Involving the Family in Patient Care: A Culturally Tailored Communication Model

Providing family updates: a primer for the medical trainee

Providing family updates is a common clinical task for medical trainees and practitioners working in hospital settings. Good clinical communication skills are essential in clinical care as it is associated with improved patient satisfaction, understanding of condition, treatment adherence, and better overall clinical outcomes. Moreover, poor communications are often the source of medical complaints. However, while patient-centred communication skills training has generally been incorporated into clinical education, there hitherto remains inadequate training on clinical communications with patients' families, which carry different nuances. In recent years, it is increasingly recognized that familial involvement in the care of hospitalized patients leads to better clinical and psychological outcomes. In fact, in Asian populations with more collectivistic cultures, families are generally highly involved in patient care and decision-making. Therefore, effective clinical communications and regular provision of family updates are essential to build therapeutic rapport, facilitate familial involvement in patient care, and also provide a more holistic understanding of the patient's background and psychosocial set-up. In this article, we herein describe a seven-step understand the clinical context, gather perspectives, deliver medical information, address questions, concerns and expectations, provide tentative plans, demonstrate empathy, postcommunication reflections model as a practical guide for medical trainees and practitioners in provision of structured and effective family updates in their clinical practice.

An insight into clinicians' practices in breaking bad news of oral cancer diagnosis

Communication is an integral component of effective healthcare delivery to patients, and this includes breaking bad news (BBN). However, clinicians in dentistry are rarely exposed to diseases that can negatively and seriously affect an individual's view of their future and pose a mortality risk, except for oral cancer. The aim of this study was to assess clinician practices in BBN of oral cancer diagnosis in Malaysia. An exploratory sequential mixed-methods study design was used. A qualitative study was conducted among 12 clinicians to gather relevant information regarding their practices in BBN of oral cancer diagnosis using a descriptive-interpretive approach. The themes that emerged were preparation for BBN, BBN setting, communication, emotional aspects, and summarizing the session. These themes were used to develop a questionnaire with 34 items. In the quantitative study, this questionnaire was sent to 87 clinicians who had experienced BBN of oral cancer diagnosis in the past 5 years; the response rate was 100%. An arbitrary cut-off score between the third and fourth quartiles was set to distinguish 'good' and 'poor' practice in BBN among the clinicians. The data analysis was performed using IBM SPSS Statistics version 23.0. Overall, at least two-thirds of the clinicians had good practices in BBN of oral cancer diagnosis. The clinicians' designation (oral and maxillofacial surgery consultant/specialist vs dental officer) and BBN experiences were factors associated with their practices in BBN of oral cancer diagnosis.

Perspectives of Hospitalized Mental Health Care Users Concerning the Involvement of Family Members in Their Care: A Qualitative Study

The value of families and professionals in mental health care is well understood. Patient perspectives appear to have gotten less attention to date. This study investigated the perspectives of hospitalized mental health care users on the involvement of family members in their care using a qualitative phenomenological design. The participants with lived experience of family members being involved in their care were chosen using non-probability, purposive sampling. Individual interviews were carried out with the assistance of a voice recorder and observation notes. Because of data saturation, only fifteen people were interviewed. The interviews were transcribed verbatim and analyzed using Colaizzi's method. It started with reading and reviewing the transcript to extract key statements about the phenomenon. The meaning was then determined by carefully studying the primary significant statements and phrases. The established meanings were then organized into themes and subthemes. The three themes that emerged from the data analysis are as follows: a wide variation in patients' perspectives when family members remind them of their medicine, unpredictable visitation by family members, and a lack of support from family members. There were also the following five sub-themes: not visiting mental health care users in the hospital causes uncertainty about their future, mental health care users were concerned by fewer visits from relatives, friends were perceived as a contributory factor to no or limited visitation by family members, disappointment by a lack of financial support, and perceived lack of emotional support from family members. There is a need for family members to visit mental health care users to remove uncertainty about their future. Healthcare providers should listen to mental health care users to identify the challenges they are faced with, and hospital policies tailored to enhancing the involvement of family members should be formulated.

Creating age-friendly nursing homes: The time is now

The current global age-friendly movement supports older adults by promoting different policies and services. However, there is a dearth of attention to nursing home (NH) residents as part of age-friendly movements. The pioneering idea of an age-friendly health system, i.e., the "4 Ms" model is significant for NHs and formative for further developments; however, it does not identify unique components of NH care. This article aims to identify specific aspects of person-centered care in the literature to advance the development of a standardized conceptual framework. Along with residents, NH staff and administrators are integral parts of NHs. Incorporating the central role of caregivers, this study proposes a new "8 Ms" framework to describe the age-friendly NH. The traditional 4 Ms model notes that everything related to care matters to residents, along with care related to medication, mobility, and mentation. The proposed age-friendly framework introduces five additional "M," i.e., meaningful care, motivation, moderation, modification, and monitoring. This framework is proposed to advance education, training, clinical practice, research, and advocacy to promote quality of care in NHs. Application of the 8 Ms framework may yield multiple benefits, assuring good quality of care to residents, caregivers' job satisfaction, and supporting NH management in providing residents optimal care.

Family-Focused Nursing Research in WHO Afro-Region Member States: A Scoping Review

Although family nursing research has become an important focus for over the past 20 years, the evolution and extent of family nursing research in the World Health Organization (WHO) Afro-regions is less explored. The purpose of this scoping review was to map the evidence of family-focused nursing research using the Joanna Briggs Institute Scoping Review methodology. A systematic electronic search of articles was carried out for the period January 1, 2000 to December 31, 2020. The review process culminated in 85 articles, evidencing an increase in publications particularly in 2019 (n = 12). Eighteen countries were involved, with the Southern African region contributing 52% of the studies. Family members were predominantly described as parents, siblings, and children, with the most focused area of study being family experiences (n = 52). The majority of studies (n = 59) used qualitative methodologies. Despite the recent increase in family-focused nursing research in the WHO Afro-regions, further qualitative research, including more complex methodologies and interventions are still required to build contextualized evidence-based family-focused nursing.

Management of chronic non-communicable diseases in Ghana: a qualitative study of patients' coping strategies and the role of caregivers

BACKGROUND

Chronic Non-Communicable Diseases (CNCDs) has become a major cause of mortality and disability globally. We explored the coping strategies adopted by CNCD patients and the roles of caregivers in the management of CNCDs in Ghana.

METHODS

This was a qualitative study that adopted an exploratory design. The study was carried out at the Volta Regional Hospital. Purposive convenience sampling procedures were used to sample patients and caregivers. Data for the study were collected using in-depth interview guides. Data were collected among 25 CNCDs patients and 8 caregivers and analysed thematically using ATLAS.ti.

RESULTS

Patients adopted a variety of strategies to cope with their condition. These strategies were emotion-oriented coping, task-oriented coping, and avoidance-oriented coping. Family members were the main caregivers, who provided social and financial support for patients. Financial challenges, inadequate family support, poor attitudes of health workers, delays at the health facility, unavailability of drugs at the facility, and patients' non-adherence to the medical advice were major challenges that militated against caregivers' efforts in supporting patients in the management of their CNCDs.

CONCLUSION

We found that patients adopted various strategies to cope with their conditions. The roles of the caregivers in supporting patients in the management practices were identified as very important as they contribute immensely to the financial and social support for the patients in their management of CNCDs. It is crucial that health professionals actively involve caregivers in every aspect of the day-to-day management of CNCDs as these caregivers spend more time with these patients and understand them better.

Perception of Nurses' Support among Family Members of Hospitalized Patients in A Tertiary Health Facility in South-West, Nigeria

Introduction

Family members of hospitalized patients are often faced with challenges and may experience difficulty in coping without appropriate support. The aim of this study was to assess hospitalized patients' family members' perception of nurses' support.

Methods

A cross-sectional descriptive design was utilized. A total of 138 family members of hospitalized patients in a tertiary health facility were selected using a purposive sampling technique. Data were collected with an adopted structured questionnaire. Analyses of data were performed using frequency, percentage, mean, standard deviation, and multiple regression. The level of significance was set at 0.05 (p < .05. Also, age, gender, and type of family were the predictors of emotional support (R2 = 84, F(6, 131) = 5.92, p < .05.

Results

Twenty-seven qualitative studies were included in the review. A thematic synthesis showed over 100 themes and subthemes across the studies. A cluster analysis revealed positive elements and others that were seen in the studies as a barrier (hindrance) to clinical learning. Positive elements included supportive instructors, close supervision, and belonging (in the team). Unsupportive instructors, a lack of supervision and not being included were seen as a hindrance. Three key overarching themes that could describe a successful placement were revealed as "Preparation," "Welcomed and wanted" and "Supervision experiences". A conceptual model of clinical placement elements conducive to nursing students' learning was developed to enhance understanding of the complexities associated with supervision. The findings and model are presented and discussed.

Conclusion

A significant number of families of hospitalized patients reported poor perception of cognitive, emotional, and overall support from nurses. Adequate staffing is a prerequisite for effective family support. Nurses also need appropriate training in providing family support. The focus of family support training should emphasize practices that nurses can use in everyday interactions with patients and family members.

Family caregivers' perspectives of cultural beliefs and practices towards mental illness in Zambia: an interview-based qualitative study

Many elements of mental illness, including accessibility and utilization of mental health care, are influenced by societal cultural ideas. In Zambia, for example, traditional healers are not recognized, yet a large segment of the population continues to use their services due to their conviction. Despite this, studies on cultural beliefs and practices regarding mental illness in Zambia are scarce. Thus, this study is contextualized in Lusaka, Zambia, with the goal of filling a gap in the knowledge by exploring the cultural beliefs and practices surrounding mental illness as experienced by family caregivers caring for a next-of-kin with mental illness. Using a qualitative exploratory design, a purposeful sample of 15 family caregivers of next-of-kins diagnosed with mental illness were recruited. Data were collected via individual interviews, and analyzed using qualitative thematic analysis. The analysis revealed four main themes: (1) prevailing beliefs on cause of mental illness; (2) encountering social support and neglect; (3) recognizing the need of professional help; and (4) seeking culturally influenced help. Findings show that traditional attributions (for example, being bewitched, demon possession and sexual relations with uncleansed widows) are deeply embedded in beliefs and descriptions of what causes mental illness. These beliefs were found to influence not only help-seeking practices but also how people perceived and related to families. Given that beliefs influence caregiver help-seeking, these findings have implications for culturally sensitive practice. The study recommends that public health practitioners consider cultural beliefs and practices when developing health promotion programs, and public health messages.

The effect of group psychological training on the attitude of family caregivers of patients with schizophrenia

Background and aim

Mental disorders are among the most common diseases in the world. Not only the lack of social support and health services but also the social stigma surrounding individuals with mental disorders and their family members has exacerbated the difficulty of living with and caring for these patients. The present study aimed to determine the effect of group psychological training on the attitudes of family caregivers taking care of patients with schizophrenia as a common mental disorder.

Materials and methods

This interventional study was conducted on 60 caregivers of patients with schizophrenia who had a history of hospitalization in the psychiatric ward of Imam Reza Hospital of Birjand in 2020. The intervention group attended eight 90-minute sessions of psychological training in four weeks. However, the control group received no educational intervention during the study period. the opinions about mental illness scale (OMI) modified by Cohen and Struening was used to collect data before and after the intervention. Data were analyzed using SPSS₁₆ by running descriptive statistics, Chi-square, independent t-test, and paired t-test at the significance level of 0.05.

Results

The mean scores of attitudes toward mental illness were not significantly different between the intervention (87.37 ± 15.51) and control (89.48 ± 14.08) groups before the intervention (P > 0.05). However, the mean scores of the intervention group (156.44 ± 10.09) increased significantly compared to the mean scores of the control group (88.4 ± 16.15) followed by the intervention (P < 0.05).

Conclusion

According to the study results, psychological group training is effective in improving the attitudes of family caregivers of schizophrenic patients. So, it can be applied method of this study as simple, low-cost, and effective in improving the life quality of schizophrenic patients and their families.

Placing Users at the Center: Evaluating Exam Room Design for Improved User Experience

OBJECTIVE

This article proposes a method for evaluating the design affordances of primary care exam rooms from the perspectives of users using functional scenario (FS) analysis.

GOAL

This study aims to develop quantifiable criteria and spatial metrics for evaluating how exam room design supports the needs of different users. These criteria and metrics can be used in the early stages of the design process to choose between alternatives.

BACKGROUND

The primary care exam room is an essential space in healthcare, as it is the first point of contact between the healthcare provider and the patient. However, there is a lack of rigorous evaluation metrics for exam room design that supports improved user experiences and better health outcomes.

METHOD

A total of nine primary care exam rooms were analyzed using FS analysis. We identified three key user groups involved in the clinical examination process-providers, patients, and care partners-and translated their needs into FSs. We developed spatial metrics for each FS to quantify the extent to which the needs were spatially supported.

RESULTS

We developed 11 FSs in total: three from the providers', five from the patients', and three from the care partners' perspectives. The results revealed possible design strategies for improved user experiences.

CONCLUSIONS

We quantitatively measured the affordance of primary care exam room design for multiple stakeholders. We expect that the criteria and metrics presented in this article will improve the understanding of different users' perspectives and provide new design guidance for improved user experiences.

Critical care nursing role in low and lower middle-income settings: a scoping review

OBJECTIVES

A scoping review was conducted to answer the question: How is critical care nursing (CCN) performed in low-income countries and lower middle-income countries (LICs/LMICs)?

DESIGN

Scoping review guided by the JBI Manual for Evidence Synthesis.

DATA SOURCES

Six electronic databases and five web-based resources were systematically searched to identify relevant literature published between 2010 and April 2021.

REVIEW METHODS

The search results received two-stage screening: (1) title and abstract (2) full-text screening. For sources of evidence to progress, agreement needed to be reached by two reviewers. Data were extracted and cross-checked. Data were analysed, sorted by themes and mapped to region and country.

RESULTS

Literature was reported across five georegions. Nurses with a range formal and informal training were identified as providing critical care. Availability of staff was frequently reported as a problem. No reports provided a comprehensive description of CCN in LICs/LMICs. However, a variety of nursing practices and non-clinical responsibilities were highlighted. Availability of equipment to fulfil the nursing role was widely discussed. Perceptions of inadequate resourcing were common. Undergraduate and postgraduate-level preparation was poorly described but frequently reported. The delivery of short format critical care courses was more fully described. There were reports of educational evaluation, especially regarding internationally supported initiatives.

CONCLUSIONS

Despite commonalities, CCN is unique to regional and socioeconomic contexts. Nurses work within a complex team, yet the structure and skill levels of such teams will vary according to patient population, resources and treatments available. Therefore, a universal definition of the CCN role in LIC/LMIC health systems is likely unhelpful. Research to elucidate current assets, capacity and needs of nurses providing critical care in specific LIC/LMIC contexts is needed. Outputs from such research would be invaluable in supporting contextually appropriate capacity development programmes.

One-Month versus Three-Month Formulation of Paliperidone Palmitate Treatment in Psychotic Disorders: Patients', Relatives', and Mental Health Professionals' Perspectives

PURPOSE

Paliperidone palmitate is the only available long acting injectable (LAI) antipsychotic with a monthly and three-monthly formulation. LAIs may help battle non-adherence. Studies about the experiences of switching from the monthly (PP1M) to the three-monthly formulation (PP3M) of paliperidone are scarce. Therefore, the aim of this study is to evaluate the perspectives of patients, relatives, and mental health professionals on PP3M compared with PP1M.

MATERIAL AND METHODS

This was a multicenter, retrospective, non-interventional one-time questionnaire survey among patients with psychotic disorders who switched from PP1M to PP3M (n = 38), their relatives (n = 13) and mental health professionals (n = 38). General satisfaction and (un)desired effects were measured using the Medication Satisfaction Questionnaire (MSQ) and the Subjects' Reaction to Antipsychotics (SRA), respectively. Additional questionnaires assessed socio-demographic variables, preference, effectiveness, side-effects, and confidence in PP3M compared to PP1M.

RESULTS

Mean number of received PP3M injections was 4.2 (SD 2.5). The three study groups reported a high level of confidence in PP3M. High general satisfaction rates about PP3M among patients (69%) and mental health professionals (95%) were reported. The majority of patients, relatives, and mental health professionals reported similar or in some cases even greater effectiveness and similar or in some cases even less side-effects of PP3M compared to PP1M. Sixty-seven percent of the relatives reported less concerns about non-adherence after switching to PP3M.

CONCLUSION

Most patients, relatives, and mental health professionals prefer PP3M over PP1M. The positive attitudes of all parties may facilitate the more frequent use of PP3M and potentially the clinical outcomes.

Family-Centered Primary Care for Older Adults with Cognitive Impairment

Cognitive impairment (e.g. dementia) presents challenges for individuals, their families, and healthcare professionals alike. The primary care setting presents a unique opportunity to care for older adults living with cognitive impairment, who present with complex care needs that may benefit from a family-centered approach. This indepth systematic review was completed to address three aims: (a) identify the ways in which families of older-adult patients with cognitive impairment are engaged in primary care settings, (b) examine the outcomes of family engagement practices, and (c) organize and discuss the findings using CJ Peek's Three World View. Researchers searched PubMed, Embase, and PsycINFO databases through July 2019. The results included 22 articles out of 6743 identified in the initial search. Researchers provided a description of the emerging themes for each of the three aims. It revealed that family-centered care and family engagement yields promising results including improved health outcomes, quality care, patient experience, and caregiver satisfaction. Furthermore, it promotes and advances the core values of medical family therapy: agency and communion. This review also exposed the inconsistent application of family-centered practices and the need for improved interprofessional education of primary care providers to prepare multidisciplinary teams to deliver family-centered care. Utilizing the vision of Patient- and Family-Centered Care and the lens of the Three World View, this systematic review provides Medical Family Therapists, healthcare administrators, policy makers, educators, and clinicians with information related to family engagement and how it can be implemented and enhanced in the care of patients with cognitive impairment.

Reducing Futile Acute Care Services for Terminally Ill Patients With Cancer: The Dignity Project

PURPOSE:

Patients with terminal diseases frequently undergo interventions that are futile and may be detrimental to their quality of life. We conducted a quality improvement project aimed to reduce the utilization of futile acute care services (ACSs) for patients with cancer treated with a palliative intent.

METHODS:

A multidisciplinary team reviewed the records of terminally ill patients with cancer who died between November 2017 and May 2018, during their admission at our institution. The review aimed to assess the magnitude of improper utilization of ACSs and admission to the intensive care unit (ICU). Lack of timely documentation of the goals of care (GOCs) was the main reason for this problem. We defined timely documentation as the availability of electronic documentation of patients' GOC before the need for ACSs. Interventions were implemented to improve the process; postintervention data were captured and compared with the baseline data.

RESULTS:

After the delivery of staff education and the implementation of mandatory documentation of the GOCs in the healthcare electronic record system, the timely documentation of the GOCs for patients with a palliative intent increased significantly from 59% at baseline to 83% in the postintervention phase. The impact of this intervention led to a decrease in admissions to the ICU from 26% to 12% and an estimated annual cost saving of $777,600 in US dollars.

CONCLUSION:

Our interventions resulted in improved documentation of the GOCs and decrease in the utilization of ACSs including ICU admissions and the associated cost.