lyndsay Lindley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Miriam Boyles
- Newcastle University, Campus for Ageing and Vitality (former Newcastle General Hospital), Newcastle Upon Tyne, UK
| | - Louise Robinson
- Newcastle University, Campus for Ageing and Vitality (former Newcastle General Hospital), Newcastle Upon Tyne, UK
| | - Clare Abley
- Newcastle University, Campus for Ageing and Vitality (former Newcastle General Hospital), Newcastle Upon Tyne, UK
| |
Collapse
|
22
|
[Transcultural adaptation into Spanish of the Patient empowerment in long-term conditions questionnaire]. Aten Primaria 2017; 51:24-31. [PMID: 29277376 PMCID: PMC6836925 DOI: 10.1016/j.aprim.2017.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/21/2017] [Accepted: 09/26/2017] [Indexed: 11/22/2022] Open
Abstract
Objetivo Describir el proceso de traducción y adaptación transcultural del instrumento Patient empowerment in long-term condition al español. Diseño Traducción, adaptación transcultural y análisis de la comprensibilidad mediante entrevistas cognitivas. Emplazamiento Asistencia primaria y hospitalaria. Participantes Diez pacientes ingresados en un servicio de cardiología de un hospital universitario. Mediciones principales 1) Traducción directa; 2) síntesis y conciliación de las versiones por un comité de expertos; 3) traducción inversa; 4) conciliación de la traducción inversa con la autora del cuestionario original, y 5) análisis de la comprensibilidad mediante entrevistas cognitivas a una muestra de pacientes. Resultados Las versiones de traducción directa no presentaron grandes diferencias entre ellas. De los 47 ítems que componen el cuestionario, el comité de expertos introdujo cambios en 23 ítems. La versión de la traducción inversa fue aceptada por la autora del cuestionario original. En las entrevistas cognitivas, los pacientes señalaron una dificultad alta en un ítem y baja en 4. Conclusiones La versión española del cuestionario Patient Empowerment in long-term conditions es equivalente semántica y conceptualmente al instrumento original. En una fase posterior se procederá a un proceso de validación en el que se establecerán las propiedades psicométricas.
Collapse
|
23
|
Årestedt L, Persson C, Rämgård M, Benzein E. Experiences of encounters with healthcare professionals through the lenses of families living with chronic illness. J Clin Nurs 2017; 27:836-847. [PMID: 29076223 DOI: 10.1111/jocn.14126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 01/04/2023]
Abstract
AIMS AND OBJECTIVES To describe and explore the experience of healthcare encounters in families living with chronic illness. BACKGROUND Living with chronic illness is a family concern and often includes frequent encounters with healthcare professionals. These encounters affect how persons with illness and family members handle everyday life. Disease-related explanations are perceived by healthcare professionals as being of higher importance than the actual experience of illness, even though patients are concerned with issues involving their everyday life. DESIGN A descriptive design with a qualitative approach. METHODS Narrative family interviews were conducted with twelve families, using a qualitative content analysis. RESULTS One main category was indicated following analysis, specifically "The impact of an accompanying family member." Additionally, three subcategories were revealed; "The importance of collaboration," "Mutual understanding," "A desire to be confirmed in one's illness". CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE Having a participating family member increased the sense of power in families during encounters with healthcare professionals. This participation constitutes a level of support, making it easier for families to handle everyday life due to illness. Family members are, in most cases, included in discussions and decisions, both before and after encounters, and it should be a natural for healthcare professionals to invite them to the encounter too. This is an offer that may not fit every family, but the person with illness or the family should at least have the opportunity to choose.
Collapse
Affiliation(s)
- Liselott Årestedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Carina Persson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Centre for Collaborative Palliative Care, Linnaeus University, Kalmar, Sweden
| | - Margareta Rämgård
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Eva Benzein
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Centre for Collaborative Palliative Care, Linnaeus University, Kalmar, Sweden
| |
Collapse
|
24
|
Ringdal M, Chaboyer W, Ulin K, Bucknall T, Oxelmark L. Patient preferences for participation in patient care and safety activities in hospitals. BMC Nurs 2017; 16:69. [PMID: 29200965 PMCID: PMC5696683 DOI: 10.1186/s12912-017-0266-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/13/2017] [Indexed: 12/03/2022] Open
Abstract
Background Active patient participation is a patient safety priority for health care. Yet, patients and their preferences are less understood. The aim of the study was to explore hospitalised patients’ preferences on participation in their care and safety activities in Sweden. Methods Exploratory qualitative study. Data were collected over a four-month period in 2013 and 2014. Semi-structured interviews were conducted with 20 patients who were admitted to one of four medical wards at a university hospital in Sweden. Data were analysed using thematic analysis. Results Nine men and eleven women, whose median age was 72 years (range 22–89), were included in the study. Five themes emerged with the thematic analysis: endorsing participation; understanding enables participation; enacting patient safety by participation; impediments to participation; and the significance of participation. This study demonstrated that patients wanted to be active participants in their care and safety activities by having a voice and being a part of the decision-making process, sharing information and possessing knowledge about their conditions. These factors were all enablers for patient participation. However, a number of barriers hampered participation, such as power imbalances, lack of patient acuity and patient uncertainty. Patients’ participation in care and patient safety activities seemed to determine whether patients were feeling safe or ignored. Conclusion This study contributes to the existing literature with fundamental evidence of patients’ willingness to participate in care and safety activities. Promoting patient participation begins by understanding the patients’ unique preferences and needs for care, establishing a good relationship and paying attention to each patient’s ability to participate despite their illness.
Collapse
Affiliation(s)
- Mona Ringdal
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Box 457, 40530 Gothenburg, SE Sweden.,Department of Anaesthesiology and Intensive Care, Kungälvs hospital, Kungälv, Sweden
| | - Wendy Chaboyer
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Box 457, 40530 Gothenburg, SE Sweden.,National Centre of Research Excellence in Nursing Interventions (NCREN) Menzies Health Institute, School of Nursing, Griffith University, Gold Coast, Australia
| | - Kerstin Ulin
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Box 457, 40530 Gothenburg, SE Sweden.,Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tracey Bucknall
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Deakin University's Centre for a Quality and Patient Safety-Alfred Health Partnership, Melbourne, Victoria, Australia
| | - Lena Oxelmark
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Box 457, 40530 Gothenburg, SE Sweden.,Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
25
|
Moe A, Ingstad K, Brataas HV. Patient influence in home-based reablement for older persons: qualitative research. BMC Health Serv Res 2017; 17:736. [PMID: 29141681 PMCID: PMC5688713 DOI: 10.1186/s12913-017-2715-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reablement services are rehabilitation for older people living at home, being person-centered in information, mapping and the goal-setting conversation. The purpose of this study was to gain knowledge about conversation processes and patient influence in formulating the patients' goals. There are two research questions: How do conversation theme, structure and processes appear in interactions aiming to decide goals of home-based reablement rehabilitation for the elderly? How professionals' communication skills do influence on patients' participation in conversation about everyday life and goals of home-based reablement? METHODS A qualitative field study explored eight cases of naturally occurring conversations between patients and healthcare professionals in a rehabilitation team. Patients were aged 67-90 years old. The reablement team consisted of an occupational therapist, physiotherapist, nurse and care workers. Data was collected by audio recording the conversations. Transcribed text was analyzed for conversational theme and communication patterns as they emerged within main themes. RESULTS Patient participation differed with various professional leadership and communication in the information, mapping and goalsetting process. In the data material in its entirety, conversations consisted mainly of three parts where each part dealt with one of the three main topics. The first part was "Introduction to the program." The main part of the talk was about mapping ("Varying patient participation when discussing everyday life"), while the last part was about goal setting ("Goals of rehabilitation"). CONCLUSIONS Home-based reablement requires communication skills to encourage user participation, and mapping of resources and needs, leading to the formulation of objectives. Professional health workers must master integrating two intentions: goal-oriented and person-centered communication that requires communication skills and leadership ability in communication, promoting patient influence and goal-setting. Quality of such conversations is complex, and requires the ability to apply integrated knowledge, skills and attitudes appropriate to communication situations.
Collapse
Affiliation(s)
- Aud Moe
- Faculty of Health Science, Nord University, Postboks 1490, N-8049, Bodø, Norway. .,Centre of Care Research, Central Norway, Postboks 1490, Bodø, N-8049, Norway.
| | - Kari Ingstad
- Faculty of Health Science, Nord University, Postboks 1490, N-8049, Bodø, Norway
| | - Hildfrid V Brataas
- Faculty of Health Science, Nord University, Postboks 1490, N-8049, Bodø, Norway
| |
Collapse
|
26
|
Tobiano G, Bucknall T, Sladdin I, Whitty JA, Chaboyer W. Patient participation in nursing bedside handover: A systematic mixed-methods review. Int J Nurs Stud 2017; 77:243-258. [PMID: 29149634 DOI: 10.1016/j.ijnurstu.2017.10.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 08/30/2017] [Accepted: 10/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Numerous reviews of nursing handover have been undertaken, but none have focused on the patients' role. OBJECTIVES To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. DESIGN Systematic mixed- methods review. DATA SOURCES Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. REVIEW METHODS Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. RESULTS Segregated synthesis of research of patients' perceptions revealed two contrasting categories; patient-centred handover and nurse-centred handover. Segregated synthesis of research of nurses' perceptions included three categories: viewing the patient as an information resource; dealing with confidential and sensitive information; and enabling patient participation. The segregated synthesis of QI projects included two categories: nurse barrier to enacting patient participation in bedside handover; and involving patients in beside handover. Once segregated findings were configured, we discovered that the patient's role in bedside handover involves contributing clinical information related to their care or progress, which may influence patient safety. Barriers related to nurses' concerns for the consequences of encouraging patient participation, worries for sharing confidential and sensitive information and feeling hesitant in changing their handover methods. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and involving both patients and nurses throughout the change process. CONCLUSIONS Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses and patient views. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects.
Collapse
Affiliation(s)
- Georgia Tobiano
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus,Parklands Drive, Southport, QLD 4222 Australia.
| | - Tracey Bucknall
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Faculty of Health, Deakin University and Alfred Health, 221 Burwood Hwy, Burwood, Victoria 3125, Australia; Alfred Health, The Alfred, 55 Commercial Rd, Melbourne, VIC 3004 Australia.
| | - Ishtar Sladdin
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus,Parklands Drive, Southport, QLD 4222 Australia.
| | - Jennifer A Whitty
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
| | - Wendy Chaboyer
- National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222 Australia.
| |
Collapse
|
27
|
Yeh MY, Wu SC, Tung TH. The relation between patient education, patient empowerment and patient satisfaction: A cross-sectional-comparison study. Appl Nurs Res 2017; 39:11-17. [PMID: 29422144 DOI: 10.1016/j.apnr.2017.10.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/11/2017] [Accepted: 10/15/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Patient empowerment is a paradigm of clinical practice. The goal of patient empowerment is to lead patients' health and wellbeing. The aim of this study is to evaluate the relation between patient education, patient empowerment and patient satisfaction based on multi-hospital cross-sectional study design in Taiwan. METHODS In this cross-sectional survey, 609 inpatients in four teaching hospitals in northern Taiwan from August 2009 to July 2010 were recruited. Data were collected using Chinese version of the Patient Perceptions of Empowerment Scale (PPES), Sufficiency of Patient Education Questionnaire (SPEQ) and Patient Satisfaction Questionnaire (PSQ). The multiple linear regression model was used to assess the independent effects of relevant factors on patient empowerment after controlling for the covariates. RESULTS The overall mean empowerment scores was 44.80±5.94. There was a significant difference between the total scores and four dimensions of patient empowerment at different hospitals (t=5.44, p≤0.01). Sufficient patient education (β=0.568, 95%CI: 0.486-0.649) and patient satisfaction (β=0.317, 95%CI: 0.259-0.375) could significantly predict patient empowerment based on the multiple linear regression analysis, with a total variance was 54.4%. CONCLUSIONS In conclusion, both sufficient patient education and patient satisfaction were positively related to patient empowerment. Hospitals in Taiwan should try to improve their patients' active involvement toward empowerment.
Collapse
Affiliation(s)
- Mei-Yu Yeh
- School of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Shu-Chen Wu
- Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng-Hsin General Hospital, Taipei, Taiwan.
| |
Collapse
|
28
|
Halbach P, Keller AO. Evaluating Motivational Interviewing in the Physician Assistant Curriculum. J Physician Assist Educ 2017; 28:132-137. [PMID: 28762991 PMCID: PMC5561004 DOI: 10.1097/jpa.0000000000000133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Motivational interviewing (MI) is an evidence-based technique that enables clinicians to help patients modify health behaviors. Although MI is an essential tool for physician assistants (PAs), the extent to which it is addressed in PA curricula in the United States is unknown. This study is a comprehensive description of MI education in PA programs in the United States. METHODS Data are from the 2014 Physician Assistant Education Association Annual Program Survey. Descriptive statistics were conducted on de-identified data from all 186 PA programs in the United States. RESULTS Of the 186 PA programs surveyed, 72.58% (n = 135) reported at least one course providing MI training. Availability of courses providing training in skills essential to the MI process varied. Having a course with verbal communication training was most frequently endorsed, and having a course with training in developing discrepancy was least frequently endorsed. The most popular teaching modality was lecture (84.95%, n = 158), whereas only 41.40% (n = 77) and 58.60% (n = 109) reported role play with evaluation and standardized patient exercises with evaluation, respectively. CONCLUSIONS More than 70% of programs included at least one course in their curriculum that provided training in MI, suggesting that PA programs recognize the importance of MI. Instruction in change talk was not provided in nearly half of the programs. Role-play and standardized patient exercises with evaluation were underused methods despite their proven efficacy in MI education. As the first comprehensive benchmark of MI education for PAs, this study shows that although most programs address MI, opportunities exist to improve MI training in PA programs in the United States.
Collapse
Affiliation(s)
- Patrick Halbach
- Patrick Halbach, MS, MPAS, PA-C, is a physician assistant in the Department of Orthopaedic Surgery at the University of Minnesota in Minneapolis. Abiola O. Keller, PhD, MPH, PA-C, is a clinical assistant professor and director of clinical research in the Department of Physician Assistant Studies at Marquette University, College of Health Sciences in Milwaukee, Wisconsin
| | | |
Collapse
|
29
|
Transcultural adaptation and validation of the patient empowerment in long-term conditions questionnaire. BMC Health Serv Res 2017; 17:324. [PMID: 28472988 PMCID: PMC5418845 DOI: 10.1186/s12913-017-2271-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/26/2017] [Indexed: 12/28/2022] Open
Abstract
Background Patient empowerment is a key element to improve the results in health, increase satisfaction amongst users and obtain higher treatment compliance. The main objective of this study is to validate the Spanish version of the questionnaire “Patient empowerment in long-term conditions” which evaluates the patients’ level of empowerment of chronic diseases. The secondary objective is to identify factors which predict basal empowerment and changes (improvement or deterioration) in patients with Heart Failure (HF). Methods An observational and prospective design of psychometric type to validate a questionnaire (aim 1) and a prospective study of cohorts (aim 2). The study will include 121 patients with confirmed diagnosis of HF. Three measurements (basal, at 15 days and at 3 months) will be carried out: quality of life, self-care and empowerment. Descriptive and inferential analyses will be used. For the first aim of the study (validation), the test-retest reproducibility will be assessed through intraclass correlation coefficient; internal consistency will be assessed through Cronbach’s alpha coefficient; construct validity through Pearson’s correlation coefficient; and sensibility to change through effect size coefficient. Discussion Set a valid questionnaire to measure the level of empowerment of patients with chronic diseases could be an effective tool to assess the results from the provision of the health care services. It will also allow us to identify at an early stage, those groups of patients with a low level of empowerment. Hence, they could become a risk group due to poor management of the disease, with a high rate of decompensation and a higher use rate of the health system resources.
Collapse
|
30
|
The Experience of Patients Engaged in Co-designing Care Processes. Health Care Manag (Frederick) 2016; 35:284-293. [DOI: 10.1097/hcm.0000000000000132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Virtanen H, Leino-Kilpi H, Salanterä S. Nursing students’ knowledge about an empowering discourse: Pretest and posttest assessment. Collegian 2016. [DOI: 10.1016/j.colegn.2015.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Cerezo PG, Juvé-Udina ME, Delgado-Hito P. Concepts and measures of patient empowerment: a comprehensive review. Rev Esc Enferm USP 2016; 50:667-674. [DOI: 10.1590/s0080-623420160000500018] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/30/2016] [Indexed: 02/03/2023] Open
Abstract
Abstract OBJECTIVE Analyze the definitions and dimensions of empowerment. Identify the strengths and weaknesses of empowerment measures based on the conceptual model. METHOD This was a comprehensive literature review of publications on the MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. RESULTS Twenty-nine articles were selected. Seventeen definitions and seven dimensions of empowerment, and 10 empowerment measures were selected. Empowerment can be seen as an enabling process involving a shift in the balance of power, or as an outcome of this process. The dimensions reflect outcome indicators, such as participation in decision-making and control, and process indicators, such as knowledge acquisition and coping skills. Six of the tools analyzed by this study could be said to provide a robust measure of patient empowerment. CONCLUSION we propose a definition of empowerment that helps to deepen understanding of the term and, therefore, its operationalization.
Collapse
Affiliation(s)
| | | | - Pilar Delgado-Hito
- Universidad de Barcelona, España; Instituto de Investigación Biomédica de Bellvitge, España
| |
Collapse
|
33
|
Nygren Zotterman A, Skär L, Olsson M, Söderberg S. Being in togetherness: meanings of encounters within primary healtcare setting for patients living with long-term illness. J Clin Nurs 2016; 25:2854-62. [PMID: 27383692 DOI: 10.1111/jocn.13333] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to elucidate meanings of encounters for patients with long-term illness within the primary healthcare setting. BACKGROUND Good encounters can be crucial for patients in terms of how they view their quality of care. Therefore, it is important to understand meanings of interactions between patients and healthcare personnel. DESIGN A phenomenological hermeneutic method was used to analyse the interviews. METHODS Narrative interviews with ten patients with long-term illness were performed, with a focus on their encounters with healthcare personnel within the primary healthcare setting. A phenomenological hermeneutical approach was used to interpret the interview texts. RESULTS The results demonstrated that patients felt well when they were seen as an important person and felt welcomed by healthcare personnel. Information and follow-ups regarding the need for care were essential. Continuity with the healthcare personnel was one way to establish a relationship, which contributed to patients' feelings of being seen and understood. Good encounters were important for patients' feelings of health and well-being. Being met with mistrust, ignorance and nonchalance had negative effects on patients' perceived health and well-being and led to feelings of lower confidence regarding the care received. CONCLUSIONS Patients described a great need to be confirmed and met with respect by healthcare personnel, which contributed to their sense of togetherness. Having a sense of togetherness strengthened patient well-being. RELEVANCE TO CLINICAL PRACTICE By listening and responding to patients' needs and engaging in meetings with patients in a respectful manner, healthcare personnel can empower patients' feelings of health and well-being. Healthcare personnel need to be aware of the significance of these actions because they can make patients experience feelings of togetherness, even if patients meet with different care personnel at each visit.
Collapse
Affiliation(s)
- Anna Nygren Zotterman
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Lisa Skär
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Malin Olsson
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Siv Söderberg
- Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden.
| |
Collapse
|
34
|
Wåhlin I. Empowerment in critical care - a concept analysis. Scand J Caring Sci 2016; 31:164-174. [PMID: 27164009 DOI: 10.1111/scs.12331] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/29/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this paper was to analyse how the concept of empowerment is defined in the scientific literature in relation to critical care. As empowerment is a mutual process affecting all individuals involved, the perspectives of not only patients and next of kin but also staff were sought. METHOD A literature review and a concept analysis based on Walker and Avant's analysis procedure were used to identify the basic elements of empowerment in critical care. Twenty-two articles with a focus on critical care were discovered and included in the investigation. FINDINGS A mutual and supportive relationship, knowledge, skills, power within oneself and self-determination were found to be the common attributes of empowerment in critical care. The results could be adapted and used for all parties involved in critical care - whether patients, next of kin or staff - as these defining attributes are assumed to be universal to all three groups, even if the more specific content of each attribute varies between groups and individuals. CONCLUSION Even if empowerment is only sparsely used in relation to critical care, it appears to be a very useful concept in this context. The benefits of improving empowerment are extensive: decreased levels of distress and strain, increased sense of coherence and control over situation, and personal and/or professional development and growth, together with increased comfort and inner satisfaction.
Collapse
Affiliation(s)
- Ingrid Wåhlin
- School of Health and Caring Sciences, Linnaeus University, Växjö, Kalmar, Sweden.,Research Section, Kalmar County Council, Kalmar, Sweden.,Intensive Care Department, Kalmar Hospital, Kalmar, Sweden
| |
Collapse
|
35
|
Che HL, Yeh MY, Jiang RS, Wu SM. Taiwanese nurses’ experiences of difficulties in providing patient education in hospital settings. Nurs Health Sci 2016; 18:113-9. [DOI: 10.1111/nhs.12266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 10/23/2015] [Accepted: 10/29/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Hui-Lian Che
- Department of Gerontological Care and Management; Chung Gung University of Science and Technology; Guishan Dist. Taoyuan city Taiwan
| | - Mei-Yu Yeh
- Graduate Institute of Health Care; Chang Gung University of Science and Technology; Guishan Dist. Taoyuan city Taiwan
| | - Ru-Shang Jiang
- Department of Nursing; Chung Gung University of Science and Technology; Puzi City Chiayi Country Taiwan
| | - Shu-Mei Wu
- Department of Nursing; Chang Gung University of Science and Technology; Guishan Dist. Taoyuan city Taiwan
| |
Collapse
|
36
|
Chen J, Mullins CD, Novak P, Thomas SB. Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities. HEALTH EDUCATION & BEHAVIOR 2016; 43:25-34. [PMID: 25845376 PMCID: PMC4681678 DOI: 10.1177/1090198115579415] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making.
Collapse
Affiliation(s)
- Jie Chen
- University of Maryland, Baltimore, MD, USA
| | | | | | | |
Collapse
|
37
|
Boehmer KR, Shippee ND, Beebe TJ, Montori VM. Pursuing minimally disruptive medicine: disruption from illness and health care-related demands is correlated with patient capacity. J Clin Epidemiol 2016; 74:227-36. [PMID: 26780257 DOI: 10.1016/j.jclinepi.2016.01.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 11/06/2015] [Accepted: 01/03/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chronic conditions burden patients with illness and treatments. We know little about the disruption of life by the work of dialysis in relation to the resources patients can mobilize, that is, their capacity, to deal with such demands. We sought to determine the disruption of life by dialysis and its relation to patient capacity to cope. METHODS We administered a survey to 137 patients on dialysis at an academic medical center. We captured disruption from illness and treatment, and physical, mental, personal, social, financial, and environmental aspects of patient capacity using validated scales. Covariates included number of prescriptions, hours spent on health care, existence of dependents, age, sex, and income level. RESULTS On average, patients reported levels of capacity and disruption comparable to published levels. In multivariate regression models, limited physical, financial, and mental capacity were significantly associated with greater disruption. Patients in the top quartile of disruption had lower-than-expected physical, financial, and mental capacity. CONCLUSIONS Our sample generally had capacity comparable to other populations and may be able to meet the demands imposed by treatment. Those with reduced physical, financial, and mental capacity reported higher disruption and represent a vulnerable group that may benefit from innovations in minimally disruptive medicine.
Collapse
Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
| | - Nathan D Shippee
- Division of Health Policy and Management, School of Public Health, Mayo Mail Code 197, 420 Delaware St. S.E., Minneapolis, MN, USA
| | - Timothy J Beebe
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Department of Health Science Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| |
Collapse
|
38
|
Malm D, Rolander B, Ebefors EM, Conlon L, Nygårdh A. Reducing the Prevalence of Catheter-Related Infections by Quality Improvement: Six-Year Follow-Up Study. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.62008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
39
|
Tobiano G, Bucknall T, Marshall A, Guinane J, Chaboyer W. Nurses' views of patient participation in nursing care. J Adv Nurs 2015. [DOI: 10.1111/jan.12740] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Georgia Tobiano
- Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Gold Coast Queensland Australia
| | - Tracey Bucknall
- Centre for Quality and Patient Safety; School of Nursing and Midwifery; Deakin University; Melbourne Victoria Australia
- Alfred Health; Melbourne Victoria Australia
| | - Andrea Marshall
- National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients; Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Southport Queensland Australia
- Gold Coast Health; Southport Queensland Australia
| | - Jessica Guinane
- School of Nursing and Midwifery; Deakin University; Melbourne Victoria Australia
| | - Wendy Chaboyer
- National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients; Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Southport Queensland Australia
| |
Collapse
|
40
|
Tobiano G, Bucknall T, Marshall A, Guinane J, Chaboyer W. Patients’ perceptions of participation in nursing care on medical wards. Scand J Caring Sci 2015; 30:260-70. [DOI: 10.1111/scs.12237] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Georgia Tobiano
- Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Gold Coast Qld Australia
| | - Tracey Bucknall
- Centre for Quality and Patient Safety; School of Nursing and Midwifery; Deakin University; Melbourne Vic Australia
- Alfred Health; Melbourne Vic Australia
| | - Andrea Marshall
- Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Gold Coast Qld Australia
- National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients; Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Gold Coast Qld Australia
| | - Jessica Guinane
- School of Nursing and Midwifery; Deakin University; Melbourne Vic Australia
| | - Wendy Chaboyer
- Gold Coast University Hospital; Gold Coast Qld Australia
- National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients; Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Gold Coast Qld Australia
| |
Collapse
|
41
|
Tobiano G, Marshall A, Bucknall T, Chaboyer W. Patient participation in nursing care on medical wards: An integrative review. Int J Nurs Stud 2015; 52:1107-20. [PMID: 25769475 DOI: 10.1016/j.ijnurstu.2015.02.010] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 12/19/2014] [Accepted: 02/12/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patient participation is a way for patients to engage in their nursing care. In view of the possible link between patient participation and safety, there is a need for an updated review to assess patient participation in nursing care. OBJECTIVES To investigate patients' and nurses' perceptions of and behaviours towards patient participation in nursing care in the context of hospital medical wards. DESIGN Integrative review. DATA SOURCES Three search strategies were employed in August 2013; a computerised database search of Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Medline and PsychINFO; reference lists were hand-searched; and forward citation searching was executed. REVIEW METHODS After reviewing the studies, extracting study data and completing summary tables the methodological quality was assessed using the Mixed-Methods Assessment Tool by two reviewers. Reviewers met then to discuss discrepancies as well as the overall strengths and limitations of the studies. Discrepancies were overcome through consensus or a third reviewer adjudicated the issue. Within and across study analysis and synthesis of the findings sections was undertaken using thematic synthesis. RESULTS Eight studies met inclusion criteria. Four themes were identified - enacting participation, challenges to participation, promoting participation and types of participation. Most studies included were conducted in Europe. The majority of studies used qualitative methodologies, with all studies sampling patients; nurses were included in three studies. Data were largely collected using self-reported perceptions; two studies included observational data. Methodological issues included a lack of reflexivity, un-validated data collection tools, sampling issues and low response rates. CONCLUSIONS On medical wards, patients and nurses desire, perceive or enact patient participation passively. Challenging factors for patient participation include patients' willingness, nurses' approach and confusion around expectations and roles. Information-sharing was identified as an activity that promotes patient participation, suggesting nurses encourage active communication with patients in practice. Involving patients in assessment and care planning may also enhance patient participation. For education, enhancing nurses' understanding of the attributes of patient participation, as well as patient-centred care approaches may be beneficial for medical ward nurses. From here, researchers need to examine ways to overcome the barriers to patient participation; further nurse participants and observational data is required on medical wards.
Collapse
Affiliation(s)
- Georgia Tobiano
- Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia.
| | - Andrea Marshall
- Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; The Gold Coast University Hospital, Queensland, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Alfred Health, Victoria, Australia
| | - Wendy Chaboyer
- Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| |
Collapse
|
42
|
Dwarswaard J, Bakker EJM, van Staa A, Boeije HR. Self-management support from the perspective of patients with a chronic condition: a thematic synthesis of qualitative studies. Health Expect 2015; 19:194-208. [PMID: 25619975 DOI: 10.1111/hex.12346] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Receiving adequate support seems to be crucial to the success of self-management. Although different empirical studies separately examined patients' preferences for self-management support (SMS), an overview is lacking. OBJECTIVE The aim of this qualitative review was to identify patients' needs with respect to SMS and to explore by whom this support is preferably provided. SEARCH STRATEGY Qualitative studies were identified from Embase, MEDLINE OvidSP, Web of science, PubMed publisher, Cochrane central, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. INCLUSION CRITERIA Articles needed to meet all of the following criteria: (i) focuses on self-management, (ii) concerns adult patients with rheumatic diseases (rheumatoid arthritis and fibromyalgia), a variant of cancer or chronic kidney disease, (iii) explores support needs from the patients' perspective, (iv) uses qualitative methods and (v) published in English. DATA EXTRACTION AND SYNTHESIS A thematic synthesis, developed by Thomas and Harden, was conducted of the 37 included studies. MAIN RESULTS Chronic patients need instrumental support, psychosocial support and relational support from health-care professionals, family/friends and fellow patients to manage the chronic condition. Relational support is at the centre of the support needs and fuels all other types of support. DISCUSSION AND CONCLUSIONS Patients do not self-manage on their own. Patients expect health-care professionals to fulfil a comprehensive role. Support needs can be knitted together only when patients and professionals work together on the basis of collaborative partnership. Dynamics in support needs make it important to regularly assess patient needs.
Collapse
Affiliation(s)
- Jolanda Dwarswaard
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ellen J M Bakker
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hennie R Boeije
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
43
|
Rørtveit K, Sætre Hansen B, Leiknes I, Joa I, Testad I, Severinsson E. Patients’ Experiences of Trust in the Patient-Nurse Relationship—A Systematic Review of Qualitative Studies. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.53024] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
44
|
Torchi TS, Araújo STCD, Moreira AGM, Koeppe GBO, Santos BTUD. Condições clínicas e comportamento de procura de cuidados de saúde pelo paciente renal crônico. ACTA PAUL ENFERM 2014. [DOI: 10.1590/1982-0194201400095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo Identificar as condições clínicas e comportamento de procura de cuidados de saúde pelo paciente renal crônico no itinerário terapêutico para a hemodiálise.Métodos Estudo qualitativo, descritivo e exploratório a partir de entrevista com dez pacientes de uma clínica de terapia renal substitutiva em tratamento hemodialítico e análise resultante da utilização da técnica do Discurso do Sujeito Coletivo por meio do software qualiquantisofty.Resultados As condições clínicas no itinerário terapêutico evidenciaram sintomas de mal-estar e o perfil das doenças de base identificadas foram nefroesclerose hipertensiva, nefroesclerose diabética, causa indeterminada e nefroesclerose diabética associada com hipertensão arterial. Os comportamentos que prejudicaram o controle de saúde foram à demora no atendimento na rede de saúde, a não aceitação da doença e do tratamento.Conclusão Poucos tiveram acompanhamento precoce, sem manifestação de sintomas. Todavia, a maioria deles tiveram internação hospitalar de maneira repentina.
Collapse
|
45
|
Nygårdh A, Malm D, Wikby K, Ahlström G. The complexity in the implementation process of empowerment-based chronic kidney care: a case study. BMC Nurs 2014; 13:22. [PMID: 25104917 PMCID: PMC4124497 DOI: 10.1186/1472-6955-13-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/23/2014] [Indexed: 11/29/2022] Open
Abstract
Background This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care. Methods A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis. Results Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process. Conclusions The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.
Collapse
Affiliation(s)
- Annette Nygårdh
- School of Health Sciences, Jönköping University, P.O. Box 1026, Jönköping SE-551 11, Sweden
| | - Dan Malm
- School of Health Sciences, Jönköping University, P.O. Box 1026, Jönköping SE-551 11, Sweden ; Department of Internal Medicine, County Hospital Ryhov, Jönköping SE-55185, Sweden
| | | | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 187, Lund SE-221 00, Sweden
| |
Collapse
|
46
|
Brobeck E, Odencrants S, Bergh H, Hildingh C. Patients' experiences of lifestyle discussions based on motivational interviewing: a qualitative study. BMC Nurs 2014; 13:13. [PMID: 24904235 PMCID: PMC4045965 DOI: 10.1186/1472-6955-13-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 04/25/2014] [Indexed: 11/26/2022] Open
Abstract
Background According to World Health Organization about 75% of cardiovascular diseases and type 2 diabetes and 40% of all cases of cancer could be prevented if the risk factors tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol could be eliminated. Patients often need help in monitoring themselves to make the proper lifestyle changes and it is important that adequate support is provided to enable the patients to take control over their health. Motivational interviewing is a framework that can help to facilitate this movement. The aim of this study was to describe how patients in primary health care settings experience lifestyle discussions based on motivational interviewing. Methods This study has a descriptive design and qualitative content analysis was used as the method. Sixteen patients who had each visited a registered nurse for lifestyle discussions were interviewed. Results The results show that the lifestyle discussions could enable self-determination in the process of lifestyle change but that certain conditions were required. Mutual interaction between the patient and the nurse that contributes to a sense of well-being in the patients was a necessary condition for the lifestyle discussion to be helpful. When the discussion resulted in a new way of thinking about lifestyle and when patient initiative was encouraged, the discussion could contribute to change. The patient’s free will to make a lifestyle change and the nurse’s sensitivity in the discussions created fertile soil for change. Conclusions This study focuses on MI-based discussions, and the result shows that a subset of patients, who self-reported that they are motivated and aware of their role in making lifestyle changes, appreciate these strategies. However, it is not known whether discussions would be experienced in the same way if RNs used another method or if patients who were less motivated, engaged, or aware of their role in making lifestyle changes were interviewed.
Collapse
Affiliation(s)
- Elisabeth Brobeck
- Department of Research, Development and Education, Halmstad, Sweden ; School of Health and Medical Sciences Örebro University, Örebro, Sweden
| | - Sigrid Odencrants
- School of Health and Medical Sciences Örebro University, Örebro, Sweden
| | - Håkan Bergh
- Department of Research, Development and Education, Varberg, Sweden
| | - Cathrine Hildingh
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden
| |
Collapse
|
47
|
Jönsson PD, Nunstedt H, Berglund IJ, Ahlström BH, Hedelin B, Skärsäter I, Jormfeldt H. Problematization of perspectives on health promotion and empowerment in mental health nursing--within the research network "MeHNuRse" and the Horatio conference, 2012. Int J Qual Stud Health Well-being 2014; 9:22945. [PMID: 24717267 PMCID: PMC3982111 DOI: 10.3402/qhw.v9.22945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mental illness is increasing worldwide, while society's response seems to be a trend toward narrower and more specialized mental health care. This development is creating great demands on mental health nurses to include a health promotion perspective in care and support of persons with mental illness. A health promotion perspective emphasizes cooperation and communication with people who suffer from long-term mental illness, focusing on their independence and health. From a health perspective, every human being is an actor in his/her own life, with an inherent ability to make his/her own choices. However, persons who suffer from long-term mental illness are at risk of losing power and control over areas of their lives and their health. Mental health nurses are in a position to support these individuals in promoting health and in maintaining or regaining control over their lives. The emphasis of this paper is to problematize mental health nurses’ responsibility to provide health-promoting nursing care in relation to empowerment by means of emancipation, self-efficacy, and self-management. We argue that mental health nurses can work from a health-promoting perspective by using these concepts and that this challenges some of the traditional ideas of health promotion in mental health nursing. The theoretical background discussions in this paper have their origin in the research network “Mental Health Nursing Research in Scandinavia” (MeHNuRse) and from the professional discussions developed during a 2012 workshop that included mental health nurses and researchers at the European Horatio Festival in Stockholm.
Collapse
Affiliation(s)
- Patrik D Jönsson
- Department of Research, Development and Education (FoUU), Region of Halland, Halmstad, Sweden; School of Social and Health Sciences, Halmstad University, Halmstad, Sweden;
| | - Håkan Nunstedt
- Department of Nursing, Health and Culture, University West, Trollhättan, Sweden
| | | | - Britt H Ahlström
- Department of Nursing, Health and Culture, University West, Trollhättan, Sweden
| | - Birgitta Hedelin
- Department of Nursing, Gjøvik University College, Gjøvik, Norway
| | - Ingela Skärsäter
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden
| | - Henrika Jormfeldt
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden
| |
Collapse
|
48
|
Bäck-Pettersson S, Sandersson S, Hermansson E. Patients' experiences of supportive conversation as long-term treatment in a Swedish psychiatric outpatient care context: a phenomenological study. Issues Ment Health Nurs 2014; 35:127-33. [PMID: 24502471 DOI: 10.3109/01612840.2013.860646] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aims to describe patients' experiences of supportive conversation as long-term treatment in a psychiatric outpatient context. A focus group interview was conducted with six female patients (aged 40-60 years). Five key constituents captured the essence of the general structure of supportive conversation: being treated as a responsible person, sensing intimate contact and togetherness, perceiving stability in the relationship, learning to manage daily living, and growing as a person. Supportive conversations have a positive influence on the patient's state of mind and enhance self-confidence, thereby giving the inner strength to grow as a person.
Collapse
Affiliation(s)
- Siv Bäck-Pettersson
- Department of Research and Development, Primary Health Care Research Development and Education Centre , Vänersborg , Sweden
| | | | | |
Collapse
|
49
|
Funk E, Thunberg P, Anderzen-Carlsson A. Patients' experiences in magnetic resonance imaging (MRI) and their experiences of breath holding techniques. J Adv Nurs 2014; 70:1880-90. [DOI: 10.1111/jan.12351] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Eva Funk
- School of Health and Medical Sciences; Örebro University; Sweden
| | - Per Thunberg
- Department of Medical Physics; Örebro University Hospital; Sweden
| | | |
Collapse
|
50
|
Abstract
Due to their understanding of self-management, healthcare team members responsible for depressed older persons can experience an ethical dilemma. Each team member contributes important knowledge and experience pertaining to the management of depression, which should be reflected in the management plan. The aim of this study was to explore healthcare team members' reflections on the ethical dilemmas involved in promoting self-management among depressed older persons. A qualitative design was used and data were collected by means of focus group interviews. The results revealed one main theme: 'Lack of trust in the community health care system's commitment to bringing about effectiveness and change, based on three themes; 'Struggling to ensure the reliable transfer of information about depressed older persons to professionals and family members', 'Balancing autonomy, care and dignity' and 'Differences in the understanding of responsibility'. Lack of engagement on the part of and trust between the various professional categories who work in the community are extremely counterproductive and have serious implications for patient dignity as well as safety. In conclusion, ethical dilemmas occur when staff members are unable to act in accordance with their professional ethical stance and deliver an appropriate standard of care.
Collapse
|