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Liu PL, Yeo TED, Ye JF. Examining the Intervening Roles of Patient-Centered Care and Patient Activation in the Health Impacts of Offline Healthcare Obstacles and Online Health Consultations Among Deaf and Hard-of-Hearing Patients. HEALTH COMMUNICATION 2023:1-10. [PMID: 37853546 DOI: 10.1080/10410236.2023.2268909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Deaf and hard-of-hearing (DHH) patients often encounter difficulties in effective communication with healthcare professionals and are less likely to receive quality medical care. However, DHH populations are understudied in health communication research. This study examined how offline healthcare obstacles and online health consultation impact DHH patients' health, and the mediating roles of patient-centered care (PCC) and patient activation. Data from 323 DHH patients were analyzed using structural equation modeling to test the hypothesized mediation pathway model. Results indicate that offline healthcare obstacles negatively affect DHH patients' perception of patient-centeredness, which reduces their ability and confidence in self-care (conceptualized as patient activation in this study). This reduced patient activation may jeopardize DHH patients' physical and psychological health. Meanwhile, online health consultation is positively associated with PCC, and higher levels of PCC can increase patient activation, contributing to better physical and psychological health. Testing the same model with hearing-abled participants (n = 3542) revealed significant differences in these intervening relationships. Overall, this study provides valuable insights into the relationship between DHH patients' healthcare experience and their health outcomes. The findings support interventions that focus on enhancing PCC and patient activation to improve the physical and psychological health outcomes of DHH patients.
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Michielsen L, Bischoff EWMA, Schermer T, Laurant M. Primary healthcare competencies needed in the management of person-centred integrated care for chronic illness and multimorbidity: Results of a scoping review. BMC PRIMARY CARE 2023; 24:98. [PMID: 37046190 PMCID: PMC10091550 DOI: 10.1186/s12875-023-02050-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Chronic disease management is important in primary care. Disease management programmes focus primarily on the respective diseases. The occurrence of multimorbidity and social problems is addressed to a limited extent. Person-centred integrated care (PC-IC) is an alternative approach, putting the patient at the centre of care. This asks for additional competencies for healthcare professionals involved in the execution of PC-IC. In this scoping review we researched which competencies are necessary for healthcare professionals working in collaborative teams where the focus lies within the concept of PC-IC. We also explored how these competencies can be acquired. METHODS Six literature databases and grey literature were searched for guidelines and peer-reviewed articles on chronic illness and multimorbidity in primary care. A data synthesis was carried out resulting in an overview of the competencies that healthcare professionals need to deliver PC-IC. RESULTS Four guidelines and 21 studies were included and four core competencies could be derived through the synthesis: 1. interprofessional communication, 2, interprofessional collaborative teamwork, 3. leadership and 4. patient-centred communication. Included papers mostly lack a clear description of the competencies in terms of knowledge, skills and attitudes which are necessary for a PC-IC approach and on how these competencies can be acquired. CONCLUSION This review provides insight on competencies necessary to provide PC-IC within primary care. Research is needed in more depth on core concepts of these competencies which will then benefit educational programmes to ensure that healthcare professionals in primary care are better equipped to deliver PC-IC for patients with chronic illness and multimorbidity.
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Affiliation(s)
- Leslie Michielsen
- School of Health Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands.
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Erik W M A Bischoff
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tjard Schermer
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Science Support Office, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Miranda Laurant
- School of Health Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands
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Lin CH, Siao SF, Tung HH, Chung KP, Shun SC. The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients' Perspective. J Nurs Scholarsh 2021; 53:378-386. [PMID: 33634957 DOI: 10.1111/jnu.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE This study investigates the expectations, perceptions, and gaps of the healthcare service quality (HSQ) from the patients' perspective, and explores the significant demographic and clinical factors associated with the HSQ in nurse practitioner practice (NPP). DESIGN A cross-sectional design was carried out, with convenience sampling performed under the NPP in Taiwan, from June to November 2016. METHODS The Nurse Practitioner Healthcare Service Quality Scale was used to assess the expectations, perceptions, and gaps of the HSQ. The demographics, clinical characteristics, and symptom severity of patients were collected, and the Importance-Performance Analysis was applied to identify the priority of ranking items for the improvement of nurse practitioners (NPs). The Generalized Estimating Equation was used to explore the factors associated with the HSQ in NPP. FINDINGS A total of 200 patients completed the questionnaires. The results revealed that the patients had overall high expectations (M = 6.35, SD = 0.46), moderate perceptions (M = 4.21, SD = 0.95), and a mild HSQ gap (M = -2.14, SD = 0.69), with statistically significant differences (p < .001). In NPP, the largest gap in the HSQ dimensions was reliable responsiveness, followed by empathy, assurance, and tangibility. Patients with greater symptom severity and a longer in-hospital stay were associated with larger HSQ gaps; however, patients who were transferred from the emergency department had smaller gaps than those in the outpatient department. CONCLUSIONS The patients' expectations were not fully satisfied in the NPP, especially for the dimensions of reliable responsiveness and empathy. The patients' symptom severity was a significant factor related to the gaps in the HSQ. The awareness of unmet needs, from the patients' perspective, could guide the convergence of a rational policy to promote healthcare delivery in the NPP. CLINICAL RELEVANCE The managers of NPP need to pay attention to increasing NPs' reliable responsiveness and empathy, by setting the appropriate scope of practice, regulating the NP-to-patient ratio, applying for certification programs in prescribing training, and cultivating patient-centered care with shared decision making. In addition, building up the knowledge and competency of symptom management is also suggested for NP training.
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Affiliation(s)
- Chia-Hung Lin
- PhD Student, School of Nursing, National Taiwan University, and Nurse Practitioner, Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Fen Siao
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Heng-Hsin Tung
- Professor, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Kuo-Piao Chung
- Professor, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shiow-Ching Shun
- Professor, School of Nursing, National Taiwan University, Taipei, Taiwan
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Kushner RF, Batsis JA, Butsch WS, Davis N, Golden A, Halperin F, Kidambi S, Machineni S, Novick M, Port A, Rubino DM, Saunders KH, Shapiro Manning L, Soleymani T, Kahan S. Weight History in Clinical Practice: The State of the Science and Future Directions. Obesity (Silver Spring) 2020; 28:9-17. [PMID: 31858735 DOI: 10.1002/oby.22642] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
Eliciting a weight history can provide clinically important information to aid in treatment decision-making. This view is consistent with the life course perspective of obesity and the aim of patient-centered care, one of six domains of health care quality. However, thus far, the value and practicality of including a weight history in the clinical assessment and treatment of patients with obesity have not been systematically explored. For these reasons, the Clinical Committee of The Obesity Society established a task force to review and assess the available evidence to address five key questions. It is concluded that weight history is an essential component of the medical history for patients presenting with overweight or obesity, and there are strong and emerging data that demonstrate the importance of life stage, duration of exposure to obesity, maximum BMI, and group-based trajectory modeling in predicting risk for increased morbidity and mortality. Consideration of these and other patient-specific factors may improve risk stratification and clinical decision-making for screening, counseling, and management. Recommendations are provided for the key elements that should be included in a weight history, and several needs for future clinical research are outlined.
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Affiliation(s)
- Robert F Kushner
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John A Batsis
- Geisel School of Medicine at Dartmouth, Section of General Internal Medicine-3M, Dartmouth-Hitchcock Medical Center, The Dartmouth Institute, Lebanon, New Hampshire, USA
| | - W Scott Butsch
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicola Davis
- Chronic Diseases and Prevention, Office of Population Health, NYC Health + Hospitals, New York, New York, USA
| | - Angela Golden
- NP Obesity Treatment Clinic, Flagstaff, Arizona, USA
| | - Florencia Halperin
- Center for Weight Management and Metabolic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Srividya Kidambi
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sriram Machineni
- Division of Endocrinology and Metabolism, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Marsha Novick
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Ava Port
- Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland, College Park, Maryland, USA
| | - Domenica M Rubino
- Washington Center for Weight Management and Research, Arlington, Virgnia, USA
| | - Katherine H Saunders
- Division of Endocrinology, Diabetes & Metabolism, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, New York, USA
| | - Linda Shapiro Manning
- Clinical Development and Medical Affairs-Metabolism, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
| | | | - Scott Kahan
- National Center for Weight and Wellness, Johns Hopkins Bloomberg School of Public Health, Washington, DC, USA
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Kratovil AL, Julion WA. Health-care provider communication with expectant parents during a prenatal diagnosis: an integrative review. J Perinatol 2017; 37:2-12. [PMID: 27513325 DOI: 10.1038/jp.2016.123] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 11/09/2022]
Abstract
The pregnancy and health-care experience of expectant parents who receive a prenatal diagnosis of their unborn infant is distinctively fraught with uncertainty. Health-care providers (HCPs) that care for parents during this uncertain time have an exceptional opportunity to positively impact parental outcomes. An integrative literature review was conducted to explore HCPs' impact on parents' experiences of receiving a prenatal diagnosis. Thirty-three articles met study inclusion criteria (n=18 qualitative; 6 quantitative; 9 mixed methods). HCP communication was the major theme identified, because of its overarching impact on parents' experiences of receiving a prenatal diagnosis of their unborn infant. Parents' perception of the information communicated to them about their unborn infant's diagnosis by their HCP, and the manner in which that information is communicated to them, affects parents' ability to cope with the diagnosis. Recommendations for health-care delivery models, and for future research are discussed.
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Affiliation(s)
- A L Kratovil
- Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, IL, USA
| | - W A Julion
- Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, IL, USA
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Williams JS, Walker RJ, Smalls BL, Hill R, Egede LE. Patient-Centered Care, Glycemic Control, Diabetes Self-Care, and Quality of Life in Adults with Type 2 Diabetes. Diabetes Technol Ther 2016; 18:644-649. [PMID: 27541872 PMCID: PMC5069713 DOI: 10.1089/dia.2016.0079] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Affordable Care Act places a newfound emphasis on patient-centered medical home and patient-centered care (PCC). The purpose of this study was to evaluate the relationship between PCC, diabetes self-care, glycemic control, and quality of life (QOL) in a sample of adults with type 2 diabetes. METHODS Six hundred fifteen patients were recruited from two adult primary care clinics in the southeastern United States. Primary outcome variables were self-care behaviors (medication adherence, diet, exercise, blood sugar testing, and foot care), glycemic control, and QOL (physical component summary [PCS] score and mental component summary [MCS] score of SF12). PCC was assessed using a modified 7-item Picker Patient Experience Questionnaire. Regression modeling was used to assess independent associations while adjusting for relevant covariates. RESULTS In adjusted analyses, PCC was significantly associated with PCS QOL (β = -0.03, 95% confidence interval [CI] -0.05 to -0.01), MCS QOL (β = 0.09, 95% CI 0.04-0.14), medication adherence (β = 0.12, 95% CI 0.08-0.17), general diet (β = 0.12, 95% CI 0.07-0.17), specific diet (β = 0.05, 95% CI 0.01-0.08), blood sugar testing (β = 0.09, 95% CI 0.04-0.15), and foot care (β = 0.12, 95% CI 0.07-0.18). CONCLUSION PCC is associated with diabetes self-management and QOL, but was not significantly associated with glycemic control in patients with diabetes. PCC may be an important factor in self-care behaviors, but the process of focusing care around the patient may need to expand throughout the healthcare system before changes in outcomes such as glycemic control are noted.
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Affiliation(s)
- Joni S. Williams
- Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Rebekah J. Walker
- Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Brittany L. Smalls
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rachel Hill
- Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Leonard E. Egede
- Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
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Chan ZCY, Lai CKY. The nurse-patient communication: voices from nursing students. Int J Adolesc Med Health 2016; 29:/j/ijamh.ahead-of-print/ijamh-2016-0023/ijamh-2016-0023.xml. [PMID: 27371819 DOI: 10.1515/ijamh-2016-0023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/30/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Effective communication skills have been found to be one of the pivotal factors in building positive interpersonal relationships. Little is known about nursing undergraduates' perspectives on communicating with patients. OBJECTIVE This study aimed to explore nursing students' perspectives and experiences of nurse-patient communication in their clinical placement. METHODS The participants included 21 second-year undergraduates and 21 first-year master's students. Interviews were conducted in Cantonese and then transcribed in Chinese and translated into English. A content analysis approach was adopted to analyze the data. RESULTS Five themes emerged from the interview data. 'The necessity of nurse-patient communication' reveals why the students valued nurse-patient communication. 'The conversation contents' describes the content of the conversations that students typically had with patients. The third theme is 'self-reflection on the nurse-patient communication'. The last two themes, 'the communication pattern in different hospital settings' and 'the obstacles impeding nurse-patient communication', are about the students' communication styles in different hospitals and the barriers they encounter. DISCUSSION To improve students' communication skills, educators and clinical staff should listen to students, enhance students' reflective skills and strengthen their confidence. CONCLUSION Through understanding students' difficulties in the nurse-patient communication experience and the skills that they lack, educators can provide them with helpful recommendations to improve their communication skills in clinical practice. PRACTICE IMPLICATIONS The results of this study reveal that students' nurse-patient communication skills need to be improved.
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O'Hagan S, Manias E, Elder C, Pill J, Woodward-Kron R, McNamara T, Webb G, McColl G. What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients. J Adv Nurs 2013; 70:1344-55. [PMID: 24224663 DOI: 10.1111/jan.12296] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 11/28/2022]
Abstract
AIM To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients. BACKGROUND The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. To support the development of effective nursing communication in clinical practice, a good understanding of what constitutes effective communication is helpful. DESIGN An exploratory design was used involving individual interviews, focus groups and written notes from participants and field notes from researchers to investigate perspectives on nurse-patient communication. METHODS Focus groups and individual interviews were held between August 2010-September 2011 with a purposive sample of 15 nurse educators and clinicians who observed videos of interactions between nurses and simulated patients. These participants were asked to give oral feedback on the quality and content of these interactions. Verbatim transcriptions were undertaken of all data collected. All written notes and field notes were also transcribed. Thematic analysis of the data was undertaken. FINDINGS Four major themes related to nurse-patient communication were derived from the educators' and clinicians' feedback: approach to patients and patient care, manner towards patients, techniques used for interacting with patients and generic aspects of communication. CONCLUSION This study has added to previous research by contributing grounded evidence from a group of nurse educators and clinicians on the aspects of communication that are relevant for effective nurse-patient interactions in clinical practice.
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Affiliation(s)
- Sally O'Hagan
- Language Testing Research Centre, The University of Melbourne, Australia
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Ekblad S, Mollica RF, Fors U, Pantziaras I, Lavelle J. Educational potential of a virtual patient system for caring for traumatized patients in primary care. BMC MEDICAL EDUCATION 2013; 13:110. [PMID: 23957962 PMCID: PMC3765390 DOI: 10.1186/1472-6920-13-110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 08/13/2013] [Indexed: 05/23/2023]
Abstract
BACKGROUND Virtual Patients (VPs) have been used in undergraduate healthcare education for many years. This project is focused on using VPs for training professionals to care for highly vulnerable patient populations. The aim of the study was to evaluate if Refugee Trauma VPs was perceived as an effective and engaging learning tool by primary care professionals (PCPs) in a Primary Health Care Centre (PHC). METHODS A VP system was designed to create realistic and engaging VP cases for Refugee Trauma for training refugee patient interview, use of established trauma and mental health instruments as well as to give feedback to the learners. The patient interview section was based on video clips with a Bosnian actor with a trauma story and mental health problems. The video clips were recorded in Bosnian language to further increase the realism, but also subtitled in English. The system was evaluated by 11 volunteering primary health clinicians at the Lynn Community Health Centre, Lynn, Massachusetts, USA. The participants were invited to provide insights/feedback about the system's usefulness and educational value. A mixed methodological approach was used, generating both quantitative and qualitative data. RESULTS Self-reported dimensions of clinical care, pre and post questionnaire questions on the PCPs clinical worldview, motivation to use the VP, and IT Proficiency. Construct items used in these questionnaires had previously demonstrated high face and construct validity. The participants ranked the mental status examination more positively after the simulation exercise compared to before the simulation. Follow up interviews supported the results. CONCLUSIONS Even though virtual clinical encounters are quite a new paradigm in PHC, the participants in the present study considered our VP case to be a relevant and promising educational tool. Next phase of our project will be a RCT study including comparison with specially prepared paper-cases and determinative input on improving clinical diagnosis and treatment of the traumatized refugee patient.
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Affiliation(s)
- Solvig Ekblad
- Department of Learning Informatics, Management and Ethics (LIME), Cultural Medicine Unit, Karolinska Institutet, Tomtebodavägen 18A, plan 3, SE-171 77, Stockholm, Sweden
| | - Richard F Mollica
- Department of Learning Informatics, Management and Ethics (LIME), Cultural Medicine Unit, Karolinska Institutet, Tomtebodavägen 18A, plan 3, SE-171 77, Stockholm, Sweden
- Harvard Program in Refugee Trauma (HPRT), Massachusetts General Hospital, Boston, MA, USA
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Ioannis Pantziaras
- Department of Learning Informatics, Management and Ethics (LIME), Cultural Medicine Unit, Karolinska Institutet, Tomtebodavägen 18A, plan 3, SE-171 77, Stockholm, Sweden
| | - James Lavelle
- Harvard Program in Refugee Trauma (HPRT), Massachusetts General Hospital, Boston, MA, USA
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Sanders C, Bray L. Young people's evaluation of a nurse-led bladder training service: working towards developing a patient reported experience and outcome measure. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2013. [DOI: 10.1111/j.1749-771x.2012.01164.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The tradition of inherent knowledge and power of health care providers stands in stark contrast to the principles of self-determination and patient participation in patient-centered care. At the organizational level, patient-centered care is a merging of patient education, self-care, and evidence-based models of practice and consists of 4 broad domains of intervention including communication, partnerships, health promotion, and physical care. As a result of the unexamined discourse of knowledge and power in health care, the possibilities of patient-centered care have not been fully achieved. In this article, we used a critical social theory lens to examine the discursive influence of power upon the integration of patient-centered care into health care organizations. We begin with an overview of patient-centered care, followed by a discussion of the various ways that it has been introduced into health care organizations. We proceed by deconstructing the inherent power and knowledge of health care providers and shed light on how these long-standing traditions have impeded the integration of patient-centered care. We conclude with a discussion of viable solutions that can be used to implement patient-centered care into health care organizations. This article presents a perspective through which the integration of patient-centered care into health organizations can be examined.
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Mahone IH, Farrell S, Hinton I, Johnson R, Moody D, Rifkin K, Moore K, Becker M, Barker MR. Shared decision making in mental health treatment: qualitative findings from stakeholder focus groups. Arch Psychiatr Nurs 2011; 25:e27-36. [PMID: 22114804 PMCID: PMC3224341 DOI: 10.1016/j.apnu.2011.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 04/06/2011] [Accepted: 04/12/2011] [Indexed: 11/15/2022]
Abstract
PURPOSE This article reports on findings from seven stakeholder focus groups conducted in exploring shared decision making (SDM) between provider and consumer in mental health (MH) treatment in public MH. BASIC PROCEDURES Seven focus groups were conducted with stakeholders-consumers, family members, prescribers, MH clinicians, and rural providers. Each of the focus groups was recorded digitally, transcribed into text, and analyzed qualitatively for recurring themes. MAIN FINDINGS Provider barriers to SDM include history of the medical model, MH crises, lack of system support, and time. Consumer-related barriers included consumer competency, fears, insight, literacy, and trauma from past experiences. Information-exchange issues include consumer passivity, whether consumers could be viewed as experts, and importance of adequate history information. New skills needed to practice SDM included provider's knowledge about alternative treatments, mastery of person-first language, and listening skills; consumer's ability to articulate their expert information; and computer skills for both providers and consumers. Outcomes expected from practice of SDM include greater sharing of power between provider and consumer, greater follow-through with treatment plans, greater self-management on the part of consumers, and improved therapeutic alliances. PRINCIPAL CONCLUSIONS Implementing SDM in public MH will impact consumers and their families, providers, prescribers, and administrators. More SDM trials in public MH are needed to answer some of the many questions that remain.
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Affiliation(s)
- Irma H Mahone
- UVA School of Nursing, Charlottesville, VA 22903-3388, USA.
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Corser W, Lein C, Holmes-Rovner M, Gossain V. Contemporary Adult Diabetes Mellitus Management Perceptions. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2010. [DOI: 10.2165/11318450-000000000-00000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Nieuwenhuijsen ER. An insider's view on person-centred rehabilitation: A case study. Disabil Rehabil 2009; 31:1529-39. [DOI: 10.1080/09638280802620988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schenker Y, Stewart A, Na B, Whooley MA. Depressive symptoms and perceived doctor-patient communication in the Heart and Soul study. J Gen Intern Med 2009; 24:550-6. [PMID: 19274477 PMCID: PMC2669866 DOI: 10.1007/s11606-009-0937-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/02/2008] [Accepted: 01/26/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Doctor-patient communication is an important marker of health-care quality. Little is known about the extent to which medical comorbidities, disease severity and depressive symptoms influence perceptions of doctor-patient communication in patients with chronic disease. METHODS In a cross-sectional study of 703 outpatients with chronic coronary disease, we evaluated the extent to which patient reports of doctor-patient communication were influenced by medical comorbidities, disease severity and depressive symptoms. We assessed patient reports of doctor-patient communication using the Explanations of Condition and Responsiveness to Patient Preferences subscales from the "Interpersonal Processes of Care" instrument. Poor doctor-patient communication was defined as a score of <4 (range 1 to 5) on either subscale. All patients completed the nine-item Patient Health Questionnaire (PHQ) for measurement of depressive symptoms and underwent an extensive evaluation of medical comorbidities and cardiac function. RESULTS In univariate analyses, the following patient characteristics were associated with poor reported doctor-patient communication on one or both subscales: female sex, white or Asian race and depressive symptoms. After adjusting for demographic factors, medical comorbidities and disease severity, each standard deviation (5.4-point) increase in depressive symptom score was associated with a 50% greater odds of poor reported explanations of condition (OR 1.5, 95% CI, 1.2-1.8; p < 0.001) and a 30% greater odds of poor reported responsiveness to patient preferences (OR 1.3, 95% CI, 1.1-1.5; p = 0.01). In contrast, objective measures of disease severity (left ventricular ejection fraction, exercise capacity, inducible ischemia) and medical comorbidities (hypertension, diabetes, myocardial infarction) were not associated with reports of doctor-patient communication. CONCLUSIONS In outpatients with chronic coronary heart disease, depressive symptoms are associated with perceived deficits in doctor-patient communication, while medical comorbidities and disease severity are not. These findings suggest that patient reports of doctor-patient communication may partly reflect the psychological state of the patient.
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Affiliation(s)
- Yael Schenker
- Department of Medicine, University of California, San Francisco, Box 1364, San Francisco, CA 94143, USA.
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Gobbo Montoya M. [Communication skills with patients. The psychologists' point of view]. REUMATOLOGIA CLINICA 2009; 5:47-48. [PMID: 21794576 DOI: 10.1016/j.reuma.2008.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 05/31/2023]
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Fleischer S, Berg A, Zimmermann M, Wüste K, Behrens J. Nurse-patient interaction and communication: A systematic literature review. J Public Health (Oxf) 2009. [DOI: 10.1007/s10389-008-0238-1] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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