Patient-centred orientation of students from different healthcare disciplines, their understanding of the concept and factors influencing their development as patient-centred professionals: a mixed methods study

Becoming partners in rehabilitation with patients in intensive care: physiotherapists' perspectives

PURPOSE

Person-centred care is widely accepted as being central to high quality care, but little is known about how physiotherapists implement person centred rehabilitation in Intensive Care. This study explores the self-reported experiences and interpretations of physiotherapists delivering person-centred rehabilitation in this setting.

METHODS

A qualitative study using Interpretative Phenomenological Analysis explored the lived experiences of physiotherapists and students who have worked in Intensive Care. Three focus groups, with four participants in each, were conducted. Data were fully transcribed, analysed and managed using NVivo software.

RESULTS

Participants shared similar interpretations about the principles of person-centred care. Operationalising person-centred rehabilitation during early recovery was not easily achievable. As the person's clinical condition improved, participants moved away from routine physiotherapy and their practice became more person-centred through the development of a partnership. Participants connected as humans to understand the person and respond to their needs within a culture that valued person-centred care.

CONCLUSIONS

Physiotherapists aspire to develop a partnership with their patients by connecting on a human level with them and addressing their biopsychosocial needs. Physiotherapists with experience of developing patient partnerships influence the culture of the Intensive Care team and are role-models to facilitate collaborative person-centred activity in others.

Person-centred care in the context of higher education - a discourse analysis based on interviews with programme directors

BACKGROUND

As person centred care (PCC) is being implemented globally, higher educational institutions (HEI) have begun to play a crucial part in enabling this transition. In Sweden, however, the delivery of PCC is inconsistently implemented in medicine, nursing, occupational therapy, and physiotherapy study programmes. This inconsistency is partly the result of a lack of a national strategy across HEI. Program directors are responsible for the PCC content of their programs, so their views influence how PCC is taught. Using interviews with programme directors in higher education, we aim to deepen the understanding of the preconditions needed to implement PCC by exploring discourses and identifying subject positions of how PCC is taught and learned.

METHODS

We performed a discourse analysis based on interviews with program directors in the above-mentioned national study programmes. A discourse can be seen as a struggle over identity. The subject position - i.e., discourses designate positions for persons to occupy as subjects - guided our analysis and identification of the subject positions of the teacher and the student in teaching and learning PCC.

RESULTS

This study unfolded in two main antagonistic aspects with respect to teaching and learning PCC, resulting in four subject positions for the teacher and four corresponding subject positions for the students. First, the teacher and student were given a subject position as change agents towards a more egalitarian healthcare and were assigned a subject position to cope with a practical reality they could not change. Second, the teacher and student were assigned a subject position that embodied profession-specific identities, navigating and valuing these boundaries. Simultaneously, both teachers and students assumed a subject position that required interprofessional interaction and co-creation for teaching and learning PCC.

CONCLUSION

This study demonstrates the discursive tension surrounding the implementation of PCC in HEI, and the findings can serve as a basis for creating future relevant and high-quality learning activities. The process of negotiating diverse and co-existing perspectives as well as building interprofessional trust when incorporating PCC into higher education is essential and requires further exploration.

Generic competence among health sciences students in higher education - A cross-sectional study

BACKGROUND

Highly competent health care experts are needed for the development of the social and health care sectors. More knowledge is needed on the levels of generic competencies that health sciences experts possess, particularly in the context of complex decision-making.

OBJECTIVES

To describe self-evaluated generic competence of health sciences students and its associated factors.

DESIGN

A cross-sectional observational study design.

PARTICIPANTS

A total of 291 health science students in five universities in Finland participated in this study during the spring of 2022.

METHODS

The data was collected by using the HealthGenericCom instrument with 88 items and 8 sum dimensions using a five-point Likert scale (1-poor to 5-excellent): 1) competence in leadership, administration, and finance; 2) people-centred guiding competence; 3) competence of health promotion; 4) competence of evidence-based practice; 5) digital competence; 6) competence in work well-being and self-management; 7) competence in collaboration and problem-solving, and 8) competence in societal interaction. The K-means cluster algorithm was used to classify generic competence profiles to identify the profiles of health sciences students.

RESULTS

Four generic health sciences competence profiles (A = 18 %, B = 23 %, C = 33 %, D = 26 %) were identified. Profile A demonstrated the lowest level of most generic competencies in health sciences. Digital competence was shown to be at the lowest level among the participants, whereas competence in collaboration, problem-solving, and health promotion was evaluated as the highest competence level. The students evaluated their competence as being higher when they were older, were currently engaged in master's degree programmes, had completed work-based practical training in social and health care, and had varied work experiences or held leading positions.

CONCLUSIONS

Students need to improve their generic competencies in health sciences, with a particular focus on developing their digital competence. More focus should be given to work-based practical training.

Patient-centered care - evidence in the context of professional health practice

OBJECTIVES

to analyze patient-centered attitudes in care and sharing practices of nursing, speech therapy, dentistry and medicine professionals.

METHODS

cross-sectional research was used with 411 professionals, and the Patient-Practitioner Orientation Scale instrument was applied as a measure of outcome.

RESULTS

physicians presented higher mean scores, reflecting a patient-centered orientation, shared control, and focus on the person, with statistical difference for all domains (p<0.02). Dentists were the professionals who presented lower scores, especially in the sharing domain, with statistical difference in relation to nurses, speech therapists, and physicians (p<0.05).

CONCLUSIONS

finally, the attitudes of professionals in the health areas studied indicated self-reported preference for centrality in patients. In this context, patient-centered care can be an important resource in health care when committed to overcoming the object man.

Patient-centred care attitudes and knowledge: a national study of BDS students in New Zealand

OBJECTIVE

The aim of this study was to investigate the attitudes and knowledge towards patient-centred care among Bachelor of Dental Surgery (BDS) students in New Zealand.

METHOD

The study was a mixed methods cross-sectional national study of the BDS students in New Zealand. All 2021 BDS students at the New Zealand's National Centre for Dentistry, New Zealand, were recruited in the study. The Patient-Practitioner Orientation Scale (PPOS) questionnaire was used to evaluate the dental students' attitudes and knowledge of patient centred care. The students' perspectives on the BDS curriculum regarding patient-centred care were also collected. ANOVA and the Student's T-test were used to compare the difference among the BDS years, gender, and background.

RESULTS

A total of N = 277 (277/346; 80% response rate) students completed the study. Female students had higher scores than male students for sharing (difference = 0.19, 95% CI 0.04-0.34, P = 0.01), caring (difference = 0.15, 95% CI 0.01-0.29, P = 0.03) and PPOS (difference = 0.17, 95% CI 0.05-0.30, P < 0.01). Domestic students had higher scores than international students for caring (difference = 0.35, 95% CI 0.21-0.50, P < 0.01) and PPOS (difference = 0.22, 95% CI 0.08-0.35, P < 0.01). Three main themes of patient-centred care were extracted from the qualitative analysis of students' perspectives: (1) Understanding of the concept of patient-centred care, (2) Perception of the importance of patient-centred care in dentistry, and (3) Perspective on the curriculum about patient-centred care.

CONCLUSION

Most dental students favoured a patient-centred approach. According to dental students, the patient-centred care component of their education should be increased.

Patient-centred learning in practice. A mixed methods study of supervision and learning in student clinics

OBJECTIVE

Patient-centred learning (PCL) allows medical students to practice a patient-centred approach; however, didactic characteristics of PCL have yet to be fully elucidated. Clinical placements structured as a student clinic (SC) enable authentic student-patient learning relations through enhanced student responsibility and can serve as examples of PCL. We explored the didactic characteristics of supervision and learning in SCs to provide recommendations for PCL-oriented medical education.

METHODS

Triangulation mixed methods study based on qualitative data collected from in-depth interviews with clinical teachers and quantitative data collected from student evaluations of supervision and learning in the SCs.

RESULTS

Supervision and learning in SCs were characterized by 1) a focus on student-patient compatibility and patient needs and resources, which indicated PCL, 2) person-centred explorative supervision to adjust challenges to students' needs and resources, and 3) support of student autonomy to take responsibility for patient treatment.

CONCLUSION

PCL was facilitated by clinical teachers through a dual person-centred didactic approach combined with autonomy-supportive didactic practice. This enabled the integration of patients' and students' needs and resources in clinical teaching.

PRACTICE IMPLICATIONS

Clinical teachers can stimulate student-patient learning relations by selecting patients, exploring students' needs and resources, and supporting student autonomy through reflective practice and backup.

A 4-factor perspective of the patient-practitioner orientation scale (PPOS): a deeper understanding of patient-centredness

BACKGROUND

Although patient-centred medical services are widely recognized and accepted, how to define and evaluate them remains a controversial topic.

OBJECTIVES

This study attempts to evaluate the underlying structure of the Patient-Practitioner Orientation Scale (PPOS) with a homogenous population and clarify the connotation of patient-centredness.

METHODS

In this cross-sectional study, 279 7th year Chinese medical students in were selected to examine the internal structure of the PPOS by means of internal consistency, exploratory, and confirmatory factor analyses.

RESULTS

Both the two-factor model and the four-factor model showed acceptable internal consistency and structural validity. The four-factor model that endorsed the implicit attitude towards the doctor-patient relationship outperformed the two-factor model in terms of adaptability.

CONCLUSIONS

The PPOS has good psychometric attributes, as evaluated by Chinese medical students. This article attempts to explore patient-centredness from the perspective of implicit attitudes that affect the doctor-patient relationship and resummarizes the four factors. These four dimensions may suggest a deeper attitude towards the doctor-patient relationship, while "sharing information" or "caring about" the "patient" is the behaviour and preference expressed on the basis of these four attitudes, which is the result rather than the cause.

PRACTICE IMPLICATIONS

Understanding the underlying attitudes towards the doctor-patient relationship can help to construct a patient-centred medical service concept and improve the doctor-patient relationship in medical education courses and the system design of medical activities.

Healthcare students' attitudes towards patient centred care: a systematic review with meta-analysis

BACKGROUND

Patient centred care is commonly recommended in clinical practice guidelines to improve patient outcomes and reduce healthcare costs. Identifying measurement tools used to assess healthcare students' attitudes towards patient centered care and determining their attitudes is the first step to ensuring patient centred care is provided in the future. The primary aim of this review was to describe the measurement tools used to assess healthcare students' attitudes towards patient centred care. The secondary aim was to quantify healthcare students' attitudes towards patient centred care.

METHODS

An electronic database search was conducted in MEDLINE, EMBASE, CINAHL from inception until March 1, 2021, with combined terms relating to 'patient centred care', 'attitudes', and 'healthcare students'. Studies that quantitatively assessed healthcare students' attitudes towards patient centred care were included. Measurement tools used in the included studies were qualitatively described. Meta-analysis was conducted to quantify healthcare students' attitudes towards patient centred care and assess the respective influence of gender, profession, and study geographical location on healthcare students' attitudes towards patient centred care.

RESULTS

The electronic search identified 3948 total studies. One hundred twenty-nine full texts were screened, and 49 studies were included. There were 16 measurement tools used to assess healthcare students' attitudes towards patient centered care. Most studies (53%, n = 26) used the Patient-Practitioner Orientation Scale (PPOS) to assess patient centered care. Meta-analyses of 20 studies with 26 total groups resulted in a pooled mean PPOS score of 4.16 on a 0-6 scale (95% Confidence Interval [CI]: 3.95, 4.37), indicating low attitudes towards patient centered care. Additional analyses found that women have significantly higher attitudes towards patients centred care than men (pooled effect 0.14 [95% CI: 0.05, 0.23], n = 8 studies) and mean PPOS scores appear similar among sub-groups of only medical students (pooled mean 4.13, 95% CI: 3.85, 4.42, n = 13 studies) and only American healthcare students (pooled mean 4.49, 95% CI: 4.35, 4.64, n = 5 studies).

CONCLUSIONS

Several different measurement tools have been used to assess healthcare students' attitudes towards patient centred care, but the most commonly used is the PPOS. Our results indicate that healthcare students have low attitudes towards patient centred care. Future studies should evaluate if attitudes towards patient centred care can be improved during healthcare education.

A systematic review of patient interactions with student pharmacists in educational settings

BACKGROUND

Patients may contribute to various aspects of student pharmacists' education within clinical, experiential and educational settings. There is an emerging body of literature describing and evaluating the contribution of patients to health care education; however, little is known about patients' contribution to pharmacy education specifically within educational settings.

OBJECTIVE

To explore the evidence relating to the involvement of patients in the education of student pharmacists, in terms of the nature, extent, and outcomes of their contribution.

METHODS

A systematic literature search was undertaken within Embase, MEDLINE, Education Resources Information Center, International Pharmaceutical Abstracts, PubMed, PsycINFO, CINAHL, and Scopus databases from inception to April 10, 2020. Inclusion criteria included primary research studies reporting on the active involvement of patients in pharmacy education, within an educational setting. Quality assessment appraisal for the included studies was conducted using the Mixed Methods Appraisal Tool.

RESULTS

Twelve studies were eligible for inclusion in this systematic review. Nine studies explored the use of patients as educators providing valuable insight about their lived experience. Six studies involved patients in question-and-answer sessions, providing students with opportunities to inquire about their lived experience in relation to medicines, health care, and medical conditions. Studies that reported on students' learning outcomes demonstrated improvements in communication skills, deeper understanding of patients' lived experience particularly relating to mental illness, and increased confidence in providing care for patients. Among patients, participation in the educational process led to greater satisfaction, empowerment, and knowledge from sharing personal experiences. There were no clinical outcomes measured among patients participating in the included studies. The 5 nonrandomized quantitative studies ranged from low to moderate levels of quality, the 4 mixed-methods studies were of low quality, and the 3 qualitative studies were of high quality.

CONCLUSION

The involvement of patients in the education of student pharmacists was found to benefit both patients and students. Student-specific outcomes included development of communication skills and new insights about patients' lived experience. Further research is needed to better understand the long-term impact of patient involvement in pharmacy education, in terms of students' learning outcomes and clinical outcomes among patients.

The development and validation of the Person-centred Practice Inventory-Student instrument: A modified Delphi study

BACKGROUND

Global health care policy and regulatory requirements indicate that nursing students must be prepared for person-centred practice. Despite this, there is no evidence of a theoretically derived instrument to measure students' perceptions of person-centred practice.

OBJECTIVES

To adapt the Person-centred Practice Inventory-Staff instrument for use with healthcare students and to test the adapted instrument.

DESIGN

This study involved a two-phased, modified Delphi Technique. In Phase 1 students' views about items in the Person-centred Practice Inventory-Staff were explored to gain consensus about items for inclusion in an adapted student version. In Phase 2, the psychometric properties of the adapted instrument were tested.

SETTING

A UK university.

PARTICIPANTS

Pre-registration nursing students.

METHODS

Phase 1 involved an iterative process including three focus groups (n = 13) followed by Delphi surveys (Round 1: n = 382; Round 2: n = 144). Thematic analysis was used to analyse students' comments and consensus percentages were calculated after each Delphi round. Phase 2 involved a survey using the adapted instrument (n = 532). The measurement model was analysed using confirmatory factor analysis.

RESULTS

The results indicated stability in the measurement model with this sample. Item correlation scores were between 0.22 and 0.74 with no evidence of collinearity and factor loadings ranged from 0.44-0.86. Fit indices indicated goodness of fit between the observed data and the respective domains in the Person-centred Practice Framework (chi-squared to degrees of freedom ratio of <3, root mean square estimations of approximation 0.06 for all domains and between 0.05 and 0.07 at 90% confidence interval. Comparative fit index estimates ranged from 0.90-0.97).

CONCLUSION

This study provides initial validation of the Person-centred Practice Inventory-Student instrument which is offered as a measure of students' perceptions of their person-centred practice. The instrument has utility in assessing the efficacy of curricula in preparing students as person-centred practitioners.

Learning to be patient-centred healthcare professionals: how does it happen at university and on clinical placements? A multiple focus group study

This article was migrated. The article was marked as recommended. Background: Developing patient-centred skills in health professional students relies on their learning experiences at the university and on clinical placements. It is not known what students perceive about their teaching on patient-centredness and their views to develop the curriculum in this aspect. Methods: Multiple focus groups were conducted with students who had experienced a minimum of two clinical placements from Medicine, Physiotherapy, Nursing and Speech and language therapy programs. Thematic analysis was conducted independently by two researchers and then themes were compared and integrated. Findings: Five focus groups with 26 participants with a mean age of 23.8 years contributed to 286 minutes of recorded data. The key findings were that their curriculum focussing on patient-centred skills used artificial methods and teaching focussed largely on biomedical aspects, but, shared modules and specialist training enabled learning. Longer and diverse placements with good role models to emulate, enabled learning. As strategies they suggested reflections and role-modelling were vital along with further interprofessional working, goal-setting and understanding of human psychology. Conclusion: Though the study is limited by its generalisability, strategies suggested by students can be further developed by superimposing them on learning theories. These strategies need to be tested in future studies.