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Janerka C, Leslie GD, Gill FJ. Development of patient-centred care in acute hospital settings: A meta-narrative review. Int J Nurs Stud 2023; 140:104465. [PMID: 36857979 DOI: 10.1016/j.ijnurstu.2023.104465] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/29/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context. AIM To understand the development of patient-centred care in the context of acute hospital settings over the past decade. METHODS A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic. RESULTS One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care. CONCLUSIONS Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions. TWEETABLE ABSTRACT Patient-centred care in acute care settings - we have arrived! Is it sustainable?
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Affiliation(s)
- Carrie Janerka
- School of Nursing, Curtin University, Western Australia, Australia; Fiona Stanley Hospital, South Metropolitan Health Service, Western Australia, Australia.
| | - Gavin D Leslie
- School of Nursing, Curtin University, Western Australia, Australia; Fiona Stanley Hospital, South Metropolitan Health Service, Western Australia, Australia
| | - Fenella J Gill
- School of Nursing, Curtin University, Western Australia, Australia; Perth Children's Hospital, Child and Adolescent Health Service, Western Australia, Australia
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Reid JC, Dennis B, Hoad N, Clarke F, Hanmiah R, Vegas DB, Boyle A, Toledo F, Rudkowski JC, Soth M, Heels-Ansdell D, Cheung A, Willison K, Neville TH, Cheung J, Woods A, Cook D. Enhancing end of life care on general internal medical wards: the 3 Wishes Project. BMC Palliat Care 2023; 22:11. [PMID: 36788522 PMCID: PMC9925934 DOI: 10.1186/s12904-023-01133-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Initially developed in the intensive care unit (ICU) at St. Joseph's Healthcare Hamilton (SJHH) the 3 Wishes Project (3WP) provides personalized, compassionate care to dying patients and their families. The objective of this study was to develop and evaluate 3WP expansion strategies for patients cared for on General Internal Medicine (GIM) wards in our hospital. METHODS From January 2020-November 2021, we developed a phased, multicomponent approach for program expansion. We enrolled patients on the GIM wards who had a high probability of dying in hospital, then elicited, implemented, and documented wishes for them or their families. Data were analyzed descriptively. RESULTS From March 2020 to November 2020, we implemented staff education and engagement activities, created an Expansion Coordinator position, held strategic consultations, and offered enabling resources. From March 2020 to November 2021, we enrolled 62 patients and elicited 281 wishes (median [1st, 3rd quartiles] 4 [4, 5] wishes/patient). The most common wish categories were personalizing the environment (67 wishes, 24%), rituals and spiritual support (42 wishes, 15%), and facilitating connections (39 wishes, 14%). The median [1st, 3rd] cost/patient was $0 [0, $10.00] (range $0 to $86); 91% of wishes incurred no cost to the program. CONCLUSIONS The formal expansion of the 3WP on GIM wards has been successful despite COVID-19 pandemic disruptions. While there is still work ahead, these data suggest that implementing the 3WP on the GIM wards is feasible and affordable. Increased engagement of the clinical team during the pandemic suggests that it is positively received.
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Affiliation(s)
- Julie C. Reid
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Brittany Dennis
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Neala Hoad
- grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - France Clarke
- grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Rajendar Hanmiah
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Daniel Brandt Vegas
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Anne Boyle
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada
| | - Feli Toledo
- grid.416721.70000 0001 0742 7355Department of Spiritual Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Jill C. Rudkowski
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Mark Soth
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Diane Heels-Ansdell
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Andrew Cheung
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Kathleen Willison
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada ,grid.25073.330000 0004 1936 8227School of Nursing, Faculty of Health Sciences, Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Thanh H. Neville
- grid.19006.3e0000 0000 9632 6718Department of Medicine, Division of Pulmonary & Critical Care, University of California Los Angeles, Los Angeles, CA 90095 USA
| | - Jason Cheung
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Anne Woods
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada
| | - Deborah Cook
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
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Neville TH, Taich Z, Walling AM, Bear D, Cook DJ, Tseng CH, Wenger NS. The 3 Wishes Program Improves Families' Experience of Emotional and Spiritual Support at the End of Life. J Gen Intern Med 2023; 38:115-121. [PMID: 35581456 PMCID: PMC9113739 DOI: 10.1007/s11606-022-07638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 04/22/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The end-of-life (EOL) experience in the intensive care unit (ICU) is emotionally challenging, and there are opportunities for improvement. The 3 Wishes Program (3WP) promotes the dignity of dying patients and their families by eliciting and implementing wishes at the EOL. AIM To assess whether the 3WP is associated with improved ratings of EOL care. PROGRAM DESCRIPTION In the 3WP, clinicians elicit and fulfill simple wishes for dying patients and their families. SETTING 2-hospital academic healthcare system. PARTICIPANTS Dying patients in the ICU and their families. PROGRAM EVALUATION A modified Bereaved Family Survey (BFS), a validated tool for measuring EOL care quality, was completed by families of ICU decedents approximately 3 months after death. We compared patients whose care involved the 3WP to those who did not using three BFS-derived measures: Respectful Care and Communication (5 questions), Emotional and Spiritual Support (3 questions), and the BFS-Performance Measure (BFS-PM, a single-item global measure of care). RESULTS Of 314 completed surveys, 117 were for patients whose care included the 3WP. Bereaved families of 3WP patients rated the Emotional and Spiritual Support factor significantly higher (7.5 vs. 6.0, p = 0.003, adjusted p = 0.001) than those who did not receive the 3WP. The Respectful Care and Communication factor and BFS-PM were no different between groups. DISCUSSION The 3WP is a low-cost intervention that may be a feasible strategy for improving the EOL experience.
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Affiliation(s)
- Thanh H Neville
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
| | - Zachary Taich
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Anne M Walling
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Veteran Affairs, Los Angeles, USA
| | - Danielle Bear
- UCLA Office of the Patient Experience, UCLA Health, Los Angeles, CA, USA
| | - Deborah J Cook
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Neil S Wenger
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Riegel M, Randall S, Buckley T. Healthcare professionals' knowledge, skills, and role in offering and facilitating memory making during end-of-life care in the adult intensive care unit. Aust Crit Care 2021; 35:491-498. [PMID: 34531101 DOI: 10.1016/j.aucc.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/12/2021] [Accepted: 08/09/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND An activity to provide a tangible keepsake following the death of a loved one is termed 'memory making'. However, limited evidence is available related to professionals' education and support to provide memory making opportunities in the adult intensive care unit (ICU). Having a greater understanding of healthcare professionals' experiences can inform future patient/family care and support for professionals in end-of-life care. OBJECTIVE The objective of this study was to describe what participants perceive memory making to be, if they have facilitated memory making activities as part of their practice, if they perceive it as part of their role, and if they have the necessary skills to do so. METHODS Seventy-five registered nurses (75% response rate), 19 medical doctors (76% response rate), and two social workers (66.7% response rate) completed a survey at a single tertiary referral centre in an adult ICU. RESULTS Participants reported memory making to include the creation of tangible keepsakes as well as nontangible activities. Overall, participants reported high agreement scores that the responsibility for initiating memory making predominately belonged to the nurse. Participants reported skills most needed involved the ability to interact with the family, being open to the concept, and integrating memory making into their standard of care. Having developed a rapport with families was considered an enabler, whereas lack of knowledge and clinical workload were reported as inhibitors to offering memory making. CONCLUSIONS Overall, participants in this study reported positive experiences with offering memory making to families during end-of-life care in the adult ICU. Nurses are more likely to perceive professional responsibility for offering memory making, likely due to their increased time at the bedside and higher prominence and leadership in other end-of-life practices. To support professionals, education should include conceptual knowledge, procedural knowledge of keepsake creations, communication techniques using reflective practices, and organisational support to facilitate time requirements.
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Affiliation(s)
- Melissa Riegel
- Adult Intensive Care Unit, Prince of Wales Hospital, Randwick, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
| | - Sue Randall
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Thomas Buckley
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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