Expectations for Care: Older Adults' Satisfaction With and Trust in Health Care Providers

The relation between older adults’ trust beliefs in nursing home carers and adjustment to residential care

The study examined the relation between older adults’ trust beliefs in nursing home carers (NHCs) and adjustment to residential care. Seventy-six older adults (mean age = 83 years, standard deviation = 7 years from UK nursing homes completed standardised scales of trust beliefs in NHCs and adjustment to residential care (satisfaction with care-giving, social engagement in the nursing home, loneliness and a latent measure). As expected, trust beliefs in NHCs were linearly associated with adjustment to residential care on all measures. There were quadratic relations between trust beliefs in NHCs and on given measures of adjustment to residential care (latent measure, satisfaction with care-giving and loneliness). Adults with very high and those with very low trust beliefs in NHCs showed depressed levels on those measures of adjustment to residential care relative to older adults with the middle range of trust beliefs. The research highlights the importance of older adults’ trust beliefs in NHCs for adjustment to nursing homes. The findings show though, that older adults who hold very high, as well those who hold very low, trust beliefs in NHCs are at risk for lower levels of adjustment.

The mediating role of patient satisfaction and perceived quality of healthcare in the emergency department

The purpose of this research was to identify whether a certain set of drivers of satisfaction/perceived quality of healthcare (PQHC) could indirectly affect patients' confidence/trust in the emergency department (ED).Patients were seen at an ED in the public hospital in Lisbon, Portugal between January and December 2016. Data were collected between May and November 2017, using a questionnaire, by mail or e-mail. The total sample size comprised 382 patients. The data analysis included structural equation modeling to test the conceptual model with specific drivers of satisfaction/PQHC (privacy; accessibility and availability; doctors; meeting expectations; waiting time for triage [perception]; waiting time to be called back by the doctor following examinations and/or tests [perception]; information about possible delays in receiving treatment/waiting times) and with the main outcome (confidence/trust in the ED) using path analysis.The analysis of the coefficients revealed that all the mediated paths are statistically significant (P ≤ .05). Although, altogether, the direct paths did not prove statistically significant (P > .05), the overall satisfaction with doctors (P ≤ .01) and meeting expectations (P = .01) can still directly explain the confidence/trust in the ED without the mediating role of satisfaction and PQHC. Hence, overall satisfaction with doctors and meeting expectations can influence, both directly and indirectly, confidence/trust in the ED. All other variables can only indirectly affect confidence/trust in the ED, either through PQHC or through satisfaction.Even though there are more variables that influence confidence/trust in the ED through PQHC (1)waiting time to be called back by the doctor following examinations and/or tests [perception]; 2) privacy; 3) accessibility and availability; 4) doctors; 5) meeting expectations than through satisfaction (1)waiting time for triage [perception]; 2) information about possible delays in receiving treatment/waiting times; 3) doctors; 4) meeting expectations), we observe the strongest contribution in the mediation model through satisfaction, which reveals its dominant role over PQHC.

Predictors of Patient Satisfaction With Telephone Nursing Services

Patient satisfaction has been shown to be a factor in clinical outcomes, health care quality, and patient follow-through. Thus, a high level of satisfaction is a desired outcome of patient care. This article examines predictors of patient satisfaction with telephone nursing services among a sample of 1,939 respondents, using a conceptual model derived from the literature and preliminary work. The study was conducted in medical offices and call centers of a large national health maintenance organization. Calls were taped and content coded and then matched with caller questionnaire data. In the final multivariate predictive models, patient health status; caller ratings of expectations met by the nurse for listening, clarity, and collaboration; and nurse competence were the strongest predictors of satisfaction. Consistent with the literature, findings suggest that nurses should expand interpersonal communication skills, and systems should reduce barriers to effective listening, clarity, and collaboration with callers.

Satisfaction with health care among people with hearing impairment: a survey of Medicare beneficiaries

PURPOSE

The purpose of this study was to investigate the determinants of access to and satisfaction with health care from Medicare participants with hearing impairment.

METHOD

Raw data for the study was obtained from the 2004 Medicare Current Beneficiary Survey (MCBS). Satisfaction with care was assessed using 10 of the MCBS questions probing satisfaction in a number of areas related to health care. The data were analyzed using logistic regression. This analysis was conducted in three steps. The first step involved identifying potentially important predisposing and enabling variables that influenced satisfaction with care using univariate analysis. The second step involved fitting the variables retained from the first step into a multiple logistic regression equation to determine a preliminary main effects model. The final analysis included determining the odds ratio for each independent variable retained from the earlier analysis.

RESULTS

Individuals with hearing impairment demonstrated some level of dissatisfaction with quality of health care. Each of the MCBS satisfaction questions were significantly (p < 0.05) associated with at least one of the communication variables.

CONCLUSIONS

Understanding the effects of hearing impairment on satisfaction with health care is critical to the delivery of effective and efficient services to individuals with such disabilities.

IMPLICATIONS FOR REHABILITATION

Presence of communication impairment, specifically hearing impairment, affects satisfaction with health care. Medical school training regarding methods to improve diagnosis and treatment of patients with communicative impairments could lead to improved patient-provider interactions and ultimately increased satisfaction with the provider and care given. Health care providers need to allow for extended appointments for patients with communication impairments. Time accommodations could prevent misunderstandings about diagnosis and treatment methods which otherwise might have detrimental results.

Perceptions of group music therapy among elderly nursing home residents in Taiwan

OBJECTIVE

To explore the perceptions of group music therapy among elderly nursing home residents in Taiwan.

METHODS

Focus group methodology was used to explore the perceptions of elderly participants about their experience of group music therapy. Verbatim transcripts of audiotaped interviews were analysed by content analysis.

RESULTS

In total, 3 focus groups were held with 17 wheelchair-bound elderly residents. Analysis of participants' perceptions of group music therapy revealed two major themes: (1) strength derived from the group dynamic and (2) enhanced quality of life. The first theme included three subthemes: (1) sense of energy, (2) distraction from suffering, and (3) confirmation as a person. The second major theme included four subthemes: (1) variety added to life, (2) motivation to exercise, (3) learning positive behaviour, and (4) greater life satisfaction.

CONCLUSION

Elderly, wheelchair-bound residents of a nursing home in Taiwan positively viewed their experiences with our group music therapy programme, particularly its active component. The findings of this study suggest that healthcare providers should consider integrating group music therapy into their programmes for elderly nursing home residents and design the therapy to add variety to their life, give them a sense of autonomy by having them choose their preferred musical activities, and improve their cognitive function.

Hypothesized predictors of patient-physician trust and distrust in the elderly: implications for health and disease management

This study notes the differences between trust and distrust perceptions by the elderly as compared with younger populations. Given the importance of trust and distrust in compliance, changing behaviors, and forming partnerships for both health and disease management, it is necessary to be able to measure patient-doctor trust and distrust (PDTD). Following recent conceptualizations on trust and distrust as coexistent states, this study hypothesizes predictors of PDTD. We are proposing that these predictors form the basis for designing, developing and validating a PDTD scale (PDTDS). It is important to capture the trust-distrust perceptions of older patients as they confront the complexities and vulnerabilities of the modem healthcare delivery system. This is necessary if we are to design interventions to change behaviors of both the healthcare provider and the older patient.

Association of mobility limitations with health care satisfaction and use of preventive care: a survey of Medicare beneficiaries

OBJECTIVE

To examine the association between satisfaction with health care, the use of preventive health care, and mobility limitation.

DESIGN

Cross-sectional analysis of survey data.

SETTING

Community.

PARTICIPANTS

A total of 12,769 people, age greater than 65, who participated in the 2001 Medicare Current Beneficiary Survey.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Self-report of mobility limitation, satisfaction, and use of preventive health care (immunizations, cancer screening). Sampling weights were used in all analyses, including logistic regression for survey data, to calculate estimates for a Medicare population of 31 million.

RESULTS

After controlling for sociodemographic characteristics, Medicare beneficiaries with mobility limitations were significantly more dissatisfied with their health care compared with beneficiaries without mobility limitations. Receipt of preventive care did not differ for those with and without mobility limitation on some preventive services.

CONCLUSIONS

Mobility limitation is highly associated with dissatisfaction with health care among older adult beneficiaries. Although Medicare beneficiaries may receive similar rates of preventive care, those with mobility limitation may have more difficulty accessing services and be more dissatisfied with their health care in general.

Community dwelling adults' perception of interpersonal trust vs. trust in health care providers

AIMS

This study investigated community dwelling adults' definition of trust in health care providers vs. interpersonal trust, description of the attributes of a trustworthy provider, factors that influenced the development and loss of trust.

BACKGROUND

Trust is an important part of health care relationships, however, the meaning of trust for patients is not well understood. Health care providers need to understand the meaning of trust in order to build and maintain therapeutic relationships with their patients.

DESIGN

A descriptive qualitative research design was used to investigate perceptions of trust.

METHODS

Semi-structured open-ended interviews were carried out with 32 community dwelling adults. The participants were recruited from church groups, senior health programs and other community programs. The interviews were thematically analysed for: definitions of interpersonal trust vs. trust in a health care provider, attributes of a trustworthy provider and factors that were pivotal in the development and loss of trust in a health care provider.

RESULTS

Trust in health care providers differed from interpersonal trust in the role-specific attributes of the individuals. Trust, although influenced by having confidence in the provider's competence, was strongly tied to the interpersonal caring attributes of the provider. Loss of trust, on the other hand, was more closely allied with the issues of competency.

CONCLUSIONS

Perceptions of trust varied greatly among this sample, reinforcing the significance of tailoring our approach to patients on an individual basis.

RELEVANCE TO CLINICAL PRACTICE

Assuming that we will be trusted based on our role as nurses may not facilitate the development of a therapeutic relationship with some patients. Nurses and other health care providers need to be acutely aware of our patient's trust and clues of pending loss of trust because, as this study and other prior studies have shown, once trust in a provider is lost, it is nearly impossible to rebuild.

Focus Groups and Older Adults: Tactics for Success

Factors a nurse clinician should consider when planning focus group size are the number of questions to be posed, depth of responses desired, anticipated "no shows," and time period allotted. Establishing the ground rules for the session and explaining confidentiality expectations are essential starting points for the group. Nurse clinicians are well situated to use focus groups with older adults to explore a number of inquiries, from clinical problems to service utilization. Things to consider when planning focus groups with older adults include length of time the older adult group can participate, seating arrangements that comfortably accommodate individuals with disabilities, and accessible location.

Effect of communication disability on satisfaction with health care: a survey of medicare beneficiaries

PURPOSE

To examine the prevalence and characteristics of community-dwelling Medicare beneficiaries reporting a communication disability and the relationship between that disability and dissatisfaction with medical care.

METHOD

A total of 12,769 Medicare Current Beneficiary Survey respondents age 65 and older in 2001 were categorized by level of communication disability. Sampling weights were used to make inferences about the entire Medicare population.

RESULTS

Over 16 million beneficiaries reported a communication disability. Hearing problems were most commonly reported (41.99%). The association between dissatisfaction and communication disability was statistically significant (p <or= .05) for 8 of 10 items.

CONCLUSIONS

Prevalence of dissatisfaction among those with a communication disability varied, ranging from 3.43% to 19.34%. Respondents with a communication disability reported much more dissatisfaction when compared with those respondents without a communication disability.

Elderly inpatients' priorities for acute care service quality

This study examines elderly and advanced elderly inpatients' perceptions of acute care service quality, prioritises opportunities for quality improvement, and assesses variation in patients' satisfaction with care. Psychometrically-validated postal questionnaires were sent to random samplings of patients discharged from the US acute care facilities in 2002 (n = 2,057,164). Quality improvement priorities among non-elderly (< 65 years), elderly (65-74 years), and advanced elderly (> 74 years) were similar but substantial variation was found comparing single items between age groups. Elderly and advanced elderly patients rated the quality of meals and rooms significantly lower than the non-elderly, and the advanced elderly rated treatment decision making involvement significantly lower than the other two age groups. The data reveals specific, actionable areas for quality improvement and a non-linear relationship between age and satisfaction. Findings question assumptions regarding older patients' evaluations of care and indicate directions for quality improvement that account for their unique needs.