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Charumbira MY, Kaseke F, Berner K, Louw QA. A qualitative description of primary health care patients' perspectives on factors influencing demand for rehabilitation in Zimbabwe. Disabil Rehabil 2024:1-12. [PMID: 39244668 DOI: 10.1080/09638288.2024.2400595] [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: 06/22/2023] [Revised: 08/29/2024] [Accepted: 08/31/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE Although the need for rehabilitation is increasing in Zimbabwe, rehabilitation remains undervalued. Currently, Zimbabwe struggles to provide rehabilitation services at primary health care. To justify the need for establishing rehabilitation at this level of care, the demand for these services needs to be understood. This study describes the factors influencing the demand for rehabilitation by adults attending primary healthcare in Zimbabwe. MATERIALS AND METHODS The study used a qualitative descriptive approach. In-depth interviews were conducted with 18 purposefully selected patients in the Shona language and audio recorded. Transcribed data were translated and back-translated. Thematic analysis was done using Atlas.ti. version 22.2®. RESULTS Most patients at primary health care were not actively seeking nor were they able to utilise rehabilitation services because of several factors. The factors identified from the patients' responses were categorised into (i) patient and family-, (ii) healthcare professional-, and (iii) health system-related factors. Key factors included rehabilitation awareness and availability of rehabilitation. CONCLUSION The identified factors may inform rehabilitation service and policy planners in improving primary health care patients' access to rehabilitation in similar low-resource settings. Future studies may determine how the identified factors may be addressed to ensure that high need translates to high demand.
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Affiliation(s)
- Maria Yvonne Charumbira
- Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Farayi Kaseke
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Karina Berner
- Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette Abegail Louw
- Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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2
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Kähkönen O, Vähänikkilä H, Paukkonen L, Oikarinen A. Extension of the theory of adherence to treatment in patients with coronary heart disease. Chronic Dis Transl Med 2024; 10:227-237. [PMID: 39027194 PMCID: PMC11252433 DOI: 10.1002/cdt3.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 07/20/2024] Open
Abstract
Background Increased knowledge of the concept of adherence is needed for development patient-centered care, nursing interventions, and guidelines for patients with coronary heart disease (CHD). The aim of this study was to test and extend the Theory of Adherence to Treatment regarding informational support in patients with CHD. Methods The study utilized an explanatory and descriptive survey. The study was conducted in 2013 and involved 416 patients in five hospitals in Finland. The Adherence of Patients with Chronic Disease instrument and the Social Support for People with CHD instrument were used. The model was tested using structural equation modeling (SEM). Results SEM confirmed direct associations between motivation (β = 0.49, p < 0.001) and results of care (β = 0.29, p < 0.01), and indirect associations between sense of normality, fear of complications, support from nurses and next of kin, and informational support to adherence to a healthy lifestyle and medication. Informational support included information and advice on CHD risk factors, physical exercise, chest pain, medication, continuum of care, and rehabilitation. Indirect standardized path coefficients varied between 0.14 and 0.45. The model explained 45% of adherence to a healthy lifestyle and medication. Conclusion The results of this study showed that informational support is a justified extension to the original Theory of Adherence to Treatment in Patients with CHD. Informational support seems to offer a new perspective that can be used to develop patient-centered nursing interventions and thus support adherence to treatment by patients with a lifelong disease such as CHD.
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Affiliation(s)
- Outi Kähkönen
- Department of Nursing ScienceUniversity of Eastern FinlandKuopioFinland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of MedicineUniversity of OuluOuluFinland
| | - Leila Paukkonen
- Reseach Unit of Health Sciences and Technology, Faculty of MedicineUniversity of OuluOuluFinland
- Medical Research Center Oulu (MRC Oulu), Faculty of medicineUniversity of OuluOuluFinland
| | - Anne Oikarinen
- Reseach Unit of Health Sciences and Technology, Faculty of MedicineUniversity of OuluOuluFinland
- Medical Research Center Oulu (MRC Oulu), Faculty of medicineUniversity of OuluOuluFinland
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3
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Vareta D, Ventura F, Família C, Oliveira C. Perspectives of older adults with chronic illness on person-centered practice at an inpatient hospital department: a descriptive study. BMC Geriatr 2024; 24:714. [PMID: 39210262 PMCID: PMC11360336 DOI: 10.1186/s12877-024-05261-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The growing aging trend associated with a higher prevalence of chronic illnesses is increasing the demand for the development of person-centered practice in specific care settings. Knowing the person's perception of the care and the care experience is essential to improving inpatient care toward person-centeredness. This study aims to characterize the perceptions of person-centered practice of hospitalized older adults with chronic illness at a Portuguese inpatient hospital department. METHODS A quantitative, descriptive, cross-sectional approach was followed. Data were collected using a sociodemographic and health history questionnaire and the Person-Centered Practice Inventory - Care (PCPI-C). The effect of the different variables on each PCPI-C construct was determined using analysis of variance (ANOVA). RESULTS The results show that person-centered practice was positively perceived in the five constructs of the person-centered processes domain (M = 3.92; SD = 0.47). The highest-scored construct was working with the person's beliefs and values (M = 4.12; SD = 0.51), and the lowest was working holistically (M = 3.68; SD = 0.70). No significant effect of the independent variables was found to influence the perceptions of any of the constructs in the person-centered processes domain. CONCLUSIONS These results might indicate that person-centered processes are perceived uniquely by each person through individualized therapeutic relationships rather than a pattern of care shared by hospitalized older adults.
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Affiliation(s)
- Diana Vareta
- PhD Program, University of Lisbon (UL) and Nursing School of Lisbon (ESEL), Lisboa 1600-214, Portugal.
- Egas Moniz Interdisciplinary Research Centre (CiiEM), Egas Moniz Universitary Institute, Quinta da Granja, Monte de Caparica 2829-511, Portugal.
| | - Filipa Ventura
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra 3000-076, Portugal
| | - Carlos Família
- Egas Moniz Interdisciplinary Research Centre (CiiEM), Egas Moniz Universitary Institute, Quinta da Granja, Monte de Caparica 2829-511, Portugal
- Laboratory of Molecular Pathology and Forensic Biochemistry, Egas Moniz Universitary Institute, Quinta da Granja, Monte de Caparica 2829-511, Portugal
| | - Célia Oliveira
- Nursing School of Lisbon (ESEL), Lisboa 1600-096, Portugal
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Furness K, Huggins CE, Hanna L, Croagh D, Sarkies M, Haines TP. Effect of Communication Mode on Disclosure of Nutrition Impact Symptoms During Nutrition Intervention Delivered to People With Upper Gastrointestinal Cancer. Eval Health Prof 2024:1632787241267051. [PMID: 39045879 DOI: 10.1177/01632787241267051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Individuals diagnosed with upper gastrointestinal cancers experience a myriad of nutrition impact symptoms (NIS) compromise a person's ability to adequately meet their nutritional requirements leading to malnutrition, reduced quality of life and poorer survival. Electronic health (eHealth) is a potential strategy for improving the delivery of nutrition interventions by improving early and sustained access to dietitians to address both NIS and malnutrition. This study aimed to explore whether the mode of delivery affected participant disclosure of NIS during a nutrition intervention. Participants in the intervention groups received a nutrition intervention for 18 weeks from a dietitian via telephone or mobile application (app) using behaviour change techniques to assist in goal achievement. Poisson regression determined the proportion of individuals who reported NIS compared between groups. Univariate and multiple regression analyses of demographic variables explored the relationship between demographics and reporting of NIS. The incidence of reporting of NIS was more than 1.8 times higher in the telephone group (n = 38) compared to the mobile group (n = 36). Telephone predicted a higher likelihood of disclosure of self-reported symptoms of fatigue, nausea, and anorexia throughout the intervention period. A trusting therapeutic relationship built on human connection is fundamental and may not be achieved with current models of mobile health technologies.
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Affiliation(s)
- Kate Furness
- Department of Nutrition and Dietetics, Monash Health, Monash Medical Centre, Clayton, VIC, Australia
- Dietetics, Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, VIC, Australia
- Department Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Catherine E Huggins
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Lauren Hanna
- Department of Nutrition and Dietetics, Monash Health, Monash Medical Centre, Clayton, VIC, Australia
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Daniel Croagh
- Upper Gastrointestinal and Hepatobiliary Surgery, Monash Medical Centre, Clayton, VIC, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Mitchell Sarkies
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Charumbira MY, Conradie T, Berner K, Louw QA. Bridging the chasm between patients' needs and current rehabilitation care: perceptions of adults presenting for primary care in the Eastern Cape. BMC Health Serv Res 2024; 24:166. [PMID: 38317161 PMCID: PMC10840242 DOI: 10.1186/s12913-024-10564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The need for rehabilitation in low-to-middle income countries (LMICs) is rapidly increasing as more people are living longer with chronic diseases. Primary health care (PHC) is ideally placed to provide the spectrum of care required to meet most of the complex and evolving population's health needs locally. This study aimed to describe the patient journeys of adults attending primary care in the Eastern Cape province of South Africa to understand the factors that affected their access to primary care rehabilitation services (or the lack thereof) and obtain suggestions on how rehabilitation may be enhanced at primary care. METHODS A maximum variation sampling approach was used to purposefully select persons with varied chronic health conditions and demographic characteristics to gain diverse perspectives regarding their rehabilitation needs and ways in which the current rehabilitation services at primary care may be enhanced. Data were collected via face-to-face semi-structured interviews between March and June 2022 which were electronically recorded. Inductive thematic analysis of transcribed data was done and coded in Atlas.ti.22®. RESULTS Twenty-five adult patients participated in the study. The patients had different experiences at their local PHC facilities that affected their access to rehabilitation at primary care. The study found that most patients were not able to access rehabilitation at primary care. There were several personal and contextual factors that resulted in the patients having a low perceived need to receive rehabilitation that potentially lowered patients' demand for and utilization of rehabilitation at primary care. Patients suggested increasing rehabilitation workforce at primary care, improving availability of assistive devices, increasing their knowledge regarding rehabilitation, and facilitating socio-economic integration into their communities. CONCLUSIONS Patients attending primary care are not guaranteed access to rehabilitation by virtue of having entered the PHC system. It is important to consider the patient perspectives regarding their health needs and suggestions for enhancing care.
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Affiliation(s)
- Maria Yvonne Charumbira
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa.
| | - Thandi Conradie
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
| | - Karina Berner
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
| | - Quinette Abegail Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa
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Kristjánsson K, Thórarinsdóttir K. Two variants of 'constrained participation' in the care of vulnerable adults: A proof-of-concept study. Nurs Ethics 2024; 31:39-51. [PMID: 37195896 PMCID: PMC10898202 DOI: 10.1177/09697330231169930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
There has been a radical turn towards ideals of patient autonomy and person-centred care, and away from historically entrenched forms of medical paternalism, in the last 50 years of nursing practice. However, along the way, some shades of grey between the areas of ideal patient participation and of outright patient non-participation have been missed. The current article constitutes an exploratory proof-of-concept study of the real-world traction of a distinction-straddling concept of 'constrained participation' and its two sub-concepts of 'fought-for participation' and 'forced-to participation'. In order to concretise these additions to the conceptual terrain of person-centred participation and its anti-theses, we apply them to themes in the care of vulnerable older adults. In the final section, we close by eliciting some characterological, educational and clinical implications of adding these new tools also to the conceptual repertoire of nursing practice and education.
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Hipp K, Kangasniemi M, Varpula J, Lantta T. Nurses' and patient' descriptions about forms of power in pro re nata medication participation in forensic psychiatric care: A qualitative secondary analysis. Int J Ment Health Nurs 2024; 33:73-84. [PMID: 37661371 DOI: 10.1111/inm.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/13/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
Despite there being an emphasis on patient participation in their own care, it has been a challenge in pro re nata (PRN, as the circumstance arises) medication in forensic psychiatric care. The power imbalance in treatment relationships can be a barrier to patient participation and should therefore be further explored. This qualitative descriptive study aimed to explore the aspect of power in the descriptions of patients and nurses interviewed in a Finnish forensic psychiatric hospital about patient participation in PRN. A qualitative secondary analysis was conducted through the semi-structured interviews of the patients (n = 34) and nurses (n = 19). The data were analysed with deductive content analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used to ensure comprehensive reporting. The findings revealed that patients and health professionals may have conflicting goals in PRN and that they both use power to try to achieve them. Power in PRN was described in different forms, including authority, force, manipulation and persuasion. Based on our results, the power that health professionals have in PRN medication is particularly based on their legitimate authority and the hierarchical structures of the hospital environment. Patients also hold power in the dynamics of PRN medication care, but their position as a power holder can vary individually and situationally. Recognizing different forms of power and supporting patients with a decreased capacity for decision-making is essential for promoting high-quality and patient-centred forensic psychiatric nursing.
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Affiliation(s)
- Kirsi Hipp
- School of Health and Social Services, Häme University of Applied Sciences, Hämeenlinna, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, University of Turku, Satakunta Hospital District, Turku, Finland
| | - Jaakko Varpula
- Department of Nursing Science, University of Turku, Satakunta Hospital District, Turku, Finland
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Satakunta Hospital District, Turku, Finland
- Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
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8
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Alanko T, Kröger T, Nikander R, Piirainen A, Vuoskoski P. Rehabilitees' conceptions of participation after a six-month rehabilitation period: a phenomeno-graphic study. Physiother Theory Pract 2023:1-13. [PMID: 37933612 DOI: 10.1080/09593985.2023.2275703] [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: 03/22/2023] [Accepted: 10/21/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE A prerequisite for successful rehabilitation is that the rehabilitees are in central role of the rehabilitation process. However, the rehabilitees and rehabilitation professionals may both lack knowledge and understanding of how to implement rehabilitee-centered participation in practice. This study aimed to explore the qualitatively different ways of understanding rehabilitee participation as conceptualized by the rehabilitees. METHODS We generated data from individual interviews with 20 rehabilitees after a six-month rehabilitation process. These interviews were analyzed based on phenomenographic methodology. RESULTS We identified three understandings of rehabilitee participation as conceptualized by the participants: 1) Dependent participation; 2) Progressive participation; and 3) Committed participation. These categories varied according to four themes: 1) Rehabilitation process; 2) Rehabilitation in everyday life; 3) Interaction in rehabilitation; and 4) Rehabilitation support network. We also identified critical aspects highlighting differences between the qualitatively distinct categories. CONCLUSION This study generated new insights into understanding the phenomenon of rehabilitee participation, as conceptualized by rehabilitees themselves. The findings in terms of three descriptive categories and critical aspects between the categories, reflect the ascending and shifting complexity from dependent to progressive and committed participation. These findings as such can be utilized in the design, development, and implementation of rehabilitee participation and rehabilitee-centered practice.
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Affiliation(s)
- Tuulikki Alanko
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
- Outpatient clinic, Central Finland Health Care District, Jyväskylä, Finland
| | - Teppo Kröger
- Faculty of Philosophy and Education, University of Jyväskylä, Jyvaskyla, Finland
| | - Riku Nikander
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
- Outpatient clinic, Central Finland Health Care District, Jyväskylä, Finland
- GeroCenter Foundation for Aging Research & Development, University of Jyväskylä, Jyvaskyla, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
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9
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Didier A, Nathaniel A, Scott H, Look S, Benaroyo L, Zumstein-Shaha M. Protecting Personhood: A Classic Grounded Theory. QUALITATIVE HEALTH RESEARCH 2023; 33:1177-1188. [PMID: 37669352 PMCID: PMC10626982 DOI: 10.1177/10497323231190329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The importance of perceiving and considering patients as healthcare partners has been increasingly promoted. Healthcare systems around the world are now highly interested in patient engagement, participation, collaboration, and partnership. Healthcare professionals are advised that patients, as autonomous beings, should be active in and responsible for a portion of their own care. The study presented here focused on patients' perceptions of interprofessional collaboration. It was conducted using the classic grounded theory methodology. The theory of protecting personhood emerged as the core concept of hospitalized patients, cared for by interprofessional healthcare teams. This theory encapsulates the process hospitalized patients go through to find balance in their sense of self, oscillating between personhood and patienthood in the unfamiliar hospital environment. The process consists of four stages: the stage of introspection, during which hospitalized patients become aware of their self as a person and as a patient; the stage of preservation, when patients find a balance between the sense of personhood and patienthood; the stage of rupture, wherein patients experience an imbalance between their sense of personhood and patienthood; and the stage of reconciliation, in which personhood is restored. The theory of protecting personhood offers insights into a better understanding of hospitalized patients' experiences and strategies, revealing the importance of relationships, and the driving force of empowerment. This study is about patients' perspectives of interprofessional healthcare teams. A grounded theory process allowed the emergence of patients' concerns and expectations, leading to a substantive theory grounded in the patients' data.
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Affiliation(s)
- Amélia Didier
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Alvita Nathaniel
- Department of Nursing, West Virginia University, Morgantown, WV, USA
- Grounded Theory Institute, Mill Valley, CA, USA
| | | | | | - Lazare Benaroyo
- Interdisciplinary Ethics Center, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Maya Zumstein-Shaha
- Bern University of Applied Sciences Health, Bern, Switzerland
- Department of Nursing, University of Witten/Herdecke, Witten/Herdecke, Germany
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10
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Hurtig C, Bendtsen M, Årestedt L, Uhlin F, Eldh AC. Patient participation in end-stage kidney disease care: variation over time and effects of staff-directed interventions - a quasi-experimental study. BMC Nephrol 2023; 24:265. [PMID: 37691126 PMCID: PMC10494352 DOI: 10.1186/s12882-023-03313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Among those elements establishing decent quality of care from a patient perspective, opportunities to participate in accord with one's individual needs and preferences are central. To date, little is known the extent of preference-based patient participation in kidney care, and what facilitates optimal conditions. This study investigated i) preference-based patient participation in kidney care over time, and ii) the effects of interventions designed to enhance person-centred patient participation. METHODS A quasi-experimental study was conducted across nine kidney care sites in southeast Sweden. A cohort of 358 patients with stage IV chronic kidney disease (eGRF 15-19 ml/min) or V (eGRF < 15 mL/min) entered the study. Of these, 245 patients (with kidney replacement therapy or intermittent outpatient visits only) completed a survey on patient participation at four time points: every six months from August 2019 to May 2021, patients reported their preferences for and experiences of participation using the validated Patient Preferences for Patient Participation tool, the 4Ps. Between the first and second data collection points, interventions were provided for designated staff to facilitate person-centred participation, using two strategies for two subgroups at three sites each: the managers receiving a bundle of information via e-mail on patient participation in a standard dissemination procedure (three sites), or an additional half-year support program for implementation offered to 1-2 staff per site (three sites), with no intervention for a control group (three sites). The differences in 4Ps data between groups were analysed using multilevel ordinal regression. RESULTS Over time and across all sites, most patients' experiences of participation fully or almost fully matched their engagement preferences (57%-90%). Still, up to 12% of patient reports indicated that their preferences and experiences were insufficiently matched: in these cases, the patients had preferred to be more involved than they had experienced, for example, in making healthcare plans and setting health-related goals. The interventions did not affect the levels of preference-based participation, but patients in the control group sites had slightly more consistent matches. CONCLUSIONS Living with kidney failure necessitates patient engagement, but opportunities to participate in accordance with one's preferences are not fully provided for all patients. Additional efforts to support a common understanding and to ensure person-centred patient participation is still needed.
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Affiliation(s)
- Caroline Hurtig
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Liselott Årestedt
- Department of Health and Caring Sciences, Linnaeus University, 391 82, Kalmar, Sweden
| | - Fredrik Uhlin
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Nephrology, Region Östergötland, 581 85, Linköping, Sweden
- Department of Health Technologies, Tallinn University of Technology (TalTech), 19086, Tallinn, Estonia
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, 751 22, Uppsala, Sweden
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11
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Elvén M, Holmström IK, Carlestav M, Edelbring S. A tension between surrendering and being involved: An interview study on person-centeredness in clinical reasoning in the acute stroke setting. PATIENT EDUCATION AND COUNSELING 2023; 112:107718. [PMID: 37001485 DOI: 10.1016/j.pec.2023.107718] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To explore how stroke survivors experience and prefer to participate in clinical reasoning processes in the acute phase of stroke care. METHODS An explorative qualitative design was used. Individual interviews were conducted with 11 stroke survivors in the acute phase of care and analyzed using reflexive thematic analysis. RESULTS The analysis identified five themes: What's going on with me?; Being a recipient of care and treatment; The need to be supported to participate; To be seen and strengthened; and Collaboration and joint understanding. CONCLUSION Stroke survivors experience many attributes of person-centeredness in the acute phase of care but, according to their stories, their participation in clinical reasoning can be further supported. The tension between surrendering and the desire to be more actively involved in the care needs to be considered to facilitate participation in clinical reasoning. PRACTICE IMPLICATIONS Stroke survivors' participation in clinical reasoning in the acute phase can be facilitated by health professionals noticing signs prompting a shift towards increased willingness to participate. Furthermore, health professionals need to take an active role, sharing their expertise and inviting the stroke survivors to share their perspective. The findings can contribute to further develop person-centered care in acute settings.
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Affiliation(s)
- Maria Elvén
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden; School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Inger K Holmström
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Malin Carlestav
- Department of Neurology and Rehabilitation Medicine, Örebro University Hospital, Örebro, Sweden
| | - Samuel Edelbring
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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12
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Selvin M, Almqvist K, Fogelkvist M, Lundqvist LO, Schröder A. Patient Participation in Forensic Psychiatric Care: The Initial Development and Content Validity of a New Instrument. JOURNAL OF FORENSIC NURSING 2023; 19:204-213. [PMID: 37590943 PMCID: PMC10453349 DOI: 10.1097/jfn.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
ABSTRACT Patient participation is central in modern health care. However, it is a complex phenomenon that lacks a clear definition, and what constitutes participation varies depending on the context and theoretical perspective. It is known that patient participation in forensic psychiatric care is often rated as low by both patients and professionals, and it can be assumed that interventions to increase it are beneficial. In this process, management and staff could benefit from assessing perceived patient participation, and reliable and valid measurement instruments are essential. The aim of this study was to develop an instrument that could be used to measure experiences of participation in forensic psychiatric care from a patient perspective and test it for content validity. A definition of patient participation in forensic psychiatric care was formulated and operationalized in an instrument that an expert group, consisting of patients with ongoing care, evaluated for content validity. In total, 50 items were sorted into five different dimensions: to have good communication, to be involved, to have mutual trust, to trust the care, and to take responsibility. After psychometric testing, the instrument has the potential to become a tool to use in research, clinical work, and development work in the field of forensic psychiatric care. In addition to being used as a measure, the Patient Participation in Forensic Psychiatric Care can also be used to encourage a dialogue about their care and to make both patients and staff more aware of patient participation.
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Affiliation(s)
- Mikael Selvin
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
| | - Kjerstin Almqvist
- Department for Social and Psychological Studies, Karlstad University
| | - Maria Fogelkvist
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
| | - Lars-Olov Lundqvist
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
| | - Agneta Schröder
- Author Affiliations:University Health Care Research Center, Faculty of Medicine and Health, Örebro University
- Faculty of Health, Care and Nursing, Department of Nursing, Norwegian University of Science and Technology (NTNU)
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13
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Merner B, Schonfeld L, Virgona A, Lowe D, Walsh L, Wardrope C, Graham-Wisener L, Xafis V, Colombo C, Refahi N, Bryden P, Chmielewski R, Martin F, Messino NM, Mussared A, Smith L, Biggar S, Gill M, Menzies D, Gaulden CM, Earnshaw L, Arnott L, Poole N, Ryan RE, Hill S. Consumers' and health providers' views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 3:CD013274. [PMID: 36917094 PMCID: PMC10065807 DOI: 10.1002/14651858.cd013274.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. OBJECTIVES 1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care. SELECTION CRITERIA We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services. DATA COLLECTION AND ANALYSIS Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles. MAIN RESULTS We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability. AUTHORS' CONCLUSIONS Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.
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Affiliation(s)
- Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ariane Virgona
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Child and Family Evidence, Australian Institute of Family Studies, Melbourne, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Cheryl Wardrope
- Clinical Governance, Metro South Hospital and Health Service, Eight Mile Plains, Australia
| | | | - Vicki Xafis
- The Sydney Children's Hospitals Network, Sydney, Australia
| | - Cinzia Colombo
- Laboratory for medical research and consumer involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Nora Refahi
- Consumer Representative, Melbourne, Australia
| | - Paul Bryden
- Consumer Representative, Caboolture, Australia
| | - Renee Chmielewski
- Planning and Patient Experience, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | | | | | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Susan Biggar
- Consumer Representative, Melbourne, Australia
- Australian Health Practitioner Regulation Agency (AHPRA), Melbourne, Australia
| | - Marie Gill
- Gill and Wilcox Consultancy, Melbourne, Australia
| | - David Menzies
- Chronic Disease Programs, South Eastern Melbourne Primary Health Network, Heatherton, Australia
| | - Carolyn M Gaulden
- Detroit Wayne County Authority Health Residency Program, Michigan State University, Providence Hospital, Southfield, Michigan, USA
| | | | | | - Naomi Poole
- Strategy and Innovation, Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| | - Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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14
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Jerofke-Owen TA, Tobiano G, Eldh AC. Patient engagement, involvement, or participation - entrapping concepts in nurse-patient interactions: A critical discussion. Nurs Inq 2023; 30:e12513. [PMID: 35871476 DOI: 10.1111/nin.12513] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 01/25/2023]
Abstract
The importance of patients taking an active role in their healthcare is recognized internationally, to improve safety and effectiveness in practice. There is still, however, some ambiguity about the conceptualization of that patient role; it is referred to interchangeably in the literature as engagement, involvement, and participation. The aim of this discussion paper is to examine and conceptualize the concepts of patient engagement, involvement, and participation within healthcare, particularly nursing. The concepts were found to have semantic differences and similarities, although, from a nursing perspective, they can be summoned to illustrate the establishment of a mutual partnership between a patient and a nurse. The individualization of such processes requires the joint effort of engagement, involvement, or participation, represented by interactive actions of both the patient (asking questions, telling/speaking up, knowledge acquisition, learning, and decision-making) and the nurse (recognizing, responding, information sharing, teaching, and collaborating). Suggesting that the concepts can be used interchangeably comes with some caution, requiring that nurses embrace patients playing a role in their health and healthcare. Further research and practice development should focus on how patients and nurses receive and respond to each other to establish patient engagement, involvement, and participation.
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Affiliation(s)
| | - Georgia Tobiano
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia.,Gold Coast Health, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Ann C Eldh
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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15
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Mphasha MH, Skaal L, Mothiba TM, Ngoatle C, Hlahla LS. Primary health care–family partnership for better diabetes outcomes of patients: a systematic review. JOURNAL OF ENDOCRINOLOGY, METABOLISM AND DIABETES OF SOUTH AFRICA 2022. [DOI: 10.1080/16089677.2022.2140517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- MH Mphasha
- Department of Human Nutrition and Dietetics, University of Limpopo, South Africa
| | - L Skaal
- School of Health Sciences, University of Limpopo, South Africa
| | - TM Mothiba
- Faculty of Healthcare Sciences, University of Limpopo, South Africa
| | - C Ngoatle
- Faculty of Healthcare Sciences, University of Limpopo, South Africa
| | - LS Hlahla
- Faculty of Healthcare Sciences, University of Limpopo, South Africa
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16
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Tobiano G, Marshall AP, Gardiner T, Jenkinson K, Shapiro M, Ireland M. Development and psychometric testing of the patient participation in bedside handover survey. Health Expect 2022; 25:2492-2502. [PMID: 35898173 PMCID: PMC9615084 DOI: 10.1111/hex.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/19/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction When handover is conducted at the patient's bedside, active patient participation can be encouraged, which may improve the safety and quality of care. There is a need for valid and reliable tools to measure patient perceptions of participation in bedside handover, to ensure the rising number of implementation and improvement efforts are consistently and effectively evaluated. The aim of this study is to systematically develop and evaluate the psychometric properties of a self‐report survey to measure patients' perceptions of participation in bedside handover. Methods In Phase 1, our team developed a conceptual framework and item pool (n = 130). In Phase 2, content validity was assessed with four health consumers, four nurses and four researchers. Next, 10 current hospital inpatients tested the survey for end‐user satisfaction. In Phase 3, 326 inpatients completed the survey, allowing exploratory factor analysis, reliability analyses and convergent/divergent validity analyses to occur. Results Phase 1 and 2 resulted in a 42‐item survey. In Phase 3, 321 surveys were available for analysis. Exploratory factor analysis revealed a three‐factor solution, with 24 items, which matched our conceptual framework. The three factors were: ‘Conditions for patient participation in bedside handover’, ‘Level of patient participation in bedside handover’ and ‘Evaluation of patient participation in bedside handover’. There was strong evidence for factor reliability and validity. Additionally, the correlation between factors was strong. Conclusion This study furthers our conceptual understanding by showing that nurse facilitating behaviours are a strong precursor for patient participation and perceived handover outcomes, justifying the need for nursing training. A robust survey has been developed to measure patient perceptions of participation in bedside handover, which can effectively evaluate this approach to care. Engaging consumers and nurses as research team members was invaluable in ensuring that the survey is acceptable for end‐users. Patient or Public Contribution A health consumer and nurse partnered as members of the research team from study inception to dissemination.
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Affiliation(s)
- Georgia Tobiano
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia.,NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Andrea P Marshall
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Therese Gardiner
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Kim Jenkinson
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Margaret Shapiro
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Michael Ireland
- School of Psychology and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia
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17
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Hultin L, Karlsson A, Löwenmark M, Coleman S, Gunningberg L. Feasibility of PURPOSE T in clinical practice and patient participation-A mixed-method study. Int Wound J 2022; 20:633-647. [PMID: 35859322 PMCID: PMC9927909 DOI: 10.1111/iwj.13904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022] Open
Abstract
This study aimed to evaluate the feasibility of implementing an electronic version of PURPOSE T, a risk assessment instrument for pressure ulcers, in a Swedish hospital ward. A mixed-method was used. Nursing staff received training in PURPOSE T and a record review was performed (n = 30). PURPOSE T replaced the Modified Norton Scale, and after one month another record review was performed (n = 30). Individual interviews with patients (n = 15) and focus group interviews with nursing staff (n = 23) were performed after the implementation. The results of the record review and the focus group interviews showed good clinical feasibility of PURPOSE T. The record review showed that more patients were at risk of developing pressure ulcers and more nursing interventions were prescribed with PURPOSE T compared to the Modified Norton Scale. The focus group interviews showed that all nursing staff were satisfied with PURPOSE T. The instrument contributed to increased reflection and analysis as well as the opportunity for nursing staff to draw their own conclusions regarding patients´ risk status. The documentation encouraged the prescription of more preventive actions, and the nurses were more involved at bedside. However, almost all the patients expressed not receiving any information about pressure ulcers.
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Affiliation(s)
- Lisa Hultin
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden,Uppsala University HospitalUppsalaSweden
| | - Ann‐Christin Karlsson
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden,Region GotlandVisbySweden
| | - Malin Löwenmark
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden,Uppsala University HospitalUppsalaSweden
| | | | - Lena Gunningberg
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden,Uppsala University HospitalUppsalaSweden
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18
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Alders I, Smits C, Brand P, van Dulmen S. Patient coaching: What do patients want? A mixed methods study in waiting rooms of outpatient clinics. PLoS One 2022; 17:e0269677. [PMID: 35679303 PMCID: PMC9182226 DOI: 10.1371/journal.pone.0269677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Effective communication in specialist consultations is difficult for some patients. These patients could benefit from support from a coach who accompanies them to and during medical specialist consultations to improve communication in the consultation room. This study aims to investigate patients’ perspective on interest in support from a patient coach, what kind of support they would like to receive and what characterizes an ideal patient coach. Methods We applied a mixed method design to obtain a realistic understanding of patients’ perspectives on a patient coach. Patients in the waiting rooms of outpatient clinics were asked to fill out a short questionnaire which included questions about demographic characteristics, perceived efficacy in patient-provider interaction and patients’ interest in support from a patient coach. Subsequently, patients interested in a patient coach were asked to participate in a semi-structured interview. The quantitative data were examined using univariate analysis and the qualitative interview data were analysed using content analysis. Results The survey was completed by 154 patients and eight of them were interviewed. Perceived efficacy in patient-physician interactions was the only variable that showed a significant difference between patients with and without an interest in support from a patient coach. The interviews revealed that a bad communication experience was the main reason for having an interest in support from a patient coach. Before the consultation, a patient coach should take the time to get to know the patient, build trust, and help the patient create an agenda, so take the patient seriously and recognize the patient as a whole person. During the consultation, a patient coach should support the patient by intervening and mediating when necessary to elicit the patient’s agenda. After the consultation, a patient coach should be able to explain and discuss medical information and treatment consequences. An ideal patient coach should have medical knowledge, a strong personality and good communication skills. Conclusion Especially patients who had a bad communication experience in a specialist consultation would like support from a patient coach. The kind of support they valued most was intervening and mediating during the consultation. To build the necessary trust, patient coaches should take time to get to know the patient and take the patient seriously. Medical knowledge, good communication skills and a strong personality were considered prerequisites for patient coaches to be capable to intervene in specialist consultations.
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Affiliation(s)
- Irène Alders
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- * E-mail:
| | - Carolien Smits
- Program Older Adults and Health, Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Paul Brand
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands
- Postgraduate School of Medicine, University Medical Centre Groningen, Groningen, Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
- Faculty of Caring Science, University of Borås, Borås, Sweden
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Cole L, Easley J, Grightmire L, Lakshmanan EM, Matthias SJ, McBoyle K, Piercell E, Purdy A, Schneider N, Wassersug RJ, Martino R, Fitch MI. Every Story Is Different: Experiences With Body Changes Related to Cancer. Front Psychol 2022; 13:831811. [PMID: 35677121 PMCID: PMC9169964 DOI: 10.3389/fpsyg.2022.831811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
One of the important aspects of stakeholder engagement in cancer care and system planning is hearing from individuals who have been diagnosed with cancer about the impact of the diagnosis and treatment on their lives. Hearing stories from the perspectives of cancer survivors offers opportunity to gain new insight and understanding about experiences of being diagnosed and treated for cancer. This article presents ten short narratives about survivors' perspectives on body image and cancer. Each story is unique but, taken together, the picture they create is one of facing challenges, discovering personal resilience, and moving forward to engage in living. The stories emphasize the importance of communication and support from healthcare providers and understanding needs for a person-centered cancer care system.
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Affiliation(s)
- Linda Cole
- Independent Scholar, Toronto, ON, Canada
| | | | | | | | - Sharon J. Matthias
- Matthias Inc: Connecting for Innovation and Advancing Societies, Edmonton, AB, Canada
| | | | | | | | | | | | - Rosemary Martino
- Department of Speech Language Pathology, Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
| | - Margaret I. Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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20
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Ju H, Kang E, Kim Y, Ko H, Cho B. The Effectiveness of a Mobile Health Care App and Human Coaching Program in Primary Care Clinics: Pilot Multicenter Real-World Study. JMIR Mhealth Uhealth 2022; 10:e34531. [PMID: 35522461 PMCID: PMC9123543 DOI: 10.2196/34531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/07/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background
As the global burden of chronic conditions increases, their effective management is a concern. Although the need for chronic disease management using mobile self-management health care apps is increasing, there are still many barriers to their practical application in the primary care field.
Objective
This study evaluated the effectiveness of primary care services combining a mobile self-management health care app with human coaching for patients with chronic diseases in the current primary care system.
Methods
A total of 110 patients (mean age 53.2, SD 9.2 years; 64 of 110, 58.2% female) with hypertension, diabetes, dyslipidemia, or metabolic syndrome who visited one of 17 participating primary care clinics from September to November 2020 were included in this study. All participants recorded data regarding changes in body weight, sleep conditions, quality of life, depression, anxiety, stress, BMI, waist circumference, blood sugar levels, blood pressure, and blood lipids levels. The app user group (n=65) used a mobile self-management health care app with human coaching for 12 weeks, and the control group (n=45) underwent conventional self-managed health care.
Results
Patients in the app user group reported significantly more weight loss than those in the control group—the body weight of the app user group decreased by 1.43 kg (95% CI –2.07 to –0.79) and that of the control group decreased by 0.13 kg (95% CI –0.67 to 0.41; P=.002). The weight loss was markedly greater after using the app for 9 weeks than that when used for 4 weeks or 5-8 weeks (P=.002). Patients in the app user group reported better sleep quality (P=.04) and duration (P=.004) than those in the control group.
Conclusions
The combination of primary care clinics and a mobile self-management health care app with human coaching results in better management of chronic conditions. This study shows that the primary care services combining a mobile self-management health care app with human coaching are effective in the current primary care system. An implication of this study is the possibility that a mobile self-management health care app with human coaching is a treatment option in the current primary care system.
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Affiliation(s)
- HyoRim Ju
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - EunKyo Kang
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - YoungIn Kim
- Noom Korea, Noom Inc., Seoul, Republic of Korea
| | | | - Belong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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21
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Cederberg M, Fors A, Ali L, Goulding A, Mäkitalo Å. The interactive work of narrative elicitation in person-centred care: Analysis of phone conversations between health care professionals and patients with common mental disorders. Health Expect 2022; 25:971-983. [PMID: 35148442 PMCID: PMC9122427 DOI: 10.1111/hex.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/29/2021] [Accepted: 01/09/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Narratives play a central part in person-centred care (PCC) as a communicative means of attending to patients' experiences. The present study sets out to explore what activities are performed and what challenges participants face in the interactive process of narrative elicitation, carried through in patient-professional communication in a remote intervention based on PCC. METHODS Data were gathered from a randomized controlled trial (RCT) in a Swedish city where health care professionals (HCPs) conducted remote PCC for patients on sick leave due to common mental disorders. A sample of eleven audio-recorded phone conversations between HCPs and patients enroled in the RCT were collected and subjected to conversation analysis. RESULTS Three interactive patterns in narrative elicitation were identified: Completed narrative sequences driven by the patient, question-driven narrative sequences guided by the HCP, and narrative sequences driven as a collaborative project between the patient and the HCP. In the question-driven narrative sequences, communication was problematic for both participants and they did not accomplish a narrative. In the other two patterns, narratives were accomplished but through various collaborative processes. CONCLUSION This study provides insight into what challenges narrative elicitation may bring in the context of a remote PCC intervention and what interactive work patients and HCP need to engage in. Importantly, it also highlights tensions in the ethics of PCC and its operationalization, if the pursuit of a narrative is not properly balanced against the respect for patients' integrity and personal preferences. Our findings also show that narrative elicitation may represent an interactive process in PCC in which illness narratives are jointly produced, negotiated and transformed. PATIENT OR PUBLIC CONTRIBUTION Stakeholders, including patient representatives, were involved in the design of the main study (the RCT). They have been involved in discussions on research questions and dissemination throughout the study period. They have not been involved in conducting the present study.
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Affiliation(s)
- Matilda Cederberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Psychiatric Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anneli Goulding
- Region Västra Götaland, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Mäkitalo
- Department of Education, University of Oslo, Oslo, Norway.,Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden
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22
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Barbarian M, Bishop A, Alfaro P, Biron A, Brody DA, Cunningham-Allard G, Dubrovsky AS. Patient-Reported Experience in the Pediatric Emergency Department: What Matters Most? J Patient Saf 2021; 17:e1166-e1170. [PMID: 29432338 DOI: 10.1097/pts.0000000000000472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although the Child Hospital Consumer Assessment of Healthcare Providers and Systems is a validated tool for the inpatient experience, it may not address features unique to the pediatric emergency department (PED). There is currently no publicly available validated patient-reported experience survey for the PED, and what matters most in this setting remains unknown. METHODS Twelve semistructured interviews were conducted with a convenience sample of parents of children younger than 14 years at a Canadian PED. Data analysis was performed using inductive thematic analysis to identify aspects of patient-reported experiences that matter most to parents in the PED. RESULTS Five themes were identified: (1) making waiting a positive experience, (2) taking the time to provide care, (3) forging a positive partnership, (4) speak up for safe care, and (5) making the environment feel safer. Parents highlighted that while waiting for care is not desirable, it is made more acceptable through the communication of wait time estimates and the presence of child activities in the waiting room. Furthermore, although interactions with providers are brief, parents emphasized the importance of creating an environment of partnership with open communication, taking the time to examine their child, and actively demonstrating the provision of safe, quality care. CONCLUSIONS Results from this study suggest that a patient-reported experience survey in the PED may need to embed elements not currently captured in Child Hospital Consumer Assessment of Healthcare Providers and Systems, such as waiting room experience, comprehensiveness of health assessments, and observations of safety measures. Future studies can use these findings to develop a patient-reported experience survey for use in the PED.
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Affiliation(s)
- Mher Barbarian
- From the Pediatric Emergency Medicine, Montreal Children's Hospital, Montreal, Quebec
| | | | | | | | - Daniel Adam Brody
- From the Pediatric Emergency Medicine, Montreal Children's Hospital, Montreal, Quebec
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Ogrin R, Aylen T, Thurgood L, Neoh SL, Audehm R, Steel P, Churilov L, Zajac J, Ekinci EI. Older People With Type 2 Diabetes-Individualising Management With a Specialised Community Team (OPTIMISE): Perspectives of Participants on Care. Clin Diabetes 2021; 39:397-410. [PMID: 34866781 PMCID: PMC8603327 DOI: 10.2337/cd20-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite the high prevalence of diabetes in older people, there is limited information on optimal methods to support their diabetes management, including how to incorporate technology. This article reports on the results of semi-structured interviews with 41 adult participants with type 2 diabetes (mean age 74 ± 7 years) on their perspectives of a new model of care (the Older People With Type 2 Diabetes-Individualising Management With a Specialised Community Team [OPTIMISE] program) for older people with type 2 diabetes. The OPTIMISE program involved telemedicine consultations, home visits by a credentialed diabetes educator, and intermittent flash glucose monitoring. Human connection and relationships were key to the positive perspectives expressed by participants in this program that used technology to enhance the care of older people in their homes.
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Affiliation(s)
- Rajna Ogrin
- Bolton Clarke, Forest Hill, Victoria, Australia
| | - Tracy Aylen
- Bolton Clarke, Forest Hill, Victoria, Australia
| | | | | | - Ralph Audehm
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
| | - Paul Steel
- Bolton Clarke, Forest Hill, Victoria, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Jeffrey Zajac
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
- Austin Health Clinical School, Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Elif I. Ekinci
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
- Austin Health Clinical School, Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
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24
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Hammerbeck U, Hargreaves M, Hollands KL, Tyson S. Stroke survivors' perceptions of participating in a high repetition arm training trial early after stroke. Disabil Rehabil 2021; 44:6026-6033. [PMID: 34372752 DOI: 10.1080/09638288.2021.1955984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The study explored the acceptability of high repetition arm training as part of a randomised controlled trial, early after stroke, when fatigue levels and emotional strain are often high. MATERIALS AND METHODS 36 sub-acute stroke survivors (61 years+/-15) attended for assessment sessions at 3, 6, and 12 weeks after stroke. Individuals were randomised to receive 6 high repetition arm training sessions between 3 and 6 weeks (intervention) or the control group. Semi-structured interviews were conducted at trial completion. Interview transcripts were analysed through framework analysis conducted independently by 2 researchers. RESULTS Stroke survivors participated despite high levels of fatigue because they hoped for personal benefit or to potentially benefit future patients. Benefits reported from participation included physical improvements, psychological benefit, improved understanding of their condition as well as a feeling of hope and distraction. The arm training at three weeks after stroke, aiming for 420 movement repetitions was not considered to be too intensive or too early, and most individuals felt lucky to have been, or would have preferred to be in the early training group. CONCLUSION High repetition arm training early after stroke was acceptable to participants. Study participation was generally viewed as a positive experience, suggesting that early intervention may not only be physically beneficial but also psychologically.Implications for rehabilitationStroke survivors report that high repetition arm training early after stroke is acceptable.Participation in rehabilitation research early after stroke provides stroke survivors with hope and meaning despite the high prevalence of fatigue.Complex information needs to be repeated and provided in a number of formats early after stroke.
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Affiliation(s)
- Ulrike Hammerbeck
- School of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK
| | - Mary Hargreaves
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK
| | - Kristen L Hollands
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK.,School of Health Sciences, University of Salford, Salford, UK
| | - Sarah Tyson
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance & Greater Manchester Universities, Manchester, UK.,School of Health Sciences, University of Manchester, Manchester, UK
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25
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Sahota RS, Sanha S, Last A, Cassama E, Goncalves A, Kelly AH, Street A, Harding-Esch EM. Acceptability and perceived utility of different diagnostic tests and sample types for trachoma surveillance in the Bijagos Islands, Guinea Bissau. Trans R Soc Trop Med Hyg 2021; 115:847-853. [PMID: 33444436 PMCID: PMC8382514 DOI: 10.1093/trstmh/traa179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/10/2020] [Accepted: 01/05/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Trachoma is the leading infectious cause of blindness worldwide and is nearing elimination as a public health problem in Guinea Bissau. It is imperative that elimination is followed by a successful postvalidation surveillance programme. The aim of this study was to determine the acceptability and perceived utility of different diagnostic tests and sample types that could be used for postvalidation trachoma surveillance in the Bijagos Islands, Guinea Bissau. METHODS Semistructured interviews with community members and stakeholders involved in trachoma elimination were followed by focus group discussions with community members, covering experiences with trachoma and views on trachoma diagnostic methods and sample types. RESULTS In this setting, all diagnostic tests and sample types used for trachoma surveillance were generally considered acceptable by communities. A preference for laboratory-based testing and finger-prick blood samples was expressed as these results were considered more accurate and applicable to a range of diseases beyond trachoma. CONCLUSIONS Appropriate community and stakeholder engagement and communication regarding the purpose and processes around diagnostic practice prior to trachoma programme implementation are crucial for long-term successful disease-elimination efforts.
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Affiliation(s)
- Ramandeep Singh Sahota
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Salimato Sanha
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, Bisssau, Guiné Bissau
| | - Anna Last
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Eunice Cassama
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, Bisssau, Guiné Bissau
| | - Adriana Goncalves
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Ann H Kelly
- Faculty of Social Science and Public Policy, King's College London, London, WC2B 4BG, UK
| | - Alice Street
- School of Social and Political Science, Edinburgh University, Edinburgh, EH8 9LD, UK
| | - Emma M Harding-Esch
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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26
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Paukkonen L, Oikarinen A, Kähkönen O, Kyngäs H. Patient participation during primary health-care encounters among adult patients with multimorbidity: A cross-sectional study. Health Expect 2021; 24:1660-1676. [PMID: 34247439 PMCID: PMC8483210 DOI: 10.1111/hex.13306] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/11/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background Patient participation is essential for achieving high‐quality care and positive outcomes, especially among patients with multimorbidity, which is a major challenge for health care due to high prevalence, care complexity and impact on patients' lives. Objective To explore the patient participation related to their own care among patients with multimorbidity in primary health‐care settings. Methods A cross‐sectional survey was conducted among adult multimorbid patients who visited primary health‐care facilities. The key instrument used was the Participation in Rehabilitation Questionnaire. Data representing 125 patients were analysed using various statistical methods. Results The respondents generally felt patient participation to be important, yet provided highly varying accounts regarding the extent to which it was realized by professionals. Information and knowledge and Respect and encouragement were considered the most important and best implemented subcategories of participation. Several patient‐related factors had a statistically significant effect on patient perceptions of participation for all subcategories and as explanatory factors for perceptions of total participation in univariate models. Most patients reported active participation in health‐care communication, positively associated with patient activation and adherence. Gender, perceived health, patient activation and active participation were explanatory factors for total importance of participation in multivariate models, while patient activation was retained for realization of participation. Conclusions Multimorbid patients require individualized care that promotes participation and active communication; this approach may further improve patient activation and adherence. Poor perceived health and functional ability seemed to be related to worse perceptions of participation. Patient and public involvement The study topic importance was based on the patients' experiences in author's previous research and the need to develop patient‐centred care.
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Affiliation(s)
- Leila Paukkonen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Outi Kähkönen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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Forsgren E, Björkman I. Interactional practices in person-centred care: Conversation analysis of nurse-patient disagreement during self-management support. Health Expect 2021; 24:940-950. [PMID: 33774894 PMCID: PMC8235886 DOI: 10.1111/hex.13236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Person‐centred care implies a change in interaction between care professionals and patients where patients are not passive recipients but co‐producers of care. The interactional practices of person‐centred care remain largely unexplored. Objective This study focuses on the analysis of disagreements, which are described as an important part in the co‐production of knowledge in interaction. Design A qualitative exploratory study using conversation analysis. Setting and participants Data were collected from a nurse‐led person‐centred intervention in a hospital outpatient setting. Interactions between adult patients with irritable bowel syndrome (n = 17) and a registered nurse were audio‐recorded. COREQ guidelines were applied. Results Disagreements were found after demonstration of the nurse's or patients’ respective professional or personal knowledge. Disagreements were also evident when deciding on strategies for self‐management. Although negotiations between opposing views of the nurse and patient were seen as important, the patient generally claimed final authority both in knowing how IBS is perceived and in the right to choose self‐management strategies. The nurse generally oriented towards patient authority, but instances of demonstration of nurse authority despite patient resistance were also found. Discussion and conclusions This study provides information on how co‐production of knowledge and decisions occur in the context of a person‐centred care intervention. Negotiations between nurse and patient views require a flexible approach to communication, adapting interaction to each context while bearing in mind the patients having the final authority. To facilitate co‐production, the patient's role and responsibilities in interaction should be explicitly stated.
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Affiliation(s)
- Emma Forsgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Ida Björkman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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28
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Byrne AL, Harvey C, Baldwin A. Nurse navigators and person-centred care; delivered but not valued? Nurs Inq 2021; 28:e12402. [PMID: 33645885 DOI: 10.1111/nin.12402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/27/2022]
Abstract
Positioning the individual at the centre of care (person-centred care [PCC]) is essential to improving outcomes for people living with multiple chronic conditions. However, research also suggests that this is structurally challenging because health systems continue to adopt long-standing, episodic care encounters. One strategy to provide a more cohesive, individualised approach to care is the implementation of the nurse navigator role. Current research shows that although PCC is a focus of navigation, such care may be hindered by the rigid, systematised health services providing siloed specialist care. In this paper, we utilised a case study method to investigate the experiences of a nurse navigator and patient. The nurse navigator and the patient participated in individual interviews, the transcripts of which were analysed using critical discourse analysis. Findings from a larger research project suggest that traditional measures (hospital avoidance, emergency department usage) which work as the service objectives of the nurse navigator service have the potential to stifle the delivery of PCC. The analysis from this case study supports the broader findings and further highlights the need for improved alignment between service objectives and the health and well-being of the individuals utilising the services.
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Affiliation(s)
- Amy-Louise Byrne
- School of Nursing and Midwifery and Social Science, Central Queensland University, Townsville, QLD, Australia
| | - Clare Harvey
- School of Nursing and Midwifery and Social Science, Central Queensland University, Townsville, QLD, Australia
| | - Adele Baldwin
- School of Nursing and Midwifery and Social Science, Central Queensland University, Townsville, QLD, Australia
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29
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Andersen-Hollekim T, Landstad BJ, Solbjør M, Kvangarsnes M, Hole T. Nephrologists' experiences with patient participation when long-term dialysis is required. BMC Nephrol 2021; 22:58. [PMID: 33593314 PMCID: PMC7885613 DOI: 10.1186/s12882-021-02261-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/04/2021] [Indexed: 11/12/2022] Open
Abstract
Background For individuals in need of dialysis, patient participation is important when determining care goals and in decision making regarding dialysis modality. Nephrologists hold a key role in delivering evidence-based healthcare that integrates patient preferences and values throughout the trajectory, and their experiences with patient participation are important for improving health care. The aim of this study was to explore nephrologists’ experiences with patient participation in different phases of the end-stage renal disease trajectory for working-age individuals who require dialysis. Methods This explorative study comprised interviews with ten nephrologists from four different dialysis units in Central Norway. We analysed the interviews by applying an interpretive phenomenological approach. Results Nephrologists had varied experiences with patient participation throughout the different phases of the treatment trajectory. During decision making on the dialysis modality, nephrologists emphasised patients’ choices in two approaches. In the first approach, they expected patients to choose the modality based on the provided information, which could be actively steered. In the second approach, they recognised the patients’ values and lifestyle preferences through shared decision-making. Within hospital haemodialysis, nephrologists considered patients’ self-care activities equivalent to patient participation, seeing self-care as a source of patient empowerment. They identified divergent patient–professional values and organisational structures as barriers to patient participation. Conclusion Our study shows that nephrologists have different approaches to patient participation in different phases of the end-stage renal disease trajectory. Individual understanding as well as organisational structures are important factors to address to increase patient participation in end-stage renal disease care. Shared decision making, in which patient values are balanced against biomedical treatment targets, allows for mutual agreement between patients and healthcare professionals concerning medical plans and minimises the potential for patient–professional tensions.
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Affiliation(s)
- Tone Andersen-Hollekim
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Bodil J Landstad
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.,Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway
| | - Marit Solbjør
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit Kvangarsnes
- Department of Health Sciences, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Ålesund, Norway
| | - Torstein Hole
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
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Naldemirci Ö, Britten N, Lloyd H, Wolf A. Epistemic injustices in clinical communication: the example of narrative elicitation in person-centred care. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:186-200. [PMID: 33112448 PMCID: PMC7894328 DOI: 10.1111/1467-9566.13209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
The increasing popularity of the term 'person-centred' in the healthcare literature and a wide range of ideals and practices it implies point to the need for a more inclusive and holistic healthcare provision. A framework developed in a Swedish context suggested narrative elicitation as a key practice in transition to person-centred care. Initiating clinical communication by inviting people to tell their stories makes persistent yet often subtle problems in clinical communication visible. By drawing upon an observational study on narrative elicitation and vignette-based focus group interviews with nurses, our aim is to trace 'credibility deficits' (Fricker 2007. Epistemic Injustice. Power and the Ethics of Knowing. Oxford: Oxford University Press) and 'credibility excesses' (Medina 2011, Social Epistemology, 25, 1, 15-35, 2013, The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and the Social Imagination. Oxford: Oxford University Press) in narrative elicitation. We argue that narrative elicitation may be one way to tackle epistemic injustices by giving voice to previously silenced groups, yet it is not enough to erase the effects of 'credibility deficits' in clinical communication. Rather than judging individual professionals' success or failure in eliciting narratives, we underline some extrinsic problems of narrative elicitation, namely structural and positional inequalities reflecting on narrative elicitation and the credibility of patients. 'Credibility excesses' can be useful and indicative to better understand where they are missing.
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Affiliation(s)
| | - Nicky Britten
- University of Exeter Medical SchoolExeterUK
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Helen Lloyd
- School of PsychologyUniversity of PlymouthPlymouthUK
| | - Axel Wolf
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
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31
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Thorarinsdottir K, Kristjansson K. Meaningful Text: Total Hip Replacement Patients’ Lived Experience of a Nursing Care Plan Written in Lay Language. Open Nurs J 2020. [DOI: 10.2174/1874434602014010325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Person-centred care involves respecting patients’ experiences, preferences, and needs, as well as sharing information with them and involving them in care planning. Scant research has been conducted on how it influences patients to have direct access to their care planning when it has been established through the use of standardised care plans or pathways. In the orthopaedic ward in which this study was conducted, a standardised nursing care plan for total hip replacement patients (THR), which was originally written in professional language, was rewritten in lay language and used as peri-operative teaching material for this patient group.
Study Aim:
To explore the meaning THR patients ascribe to the lived experience of reading and retaining their standardised nursing care plan in lay language during their hospital stay.
Methods:
The data collection and analysis followed a method adapted by the Vancouver School of Doing Phenomenology. Data were collected through 12 in-depth interviews with six THR patients.
Results:
The main finding was that the participants acquired knowledge from the text of the care plan that was understandable and meaningful, as evidenced by the empowering impact it had on them. This impact included improved psychological wellbeing, more open communication, and the provision of a tool to keep track of care. Some revisions of the care plan were recommended.
Conclusion:
The study suggests that a patient version of standardised care plans can act as an important educational tool for THR patients that can empower them to manage their health situations.
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Olasoji M, Plummer V, Shanti M, Reed F, Cross W. The benefits of consumer involvement in nursing handover on acute inpatient unit: Post-implementation views. Int J Ment Health Nurs 2020; 29:786-795. [PMID: 32100448 DOI: 10.1111/inm.12709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
Abstract
The involvement of consumers in handover with nurses has been identified as reducing miscommunication between transitions in care and associated with reduction in adverse events in generalist nursing settings. The notion of having consumers present in nursing handover on acute mental health inpatient unit remains a relatively new concept. Central to recovery-focused mental health care is the consumer's active participation in the delivery of their care. The aim of this study was to explore the views of consumers with a mental illness about their experiences of being involved in nursing handover on acute mental health inpatient unit post-implementation of a new nursing handover involving consumers. Using an exploratory descriptive qualitative design, participants (N = 10) were recruited using purposive convenience sampling. Semi-structured interviews were undertaken, and the data were thematically analysed. Participants' principal diagnoses were schizophrenia (n = 2), schizoaffective disorder (n = 3), bipolar affective disorder (n = 2), borderline personality disorder (n = 1), and depression (n = 2). Three themes were generated from the interviews: (i) Knowing who, (ii) Shared decision-making, with subthemes: my voice was heard and not just a meet and greet, and (iii) Having time and space. The delivery of mental health care needs to put the consumer at the centre of such care regardless of the setting. In line with recovery-focused principles, the consumer's active involvement in the crucial activity of nursing handover on acute mental health inpatient unit is very important. The study has implications for ensuring consumer voices are heard in all aspects of their care delivery.
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Affiliation(s)
- Michael Olasoji
- School of Health Professions, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, Frankston, Victoria, Australia.,Peninsula Health, Frankston, Victoria, Australia
| | | | - Fiona Reed
- Peninsula Health, Frankston, Victoria, Australia
| | - Wendy Cross
- School of Nursing and Healthcare Professions, Federation University, Berwick, Victoria, Australia
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33
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Göransson C, Wengström Y, Hälleberg-Nyman M, Langius-Eklöf A, Ziegert K, Blomberg K. An app for supporting older people receiving home care - usage, aspects of health and health literacy: a quasi-experimental study. BMC Med Inform Decis Mak 2020; 20:226. [PMID: 32933500 PMCID: PMC7493150 DOI: 10.1186/s12911-020-01246-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/03/2020] [Indexed: 01/21/2023] Open
Abstract
Background During the last decade, there has been an increase in studies describing use of mHealth, using smartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people’s usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time. Methods A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6–month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics. Results The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people’s communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time. Conclusions The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, and which aspects of health of importance to support by an app.
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Affiliation(s)
- Carina Göransson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden. .,School of Health and Welfare, Halmstad University, 302 18, Halmstad, Sweden.
| | - Yvonne Wengström
- Theme Cancer, Karolinska University Hospital, 141 86, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska, Institutet, 171 77, Stockholm, Sweden
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska, Institutet, 171 77, Stockholm, Sweden
| | - Kristina Ziegert
- School of Health and Welfare, Halmstad University, 302 18, Halmstad, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden
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34
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Didier A, Dzemaili S, Perrenoud B, Campbell J, Gachoud D, Serex M, Staffoni-Donadini L, Franco L, Benaroyo L, Maya ZS. Patients' perspectives on interprofessional collaboration between health care professionals during hospitalization: a qualitative systematic review. JBI Evid Synth 2020; 18:1208-1270. [PMID: 32813373 DOI: 10.11124/jbisrir-d-19-00121] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to gain a better understanding of the interprofessional collaboration between health care professionals from the patients' point of view during hospitalisation; the influence of interprofessional collaboration on patient care, safety, and well-being; and patients' perspectives of their role in the interprofessional collaboration process. INTRODUCTION Interprofessional collaboration is a key factor in improving patient health care outcomes and safety through better communication between health care professionals, better teamwork, and better care coordination. However, implementing interprofessional collaboration in the clinical setting can prove complex. Patients are increasingly interested in becoming partners within the health care system. They have the potential to contribute to their own safety and to observe professionals during the care process, thus gaining a better understanding of the interprofessional collaboration process and facilitating changes in the behavior of health care professionals. INCLUSION CRITERIA This review considered qualitative research and mixed-method studies. Participants were hospitalized patients. Studies were included when they explored i) patients' perceptions of interprofessional collaboration, ii) the influence of interprofessional collaboration on patients' care, safety, or well-being, or iii) patients' perceptions of their own role in interprofessional collaboration. Qualitative studies focusing only on the care process or families' points of view were excluded. METHODS Searches of six databases including MEDLINE, CINAHL, Embase, Web of Science, PsycINFO, and Sociological Abstract, limited to English, French, and German were conducted from March 2017 to June 2018. Assessment of methodological quality of studies was performed using the JBI Qualitative Assessment and Review Instrument. Data were extracted using the standardized data extraction tool from JBI. Data synthesis following the JBI approach of meta-aggregation was performed. The level of confidence for each synthesized finding was established based on ConQual. RESULTS A total of 22 studies were included, which resulted in 89 findings and 24 categories. Eight synthesized findings were generated: patients' perceptions of interprofessional collaboration based on personal experiences and observations; patients' experiences with effective or ineffective interprofessional communication; patients' experience with power imbalance and paternalistic attitudes; patients' perceptions of key factors for a confident relationship with the interprofessional health care team; patients' need for comprehension of discussions between health care professionals; patients' perceptions of their role in an interprofessional health care team; patients' perceptions of opportunities for empowerment in interprofessional health care teams; and patients' need for humanizing care from interprofessional health care teams. The level of confidence of synthesized findings varied from low to moderate according to ConQual. CONCLUSIONS This systematic review synthesized the perspectives of hospitalized patients regarding interprofessional collaboration and their perceived role in collaborative practices. Hospitalized patients observe interprofessional collaboration, either directly or indirectly, and the way interprofessional collaboration is performed may impact both their care and their well-being. However, little evidence has been found regarding the impact of interprofessional collaboration on patient safety. Patients' perspectives on their perceived role is not unanimous; some patients want to play an active role in the collaborative process, whereas others prefer to trust the health care professionals' expertise. Health care professionals should consider patients' preferences and act accordingly regarding both the collaborative process and the inclusion of the patients in collaborative practices.
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Affiliation(s)
- Amélia Didier
- BEST Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins: A JBI Centre of Excellence.,HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,University Institute of Higher Education and Research in Health Care (IUFRS), University of Lausanne (UNIL), Switzerland
| | - Shota Dzemaili
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Béatrice Perrenoud
- BEST Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins: A JBI Centre of Excellence.,ELS School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Joan Campbell
- BEST Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins: A JBI Centre of Excellence.,HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - David Gachoud
- University Hospital Lausanne (CHUV), Lausanne, Switzerland.,Department of Internal Medicine, University Hospital Lausanne (CHUV)
| | - Magali Serex
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Liliana Staffoni-Donadini
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Loris Franco
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Lazare Benaroyo
- Medical Education Unit, Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.,Interdisciplinary Ethics Center, Faculty of Biology and Medicine, University of Lausanne, University of Lausanne (UNIL), Switzerland
| | - Zumstein-Shaha Maya
- BEST Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins: A JBI Centre of Excellence.,Bern University of Applied Sciences, Department of Health, Bern, Switzerland
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Crafoord MT, Fjell M, Sundberg K, Nilsson M, Langius-Eklöf A. Engagement in an Interactive App for Symptom Self-Management during Treatment in Patients With Breast or Prostate Cancer: Mixed Methods Study. J Med Internet Res 2020; 22:e17058. [PMID: 32663140 PMCID: PMC7445604 DOI: 10.2196/17058] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/05/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
Background Using mobile technology for symptom management and self-care can improve patient-clinician communication and clinical outcomes in patients with cancer. The interactive app Interaktor has been shown to reduce symptom burden during cancer treatment. It includes symptom assessment, an alert system for contact with health care professionals, access to self-care advice, and visualization of symptom history. It is essential to understand how digital interventions operate; one approach is to examine engagement by assessing usage and exploring user experiences. Actual usage in relation to the intended use—adherence—is an essential factor of engagement. Objective This study aimed to describe engagement with the Interaktor app among patients with breast or prostate cancer during treatment. Methods Patients from the intervention groups of two separate randomized controlled trials were included: patients with breast cancer receiving neoadjuvant chemotherapy (n=74) and patients with locally advanced prostate cancer receiving treatment with radiotherapy (n=75). The patients reported their symptoms daily. Sociodemographic and clinical data were obtained from baseline questionnaires and medical records. Logged data usage was retrieved from the server and analyzed descriptively and with multiple regression analysis. Telephone interviews were conducted with patients about their perceptions of using the app and analyzed using content analysis. Results The median adherence percentage to daily symptom reporting was 83%. Most patients used the self-care advice and free text message component. Among the patients treated for breast cancer, higher age predicted a lower total number of free text messages sent (P=.04). Among the patients treated for prostate cancer, higher age (P=.01) and higher education level (P=.04), predicted an increase in total views on self-care advice, while higher comorbidity (P=.004) predicted a decrease in total views on self-care advice. Being married or living with a partner predicted a higher adherence to daily symptom reporting (P=.02). Daily symptom reporting created feelings of having continuous contact with health care professionals, being acknowledged, and safe. Being contacted by a nurse after a symptom alert was considered convenient and highly valued. Treatment and time-related aspects influenced engagement. Daily symptom reporting was perceived as particularly meaningful at the beginning of treatment. Requests were made for advice on diet and psychological symptoms, as well as for more comprehensive and detailed information as the patient progressed through treatment. Conclusions Patient engagement in the interactive app Interaktor was high. The app promoted patient participation in their care through continuous and convenient contact with health care professionals. The predictive ability of demographic variables differed between patient groups, but higher age and a higher educational level predicted usage of specific app functions for both patient groups. Patients’ experience of relevance and interactivity influenced their engagement positively.
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Affiliation(s)
- Marie-Therése Crafoord
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Fjell
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kay Sundberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marie Nilsson
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ann Langius-Eklöf
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Eldh AC, Holmefur M, Luhr K, Wenemark M. Assessing and reporting patient participation by means of patient preferences and experiences. BMC Health Serv Res 2020; 20:702. [PMID: 32727451 PMCID: PMC7391651 DOI: 10.1186/s12913-020-05574-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/23/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although patient participation is strongly associated with high quality of healthcare, valid means to measure and report a comprehensive notion of patient participation are scarce. The Patient Preferences for Patient Participation (4Ps) is a new healthcare practice and research tool, comprising patients' preferences as well as experiences. The 4Ps employs 12 items for the patient to conceptualise patient participation. The aim of this paper is to describe how the two perspectives of patient participation, namely preferences and experiences, can be combined to visualise and report preference-based patient participation. METHODS With four response alternatives in each section, the 4Ps offers sixteen possible combinations of degree of match per item. Theoretical and clinical principles fostered a tentative order of six ranks and three levels of preference-based patient participation. To test the standard, statistical analyses for ordinal data were performed, using data from a randomised controlled trial evaluating an intervention aiming to improve patient participation. Further, structures for visualising the preference-based patient participation of individuals and groups were suggested. RESULTS Data from the 4Ps demonstrated the individuals' preference-based patient participation, indicating either a match or a mismatch for each item. Mismatches represented either the experience of participation surpassing the patient's preferences, or the patient's preferences for patient participation not being established. At group level, the suggested approach for visualising and reporting the 4Ps demonstrated that the intervention group had a significantly higher proportion of sufficient preference-based patient participation for certain items than the control group. These results had not been identified earlier, when using the preferences and experiences of patient participation as separate measures. CONCLUSIONS Ways to easily acquaint stakeholders with patients' preferences for patient participation are needed, in order for healthcare staff to better use resources to match the basic requirements of individuals and groups. While the 4Ps can guide professionals to patient participation as framed in legislations, concept analyses and by patients, a visualisation of the results is needed to capture preference-based patient participation. The proposed route to representing degree of match in preferences and experiences may also be relevant to other dimensions of quality of healthcare.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE751 22 Uppsala, Sweden
| | - Marie Holmefur
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, S701 82 Örebro, Sweden
| | - Kristina Luhr
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, S701 82 Örebro, Sweden
| | - Marika Wenemark
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Unit of Public Health and Statistics, Region Östergötland, S581 85 Linköping, Sweden
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Årestedt L, Martinsson C, Hjelm C, Uhlin F, Eldh AC. Context Factors Facilitating and Hindering Patient Participation in Dialysis Care: A Focus Group Study With Patients and Staff. Worldviews Evid Based Nurs 2020; 17:457-464. [DOI: 10.1111/wvn.12452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Liselott Årestedt
- Faculty of Health and Life Sciences Department of Health and Caring Sciences Linnaeus University Kalmar Sweden
| | - Caroline Martinsson
- Department of Medical and Health Sciences Division of Nursing Linköping University Linköping Sweden
| | - Carina Hjelm
- Department of Medical and Health Sciences Division of Nursing Linköping University Linköping Sweden
| | - Fredrik Uhlin
- Department of Nephrology and Department of Medical and Health Sciences Division of Drug Research Linköping University Linköping Sweden
| | - Ann Catrine Eldh
- Department of Medical and Health Sciences Division of Nursing Linköping University Linköping Sweden
- Department of Public Health and Caring Science Uppsala University Uppsala Sweden
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Harrington RL, Hanna ML, Oehrlein EM, Camp R, Wheeler R, Cooblall C, Tesoro T, Scott AM, von Gizycki R, Nguyen F, Hareendran A, Patrick DL, Perfetto EM. Defining Patient Engagement in Research: Results of a Systematic Review and Analysis: Report of the ISPOR Patient-Centered Special Interest Group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:677-688. [PMID: 32540224 DOI: 10.1016/j.jval.2020.01.019] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Lack of clarity on the definition of "patient engagement" has been highlighted as a barrier to fully implementing patient engagement in research. This study identified themes within existing definitions related to patient engagement and proposes a consensus definition of "patient engagement in research." METHODS A systematic review was conducted to identify definitions of patient engagement and related terms in published literature (2006-2018). Definitions were extracted and qualitatively analyzed to identify themes and characteristics. A multistakeholder approach, including academia, industry, and patient representation, was taken at all stages. A proposed definition is offered based on a synthesis of the findings. RESULTS Of 1821 abstracts identified and screened for eligibility, 317 were selected for full-text review. Of these, 169 articles met inclusion criteria, from which 244 distinct definitions were extracted for analysis. The most frequently defined terms were: "patient-centered" (30.5%), "patient engagement" (15.5%), and "patient participation" (13.4%). The majority of definitions were specific to the healthcare delivery setting (70.5%); 11.9% were specific to research. Among the definitions of "patient engagement," the most common themes were "active process," "patient involvement," and "patient as participant." In the research setting, the top themes were "patient as partner," "patient involvement," and "active process"; these did not appear in the top 3 themes of nonresearch definitions. CONCLUSION Distinct themes are associated with the term "patient engagement" and with engagement in the "research" setting. Based on an analysis of existing literature and review by patient, industry, and academic stakeholders, we propose a scalable consensus definition of "patient engagement in research."
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Affiliation(s)
| | - Maya L Hanna
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT USA
| | | | - Rob Camp
- Community Advisory Board Programme, EURORDIS, Barcelona, Spain
| | | | - Clarissa Cooblall
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
| | - Theresa Tesoro
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
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Jørgensen K, Praestegaard J, Holen M. The conditions of possibilities for recovery: A critical discourse analysis in a Danish psychiatric context. J Clin Nurs 2020; 29:3012-3024. [PMID: 32353905 DOI: 10.1111/jocn.15311] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/03/2020] [Accepted: 04/12/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This paper explores the conditions for the possibilities of recovery in a Danish mental healthcare practice, expressed from the perspective of nurses. The results and discussion of the study help to make visible and explore the muddle of conceptualisations of recovery in mental healthcare practice. BACKGROUND Few studies examine the possibilities of recovery for inpatients and outpatients in mental health centres from a nursing perspective. DESIGN A qualitative design using a critical social constructionist frame of understanding, in which the real world is considered as a series of social constructions. METHOD A Fairclough-inspired critical discourse analysis was chosen as the analytical strategy. The analysis is comprised of ten interviews in mental health care and notes, written by nurses, in medical records of ten patients with a mental illness admitted to a mental healthcare centre in 2016-2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to secure accurate and complete reporting of the study (See Appendix S1). RESULTS From the findings of the textual analysis and the analysis of the discourse practice, it seems clear that the social relations and structures relating to recovery in Danish psychiatry are steered and controlled by discourses that reflect, in general terms, the essence of the core of neoliberal ideology. CONCLUSION Recovery is generally articulated from an overall discourse of neoliberalism with its embedded discourses of paternalism, biomedicine, self-care and holism. All these discourses coexist in nursing practice, but the paternalistic discourse becomes the framework for the conditions for the possibility of how recovery is expressed in practice. RELEVANCE TO CLINICAL PRACTICE Nurses need to be supported to seek clarity in the understanding and operationalisation of a recovery-oriented approach, if the agenda is to be truly adopted and strengthened.
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Affiliation(s)
- Kim Jørgensen
- Mental Healthcare Services in the Capital Region of Denmark, The Research Network at the Psychiatric Center North Zealand, Hillerød, Denmark
| | | | - Mari Holen
- Department of People and Technology, Health Promotion, Roskilde University, Roskilde, Denmark
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Ogrin R, Meyer C, Appannah A, McMillan S, Browning C. The inter-relationship of diversity principles for the enhanced participation of older people in their care: a qualitative study. Int J Equity Health 2020; 19:16. [PMID: 31992306 PMCID: PMC6988242 DOI: 10.1186/s12939-020-1124-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background The health and aged care workforce must understand and support the diverse needs of older people to enhance their care experience. We previously identified five principles of diversity training for this workforce: awareness of unconscious bias and prejudice; promotion of inclusion; access and equity; appropriate engagement; and intersectionality. This study aims to explore how these principles are considered from the perspectives of older Australians. Methods Older people (≥65 years) receiving home care and nursing services based in Victoria, Australia were invited to participate in a home-based semi-structured interview about their experience of, or with, diversity. Interviews were thematically analysed using a priori categories based on our previous work on principles of diversity training, and themes were interpreted and expanded upon based on the participants’ experiences and understanding of diversity concepts and their care needs. Results Fifteen older people (seven female, eight male), mean age 76 years (range 71–85 years), were interviewed. Five themes were drawn from the data. It was found that human connection through building (1) trust and rapport was highly valued as an approach by older people, crucial as a first step to understanding what is important to the older person. Identifying with (2) intersectionality, that is, the different intersecting aspects of who they are and their experiences was understood by the participants as an important framework to meet their needs. The participants were aware of (3) unconscious bias and prejudice by health professionals and its impact on their care. Participants also noted that (4) promotion of inclusion through language was important to for a positive relationship with the healthcare worker. The participants understood that to facilitate human connection, these four principles of human interaction were critical, underpinned by (5) access and equity of the system. A model articulating these relationships was developed. Conclusion Health and aged care training should incorporate the five diversity principles to support older people to participate in their own care.
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Affiliation(s)
- Rajna Ogrin
- Bolton Clarke Research Institute, Level 1.01, 973 Nepean Hwy, Bentleigh, Victoria, 3204, Australia. .,Austin Health Clinical School, University of Melbourne, Heidelberg, Victoria, Australia. .,Biosignals and Affordable Healthcare, RMIT, Melbourne, Victoria, Australia. .,Department of Business Strategy and Innovation, Griffith University, Gold Coast, Australia.
| | - Claudia Meyer
- Bolton Clarke Research Institute, Level 1.01, 973 Nepean Hwy, Bentleigh, Victoria, 3204, Australia.,LaTrobe University, Centre for Health Communication and Participation, Bundoora, Victoria, 3086, Australia.,School of Primary and Allied Health Care, Monash University, Frankston, Victoria, 3199, Australia
| | - Arti Appannah
- LaTrobe University, Bundoora, Victoria, 3086, Australia
| | - Sally McMillan
- Bolton Clarke Clinical Learning Team, Level 1.01, 973 Nepean Hwy, Bentleigh, 3204, Australia
| | - Colette Browning
- School of Nursing and Healthcare Professions, Federation University, Ballarat, Victoria, 3353, Australia.,International Institute for Primary Health Care Research, Shenzhen, China.,Research School of Population Health, Australian National University, Canberra, ACT, 0200, Australia
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Halabi IO, Scholtes B, Voz B, Gillain N, Durieux N, Odero A, Baumann M, Ziegler O, Gagnayre R, Guillaume M, Bragard I, Pétré B. "Patient participation" and related concepts: A scoping review on their dimensional composition. PATIENT EDUCATION AND COUNSELING 2020; 103:5-14. [PMID: 31447194 DOI: 10.1016/j.pec.2019.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Several concepts on collaboration between patients and healthcare systems have emerged in the literature but there is little consensus on their meanings and differences. In this study, "patient participation" and related concepts were studied by focusing on the dimensions that compose them. This review follows two objectives: (1) to produce a detailed and comprehensive overview of the "patient participation" dimensions; (2) to identify differences and similarities between the related concepts. METHODS A scoping review was performed to synthesize knowledge into a conceptual framework. An electronic protocol driven search was conducted in two bibliographic databases and a thematic analysis was used to analyse the data. RESULTS The search process returned 39 articles after exclusion for full data extraction and analysis. Through the thematic analysis, the dimensions, influencing factors and expected outcomes of "patient participation" were determined. Finally, differences between the included concepts were identified. CONCLUSION This global vision of "patient participation" allows us to go beyond the distinctions between the existing concepts and reveals their common goal to include the patient in the healthcare system. PRACTICE IMPLICATIONS This scoping review provides useful information to propose a conceptual model of "patient participation", which could impact clinical practice and medical training programs.
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Affiliation(s)
- I Ortiz Halabi
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, CHU de Liège, Avenue de l'Hôpital, 3 - Bât 23, 4000 Liège, Belgium.
| | - B Scholtes
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, CHU de Liège, Avenue de l'Hôpital, 3 - Bât 23, 4000 Liège, Belgium.
| | - B Voz
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, CHU de Liège, Avenue de l'Hôpital, 3 - Bât 23, 4000 Liège, Belgium.
| | - N Gillain
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, CHU de Liège, Avenue de l'Hôpital, 3 - Bât 23, 4000 Liège, Belgium.
| | - N Durieux
- ULiege Library, University of Liege, BSV - Bibliothèque des Sciences de la Vie (CHU), B34 - Quartier Hôpital Avenue de l'Hôpital, 11, 4000 Liège, Belgium.
| | - A Odero
- Institute for Research on Sociology and Economic Inequalities (IRSEI) MSH, Campus Belval, University of Luxembourg, L-4366 Esch-sur-Alzette, Luxembourg.
| | - M Baumann
- Institute for Research on Sociology and Economic Inequalities (IRSEI) MSH, Campus Belval, University of Luxembourg, L-4366 Esch-sur-Alzette, Luxembourg.
| | - O Ziegler
- Department of Endocrinology, Diabetes, and Nutrition, University Hospital Centre, CHRU de Nancy, Hôpital Brabois Adultes 1, rue du Morvan 54511 VANDOEUVRE-LES, Nancy, France.
| | - R Gagnayre
- Head of the Laboratory of Education and Health Practices EA 3412, University Paris 13, LEPS, 74 Rue Marcel Cachin, 93017 Bobigny, France.
| | - M Guillaume
- Head of the Department of Public Health Sciences, Faculty of Medicine, University of Liège, CHU de Liège, Avenue de l'Hôpital, 3 - Bât 23, 4000 Liège, Belgium.
| | - I Bragard
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, CHU de Liège, Avenue de l'Hôpital, 3 - Bât 23, 4000 Liège, Belgium.
| | - B Pétré
- Department of Public Health Sciences, Faculty of Medicine, University of Liège, CHU de Liège, Avenue de l'Hôpital, 3 - Bât 23, 4000 Liège, Belgium.
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Mondahl J, Frederiksen K. Nurses' articulations of the patients' role when the vision is partnership: A qualitative study. Nurs Inq 2019; 27:e12327. [PMID: 31860162 DOI: 10.1111/nin.12327] [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: 06/03/2019] [Revised: 09/15/2019] [Accepted: 09/24/2019] [Indexed: 11/29/2022]
Abstract
Although principles such as 'patient participation' and 'patient involvement' have become ideals in health-care, they have proven to be difficult to apply in practice. In 2014, one Danish region issued an official document that included the vision of 'the patient as partner'. However, little is known about how such a vision affects clinical practice. The purpose of this study was to investigate nurses' views on how partnerships between them and patients are established considering this vision. We conducted semi-structured interviews with eight nurses working in Danish hospitals. Then, we analysed the interviews in a Norman Fairclough-inspired critical discourse analysis. During this three-dimensional analysis, we identified three discourses. We found that a liberalistic discourse wins hegemony based on the nurses' expectations of the patient's role. Nurses construct a picture of the patient's role, expecting the patient to be responsible and to participate. For the partnership to arise as envisioned, the patient is perceived as being dependent on the nurse's professional knowledge. Surprisingly, the nurses' articulations of the patient's role were identical to the vision's elements. Therefore, we suggest that the vision reflects prevailing societal norms for individuals, thereby reflecting society's attitude towards people's responsibility for their own lives.
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Affiliation(s)
- Julie Mondahl
- Department of Ear, Nose, Throat and Maxillofacial Surgery, Zealand University Hospital, Koege, Denmark
| | - Kirsten Frederiksen
- Section for Nursing, Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
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Hansen F, Berntsen GKR, Salamonsen A. Patient pathways as social drama: a qualitative study of cancer trajectories from the patient's perspective. Int J Qual Stud Health Well-being 2019; 14:1639461. [PMID: 31296127 PMCID: PMC6691787 DOI: 10.1080/17482631.2019.1639461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 01/05/2023] Open
Abstract
PURPOSE The number of persons living with and beyond cancer is increasing. Such persons often have complex needs that last, and change, over time. The aim of this study is to get insights of lived experience of person diagnosed with colorectal cancer and to create an understanding of cancer trajectories as a dynamic process. This study thus explores Victor Turner's model of social drama in a cancer care context. METHOD Turner suggests that crisis is a dynamic process structured by four phases: 1) breach of norm 2) crisis 3) redressive actions 4) reintegration or schism. The research team employed content analysis to explore material gathered through a series of qualitative interviews with nine Norwegian cancer patients over a period of one year. RESULTS To the authors' knowledge, Turner's model has not earlier been applied to such materials. The results show that Turner's model of social drama is useful in achieving new and possibly important knowledge on illness trajectories from a lived experience perspective. CONCLUSIONS The model of social drama may contribute to a deeper understanding of the processes patients are going through in long-term illness trajectories, demonstrating that illness is not a static matter.
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Affiliation(s)
- Frank Hansen
- National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Gro K. Rosvold Berntsen
- The Primary care research group, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Norwegian Center for e-Health Research, University Hospital of Northern Norway, Tromsø, Norway
| | - Anita Salamonsen
- RKBU North - Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
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Årestedt L, Martinsson C, Hjelm C, Uhlin F, Eldh AC. Patient participation in dialysis care-A qualitative study of patients' and health professionals' perspectives. Health Expect 2019; 22:1285-1293. [PMID: 31560830 PMCID: PMC6882253 DOI: 10.1111/hex.12966] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/20/2019] [Accepted: 08/28/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE End-stage renal disease (ESRD) affects a multitude of aspects in the patient's daily life, often entailing their own involvement in various aspects of the treatment. Although patient participation is a core health-care value, what the concept signifies is not yet fully known. The purpose of this paper is to conceptualize patient participation in dialysis care, depicting patients' and health-care professionals' perspectives. DESIGN This explorative study employed qualitative interviews and content analysis. SETTING AND PARTICIPANTS Seven focus group discussions engaging 42 key informants were performed, including patients, staff and managers with experience of dialysis care. RESULTS In dialysis care, patient participation connotes a sharing of information and knowledge, the learning of and planning of care, including partaking in shared decisions with regards to treatment and management, and being involved in the management of one's own health-care treatment and/or self-care activities. Although these attributes were illustrated by all stakeholders, their significance varied: patients suggested that their preferences regarding primary aspects of participation vary, while staff considered patients' performance of dialysis to be the ultimate form of participation. Further, while patients considered multiple ways to execute participation, staff suggested that aspects such as sharing information were a route to, rather than actual, involvement. CONCLUSIONS Without a common understanding to denote the idea of patient participation, staff and patients are exposed to a potential deficit in terms of facilitating patient participation in everyday encounters of dialysis treatment. Further studies and means to serve a mutual understanding are needed.
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Affiliation(s)
- Liselott Årestedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Caroline Martinsson
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Carina Hjelm
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Fredrik Uhlin
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden.,Department of Nephrology, University Hospital, Linköping, Sweden.,Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Ann Catrine Eldh
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Kilpatrick J, Elliott R, Fry M. Health professionals' understanding of person-centred communication for risk prevention conversations: an exploratory study. Contemp Nurse 2019; 55:495-506. [PMID: 31514630 DOI: 10.1080/10376178.2019.1664925] [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] [Indexed: 10/26/2022]
Abstract
Background: Health Professionals are required to balance care practices against patient risk to optimise safety. Communicating clinical risk with the patient requires confidence.Objective: The objective was to explore health professionals understanding and confidence of patient-centred communication during conversations of risk prevention.Design: An exploratory study was conducted.Methods: Nurses, physiotherapists and social workers in a metropolitan hospital in Sydney (New South Wales, Australia) completed face to face interviews (n = 16) regarding person-centred communication and clinical risk.Results: The sample was predominately female and had been a health profession for 11.5 years (mean). Six key themes were generated including: Perceptions of person-centred communication; Preparing for person-centred communication and Understanding and prioritising conversations about preventable clinical risk.Conclusions: Person-centred communication was embedded in clinical practice; the 'patient voice' was considered central. Clinical risk was a priority. Education to improve communication was highlighted as a way to enhance person-centred communication.
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Affiliation(s)
- Jacinta Kilpatrick
- Manly Hospital, Northern Sydney Local Health, Manly, NSW 2065, Australia
| | - Rosalind Elliott
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Margaret Fry
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
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Battard N, Liarte S. Including Patient’s Experience in the Organisation of Care: The Case of Diabetes. JOURNAL OF INNOVATION ECONOMICS & MANAGEMENT 2019. [DOI: 10.3917/jie.pr1.0054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Melin J, Nordin Å, Feldthusen C, Danielsson L. Goal-setting in physiotherapy: exploring a person-centered perspective. Physiother Theory Pract 2019; 37:863-880. [PMID: 31448979 DOI: 10.1080/09593985.2019.1655822] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To analyze definitions and related requirements, processes, and operationalization of person-centered goal-setting in the physiotherapy research literature; to discuss those findings in relation to underlying principles of person-centeredness; and to provide an initial framework for how person-centered goal-setting could be conceptualized and operationalized in physiotherapy. Methods: A literature search was conducted in the databases: CINAHL, PubMed, PEDro, PsycINFO, REHABdata and Scopus. A content analysis was performed on how person-centered goal-setting was described.Results: A total of 21 articles were included in the content analysis. Five categories were identified: 1) Understanding goals that are meaningful to the patients; 2) Setting goals in collaboration; 3) Facing challenges with person-centered goal-setting; 4) Developing skills by experiences and education; and 5) Changing interaction and reflective practice. These categories were abstracted into two higher-ordered interlaced themes: 1) To seek mutual understanding of what is meaningful to the patient; and 2) To refine physiotherapy interaction skills, which we suggest would be useful for further conceptualization.Conclusion: In this analysis, we interpreted person-centered goal-setting in physiotherapy as a process of interaction toward a mutual understanding of what is meaningful to the patient. Future research may explore how to integrate mindful listening, embodied interaction and continuous ethical reflection with different assessments and treatment methods.
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Affiliation(s)
- Jeanette Melin
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,RISE, Research Institutes of Sweden, Gothenburg, Sweden
| | - Åsa Nordin
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Caroline Feldthusen
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Danielsson
- Angered hospital, Research Unit, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Asplin G, Carlsson G, Fagevik Olsén M, Zidén L. See me, teach me, guide me, but it’s up to me! Patients’ experiences of recovery during the acute phase after hip fracture. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1650394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Gillian Asplin
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Gunnel Carlsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena Zidén
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital, Mölndal, Sweden
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Alders I, Henselmans I, Smits C, Visscher T, Heijmans M, Rademakers J, Brand PLP, van Dulmen S. Patient coaching in specialist consultations. Which patients are interested in a coach and what communication barriers do they perceive? PATIENT EDUCATION AND COUNSELING 2019; 102:1520-1527. [PMID: 30910403 DOI: 10.1016/j.pec.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/06/2019] [Accepted: 03/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To characterize patients interested in support by a patient coach to guide them in medical specialist consultations. METHODS We compared 76 patients interested in a patient coach with 381 patients without such an interest, using a representative panel of patients with a chronic disease in the Netherlands. Independent variables were demographic factors, socio-economic status, perceived efficacy in patient-provider interaction, communication barriers, health literacy, (duration and type of) disease(s) and activation level. RESULTS In univariate analyses, patients who are interested in a coach were significantly older, had lower health literacy skills and less self-efficacy and, overall, experienced more communication barriers (>4), than patients without such interest (1-2 barriers). Multivariate analyses indicated three communications barriers as determinants of patient interest in a coach: feeling tense, uncertainty about own understanding, and believing that a certain topic is not part of a healthcare providers' task. CONCLUSION Patients interested in a coach perceive specific barriers in communicating with their medical specialist. In addition, patients who are > = 65 years, have lower health literacy and low self-efficacy may have interest in a coach. PRACTICE IMPLICATIONS Characterizing patients interested in a patient coach facilitates identification of those who could benefit from such a coach in clinical practice.
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Affiliation(s)
- Irèn Alders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Windesheim University of Applied Sciences, Zwolle, the Netherlands.
| | - Inge Henselmans
- Dept. of Medical Psychology Academic Medical Centre University of Amsterdam, the Netherlands
| | - Carolien Smits
- Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Tommy Visscher
- Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Monique Heijmans
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Jany Rademakers
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Dept. of General Practice, CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Paul L P Brand
- Isala, Zwolle, the Netherlands; UMCG, Groningen, the Netherlands
| | - Sandra van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS One 2019; 14:e0220116. [PMID: 31369582 PMCID: PMC6675068 DOI: 10.1371/journal.pone.0220116] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Primary health professionals are well positioned to support the delivery of patient self-management in an evidence-based, structured capacity. A need exists to better understand the active components required for effective self-management support, how these might be delivered within primary care, and the training and system changes that would subsequently be needed. Objectives (1) To examine self-management support interventions in primary care on health outcomes for a wide range of diseases compared to usual standard of care; and (2) To identify the effective strategies that facilitate positive clinical and humanistic outcomes in this setting. Method A systematic review of randomized controlled trials evaluating self-management support interventions was conducted following the Cochrane handbook & PRISMA guidelines. Published literature was systematically searched from inception to June 2019 in PubMed, Scopus and Web of Science. Eligible studies assessed the effectiveness of individualized interventions with follow-up, delivered face-to-face to adult patients with any condition in primary care, compared with usual standard of care. Matrices were developed that mapped the evidence and components for each intervention. The methodological quality of included studies were appraised. Results 6,510 records were retrieved. 58 studies were included in the final qualitative synthesis. Findings reveal a structured patient-provider exchange is required in primary care (including a one-on-one patient-provider consultation, ongoing follow up and provision of self-help materials). Interventions should be tailored to patient needs and may include combinations of strategies to improve a patient’s disease or treatment knowledge; independent monitoring of symptoms, encouraging self-treatment through a personalized action plan in response worsening symptoms or exacerbations, psychological coping and stress management strategies, and enhancing responsibility in medication adherence and lifestyle choices. Follow-up may include tailored feedback, monitoring of progress with respect to patient set healthcare goals, or honing problem-solving and decision-making skills. Theoretical models provided a strong base for effective SMS interventions. Positive outcomes for effective SMS included improvements in clinical indicators, health-related quality of life, self-efficacy (confidence to self-manage), disease knowledge or control. An SMS model has been developed which sets the foundation for the design and evaluation of practical strategies for the construct of self-management support interventions in primary healthcare practice. Conclusions These findings provide primary care professionals with evidence-based strategies and structure to deliver SMS in practice. For this collaborative partnership approach to be more widely applied, future research should build on these findings for optimal SMS service design and upskilling healthcare providers to effectively support patients in this collaborative process.
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Affiliation(s)
- Sarah Dineen-Griffin
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | | | - Kylie Williams
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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