Parents' and healthcare professionals' perceptions of the quality of care: A PITSTOP model of caring

Exploration of trust between pediatric nurses and children with a medical diagnosis and their caregivers on inpatient care units: A scoping review

PROBLEM

Trust is central to the development of nurse-patient relationships. Pediatric nurses encounter difficulties developing trust with children and their caregivers. The purpose of this scoping review was to identify, examine, and summarize available evidence on the concept of trust among nurses and children/caregivers when admitted to hospital inpatient care units.

ELIGIBILITY CRITERIA

Using the Joanna Briggs Institute (JBI) methodology for conducing and reporting scoping reviews, CINAHL, MEDLINE, PsycINFO, Cochrane DSR, Cochrane Central, and JBI EBP were searched for qualitative, quantitative, mixed methods, and review studies with no time limits published in English. Included studies presented findings on the experiences of developing trust between pediatric nurses and children under 18 years of age and their caregivers within inpatient care units.

RESULTS

A total of 12,269 titles and abstracts were reviewed independently by two reviewers. 366 full-text articles were retrieved, a final of 81 studies were included in the review.

CONCLUSIONS

Trust was bi-directional between nurses and children/caregivers, developed over time during multiple interactions, and foundational to the development of relationships. Distinct facilitators and barriers to the development of trust between nurses and children/caregivers were identified. The development of trust was rewarding and enriching for both nurses and children/caregivers and was the fundamental to the provision of safe and high-quality nursing care.

IMPLICATIONS

Findings provide nurses with direction and strategies on how to develop and maintain trust with children/caregivers on inpatient care units. The development of training programs and interventions geared at equipping nurses with the skills to develop trust with children/caregivers is needed.

Exploring trust development in families of children towards surgical and emergency care providers: A scoping review of the literature

BACKGROUND

Trust is central to the therapeutic relationship between patients and their providers, yet little is known about how it is developed in the unique context of children facing surgical emergencies. We sought to identify factors fostering trust development, gaps, and areas for improvement.

METHODS

We searched eight databases from inception to June 2021 to identify studies focusing on trust in pediatric surgical and urgent care settings. PRISMA-ScR protocols were followed, and screening carried out by two independent reviewers. Data collection included study characteristics, outcomes, and results.

RESULTS

Out of 5578 articles screened, 12 fulfilled the inclusion criteria. Four major trust constructs were identified: competence, communication, dependability, and caring. Despite various instruments used, all studies reported a high level of parental trust. Nearly all studies (11/12) noted trust depending on parents' sociodemographic background, with ethnicity (3/12) and level of education and language barriers (2/12) limiting parents' confidence in physicians. High trust levels significantly correlated with effective communication and perceived quality of care. Most effective interventions enhancing trust included communication and caring trust constructs (10/12) rather than competence and dependability (5/12). Parents' individual experiences, development of compassionate interactions, and practice of family-centered care appeared important in developing trust.

CONCLUSIONS

Improving communication and providing compassionate care, as well as encouraging a patient-centered approach, appear to be most effective in promoting trust in pediatric surgical and urgent settings. Our findings can guide future educational interventions towards strengthening parental trust and promoting child- and family-centered care in pediatric surgical settings.

The perception of health care quality by primary health care managers in Ukraine

Background

Ukraine is reforming its health care system to improve quality of health care. Insight into how primary health care managers perceive quality is important for the ongoing reform as well as for the improvement of medical services.

Methods

An online survey was conducted as part of the Ukrainian-Swiss project “Medical Educational Development” in April–May 2019 based on the contact list of USAID project “Health Reform Support”, and additionally on the database of the National Health Service of Ukraine and other channels. Data were analyzed using descriptive statistics and qualitative data analysis.

Results

In total, 302 health care managers took part in the study. The majority of primary health care managers perceive quality in health care as process quality. They associate quality mostly with compliance to standards. At the same time, primary health care managers prefer to assess outcome quality via a system of indicators and feedback. There appears to be a lack of consensus about health care quality. This may be due to a lack of awareness of the national strategy for better quality of health care service.

Conclusions

Our study provides new insights into primary care managers' perceptions of health care quality in Ukraine. The absence of a clear consensus about quality complicates the discussion about quality and how to measure quality in health care. This appears to be one of the obstacles to system-wide quality improvement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08300-y.

The development of an evidence-informed Convergent Care Theory: Working together to achieve optimal health outcomes

BACKGROUND

Healthcare is a complex and divergent system with uncertainty, unpredictability, and multi-layered stakeholders. The relationships among the stakeholders are multifaceted and dynamic, requiring continual interpersonal connections, networks, and co-evolution. It is pivotal to have an evidence-informed theory to explain the phenomenon, uniting the multifaceted stakeholders' efforts.

PURPOSE

To describe the development of an evidence-informed theory, the Convergent Care Theory, assembling healthcare stakeholders to work together and achieve optimal health outcomes.

METHODS

The Convergent Care Theory was developed using a theory synthesis approach based on empirical research and literature reviews published by the theory-proposing author. The empirical evidence was categorized into: patients and families, healthcare providers, healthcare organizations, and patients' and healthcare providers' self-care.

RESULTS

The Convergent Care Theory includes four concepts: all-inclusive organizational care , healthcare professional collaborative care, person-centered precision care, and patients ' and healthcare providers' self-care. Achieving convergent care is a process requiring all stakeholders to work together. Six major facilitators emerged from the research evidence: competence, compassion, accountability, trusting, sharing, and engaging.

CONCLUSION

This article introduced the development process of the evidence-informed Convergent Care Theory. Healthcare systems are complex, with multiple stakeholders' needs to meet. The Convergent Care Theory strives to unite healthcare stakeholders, bond resources, and join forces to achieve optimal healthcare outcomes. The underpinning of the theory is a caring culture, which is an underlying code for organizational and team behaviors and the foundation of optimal health outcomes.

Promoting Breastfeeding and Lactation Among Mothers of Premature Newborns in a Hospital in China

OBJECTIVE

To promote breastfeeding and lactation in mothers separated from their premature infants admitted to the NICU in a hospital in China.

DESIGN

For this evidence-based practice project we used a mixed method of survey measures and interviews and were guided by the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice framework.

SETTING/LOCAL PROBLEM

Obstetric unit of a Women and Children's Hospital in China from September 2017 to August 2018. Before the project, the partial breastfeeding rate in the hospital was 17.9%, and the exclusive breastfeeding rate of premature infants was 1.8%; these rates were much lower than the national breastfeeding rate in the country.

PARTICIPANTS

Seventeen nurses and 70 mothers of premature infants.

INTERVENTION/MEASUREMENTS

The project included three phases: (a) finding the best evidence to promote breastfeeding in the literature and identifying the gaps between best practice and current practice, (b) implementing best practice strategies, and (c) comparing pre- and postintervention outcomes. Based on the evidence in the literature and the barriers, strategies were implemented in practice to promote breastfeeding and lactation among women separated from their preterm newborns. Chi-square and t tests were performed to compare the pre-/postintervention differences.

RESULTS

Partial breastfeeding rates increased from 17.9% to 52.7%, and exclusive breastfeeding rates increased from 1.8% to 4.1%. Compliance with breastfeeding guidelines and measures of maternal lactation volume both improved significantly.

CONCLUSION

Promoting breastfeeding and lactation among mothers of premature infants requires not only scientific knowledge but also a caring environment and family-centered practice.