The Lausanne Hospitality Model: a model integrating hospitality into supportive care

PURPOSE

Cancer care is undergoing a conceptual shift with the introduction of the principles of patient-centered care to support patients' individual needs. These needs include those related to hospitality during cancer treatments. This paper aims to provide an extension of the supportive care framework by bringing in the hospitality approach inspired by the hotel industry.

METHOD

The "Lausanne Hospitality Model," integrating hospitality into supportive care, was developed through an iterative process, combining expertise in supportive care and health services research, communication, and the hotel industry.

RESULTS

This conceptual paper integrates hospitality and service sciences into the supportive care framework. The "Lausanne Hospitality Model" offers new insights into the notions of cancer journey, patient experience, services, and practices that may be involved when facilitating hospitality. While most concepts used in the model are based on prior research, they have not been combined previously. The model highlights the place of hospitality in the patient's experience within cancer services and, by extension, its role in professional practice.

CONCLUSION

Practices involved in the delivery of cancer care need to reinforce the importance attributed to hospitality services, as they impact patients' experiences. By integrating the hospitality perspective into healthcare delivery and supportive care, this paper addresses previously theoretically overlooked aspects that impact patients' experiences during cancer care.

[Patient involvement in oncology research - Development of a reference framework in French-speaking Switzerland]

Patient and public involvement (PPI) in research is increasingly recognized and encouraged by public and funding bodies. Although gaining momentum, the implementation of PPI in Switzerland remains recent. Since 2021, the Laboratoire des Patients, affiliated to the Swiss Cancer Center Léman (SCCL), aims to establish a PPI model for oncology research adapted to the local context that will assist researchers to apply PPI approaches within their projects. Among its functions, the Laboratoire des Patients will offer a training program for patients and researchers targeting PPI in research, support throughout the projects, and consultation and mediation services for patients and researchers. This article discusses the utility of PPI in research and describes the SCCL-PPI model.

[Cancer center clinical nurse: The experience of the CHUV Prostate Cancer Center]

The University Hospital of Lausanne has heavily invested in the development of interdisciplinary oncology centers to improve the quality of care, and structure research and training. By integrating specialist nurses, it follows international recommendations. These specialists' nurses rephrase the information given by the doctor and ensure patients' understanding. They assess the patient's psychosocial situation and provides guidance if necessary. They support the patient in making informed choices about treatment and coping strategies. In addition to the outpatient clinics planned in accordance with the care pathway, she can be contacted between appointments to answer questions or concerns of any kind. This article shows the added value of these nurses in the care of oncology patients.

[Telephone follow-up of SARS-CoV-2 positive patients at the Oncology Department of Lausanne University Hospital]

Compared with the general population, oncology patients face a higher morbidity and mortality caused by the COVID-19 pandemic. As a result, health systems had to quickly adapt cancer care in order to maintain the best quality and patient safety. From March to May and from October to December 2020, 254 patients diagnosed with cancer and tested positive for SARS-CoV-2 benefited from a tele-health monitoring at the Oncology Department at CHUV. This article describes the key points of the development, implementation and operation of this tele-health monitoring, enabled by an interdisciplinary and inter-professional collaboration between different units and healthcare professionals.

Describing adverse events in Swiss hospitalized oncology patients using the Global Trigger Tool

BACKGROUND AND AIMS

The occurrence rate of adverse events (AEs) related to care among hospitalized oncology patients in Switzerland remains unknown. The primary objective of this study was to describe, for the first time, the occurrence rate, type, severity of harm, and preventability of AEs related to care, reported in health records of hospitalized hematological and solid-tumor cancer patients in three Swiss hospitals.

METHODS

Using an adapted version of the validated Global Trigger Tool (GTT) from the Institute for Healthcare Improvement, we conducted a retrospective record review of patients discharged from oncology units over a 6-week period during 2018. Our convenience sample included all records from adult patients (≥18 years of age), diagnosed with cancer, and hospitalized (>24 hours). Per the GTT method, two trained nurses independently assessed patient records to identify AEs using triggers, and physicians from the included units analyzed the consensus of the two nurses. Together, they assessed the severity and preventability of each AE.

RESULTS

From the sample of 224 reviewed records, we identified 661 triggers and 169 AEs in 94 of them (42%). Pain related to care was the most frequent AE (n = 29), followed by constipation (n = 17). AEs rates were 75.4 per 100 admissions and 106.6 per 1000 patient days. Most of the identified AEs (78%) caused temporary harm to the patient and required an intervention. Among AEs during hospitalization (n = 125), 76 (61%) were considered not preventable, 28 (22%) preventable, and 21 (17%) undetermined.

CONCLUSION

About half of the hospitalized oncology patients suffered from at least one AE related to care during their hospitalization. Pain, constipation, and nosocomial infections were the most frequent AEs. It is, therefore, essential to identify AEs to guide future clinical practice initiatives to ensure patient safety.

Health promotion for unaccompanied minor asylum seekers – a qualitative evaluation

Background

We evaluated a health promotion program (HPP) for unaccompanied minor asylum seekers (UMA) in the canton of Vaud, Switzerland. UMA are particularly vulnerable to a range of health issues, due to their age and migration experiences. Effective health promotion programs are key to empower them to overcome these challenges and to improve their health.

Methods

We adopted a qualitative design with ethnographic and participatory elements to identify strengths, opportunities for improvement and appropriateness as perceived by UMA, educators and nurses responsible for UMA health care and the HPP. Data collection included observation of HPP courses, focus group discussions with UMA and interviews with educators. Analysis was based on a grounded theory in ethnography approach.

Results

Finding include three main themes: 1) UMA’s perceived low power and control, due to predominant rules and regulations and uncertainty about the future; 2) A need for health promotion in this population, due to UMA’s risk behaviours and the educators’ perceived discomfort with health-related issues and health promotion; 3) Practical feedback regarding topics, teaching methods and HPP organisation. Main recommendations include using effective adolescent health education methods to improve the appropriateness to age and context, enhancing participation of educators in health promotion and improving practical aspects of the HPP.

Conclusions

We evaluated and documented health promotion practice in the hard to reach population of UMA. Feasible changes in teaching methods and multidisciplinary collaboration may improve the HPP. However, UMA’s social environment needs to be taken into consideration to provide effective health promotion programs.

Key messages

Unaccompanied minor asylum seeker and educators perceive the health promotion program as useful and important. To address the health promotion needs of UMA, any program must be adaptive to the contextual complexity of UMA lives.

[Barriers and facilitators to access to healthcare among asylum seekers from Eritrea and Afghanistan in the canton of Vaud, Switzerland]

Introduction : In the context of an upsurge in the number of asylum seekers arriving in Switzerland in 2015, caregivers encountered new issues.Background : We lack local studies that simultaneously analyze asylum seekers' experiences of the healthcare system and the perceptions of health professionals in contact with asylum seekers.Objectives : To assess the health problems of this population in order to gain a better understanding of their specific needs and to implement best practice interventions in order to improve access to care and efficiency of care.Methods : A qualitative study with twenty interviews, either one-to-one or in groups, with Eritrean and Afghan ASs, and three focus groups with registered nurses, interpreters, and emergency department professionals.Results : The main results concern access to healthcare in the country of origin, expectations about the living conditions in Switzerland, the effects of migration on health, cultural beliefs on physical health and psychiatry, visits to the emergency department, reasons for missed appointments, and peer support.Discussion : Information, trust, and time are the main issues identified to optimize access to care.Conclusion : Our results allow for a better understanding of specific needs and health interventions for Afghan and Eritrean ASs. Recommendations for practice were issued.

Pharmacist-nurse collaborations in medication adherence-enhancing interventions: A review

OBJECTIVES

Healthcare providers play an important role in addressing medication adherence. Pharmacists and nurses are qualified in this field even though they have different expertise. They both claim their role at the patient's side in collaboration with physicians. To avoid care duplication, such interprofessional collaborations must be carefully defined. The objectives of our review were to: 1) identify medication adherence-enhancing interventions involving pharmacists and nurses; 2) describe their respective roles.

METHODS

Literature searches were conducted in PubMed/Medline, Embase, Cochrane Library. Screening criteria were: medication adherence-enhancing interventions, at least a pharmacist and nurse collaborating with/without other healthcare professionals, role description, outpatient settings, at least one oral treatment, adult patients.

RESULTS

After screening, 21 references fulfilled the inclusion criteria. Pharmacists and nurses were both in a strategic position to identify eligible patients for adherence interventions, to assess and promote adherence. Pharmacists specifically ensured treatment efficacy, security and access, they provided information on the medication and related lifestyle advice. Nurses clinically co-managed patients with physicians; they also provided patients with information on their disease.

CONCLUSIONS

Pharmacist-nurse medication adherence-enhancing interventions are rare and often in a nascent phase.

PRACTICE IMPLICATIONS

The results of our review should help in designing new pharmacist-nurse medication adherence-enhancing interventions.

[Interprofessionnal care and multimorbidity in family medicine]

The future of interprofessionnal care for multimorbid patients can be considered at 3 levels: organisation of the system, coordination of care and promotion of relationship between patients and careers and between careers (doctor, pharmacist, nurse, health and social workers). The development of innovating systems must consider and prioritize the relationship over control and management.

Is the Front Line Prepared for the Changing Faces of Patients? Predictors of Cross-Cultural Preparedness Among Clinical Nurses and Resident Physicians in Lausanne, Switzerland

PHENOMENON: Assuring quality medical care for all persons requires that healthcare providers understand how sociocultural factors affect a patient's health beliefs/behaviors. Switzerland's changing demographics highlight the importance of provider cross-cultural preparedness for all patients-especially those at risk for social/health precarity. We evaluated healthcare provider cross-cultural preparedness for commonly encountered vulnerable patient profiles.

APPROACH

A survey on cross-cultural care was mailed to Lausanne University hospital's "front-line healthcare providers": clinical nurses and resident physicians at our institution. Preparedness items asked "How prepared do you feel to care for … ?" (referring to example patient profiles) on an ascending 5-point Likert scale. We examined proportions of "4 - well/5 - very well prepared" and the mean composite score for preparedness. We used linear regression to examine the adjusted effect of demographics, work context, cultural-competence training, and cross-cultural care problem awareness, on preparedness.

FINDINGS

Of 885 questionnaires, 368 (41.2%) were returned: 124 (33.6%) physicians and 244 (66.4%) nurses. Mean preparedness composite was 3.30 (SD = 0.70), with the lowest proportion of healthcare providers feeling prepared for patients "whose religious beliefs affect treatment" (22%). After adjustment, working in a sensitized department (β = 0.21, p = .01), training on the history/culture of a specific group (β = 0.25, p = .03), and awareness regarding (a) a lack of practical experience caring for diverse populations (β = 0.25, p = .004) and (b) inadequate cross-cultural training (β = 0.18, p = .04) were associated with higher preparedness. Speaking French as a dominant language and physician role (vs. nurse) were negatively associated with preparedness (β = -0.26, p = .01; β = -0.22, p = .01). INSIGHTS: The state of cross-cultural care preparedness among Lausanne's front-line healthcare providers leaves room for improvement. Our study points toward institutional strategies to improve preparedness: notably, making sure departments are sensitized to cross-cultural care resources and increasing provider diversity to reflect the changing Swiss demographic.

The emergence of forensic nursing and advanced nursing practice in Switzerland: an innovative case study consultation

BACKGROUND AND METHODS

The objectives of this article were to systematically describe and examine the novel roles and responsibilities assumed by nurses in a forensic consultation for victims of violence at a University Hospital in French-speaking Switzerland. Utilizing a case study methodology, information was collected from two main sources: (a) discussion groups with nurses and forensic pathologists and (b) a review of procedures and protocols. Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined by Hamric, Spross, and Hanson (2009).

RESULTS

Advanced nursing practice competencies noted in the analysis included "direct clinical practice," "coaching and guidance," and "collaboration." The role of the nurse in terms of "consultation," "leadership," "ethics," and "research" was less evident in the analysis.

DISCUSSION AND CONCLUSION

New forms of nursing are indeed practiced in the forensic clinical setting, and our findings suggest that nursing practice in this domain is following the footprints of an advanced nursing practice model. Further reflections are required to determine whether the role of the forensic nurse in Switzerland should be developed as a clinical nurse specialist or that of a nurse practitioner.

Cultural competency of health-care providers in a Swiss University Hospital: self-assessed cross-cultural skillfulness in a cross-sectional study

BACKGROUND

As the diversity of the European population evolves, measuring providers' skillfulness in cross-cultural care and understanding what contextual factors may influence this is increasingly necessary. Given limited information about differences in cultural competency by provider role, we compared cross-cultural skillfulness between physicians and nurses working at a Swiss university hospital.

METHODS

A survey on cross-cultural care was mailed in November 2010 to front-line providers in Lausanne, Switzerland. This questionnaire included some questions from the previously validated Cross-Cultural Care Survey. We compared physicians' and nurses' mean composite scores and proportion of "3-good/4-very good" responses, for nine perceived skillfulness items (4-point Likert-scale) using the validated tool. We used linear regression to examine how provider role (physician vs. nurse) was associated with composite skillfulness scores, adjusting for demographics (gender, non-French dominant language), workplace (time at institution, work-unit "sensitized" to cultural-care), reported cultural-competence training, and cross-cultural care problem-awareness.

RESULTS

Of 885 questionnaires, 368 (41.2%) returned the survey: 124 (33.6%) physicians and 244 (66.4%) nurses, reflecting institutional distribution of providers. Physicians had better mean composite scores for perceived skillfulness than nurses (2.7 vs. 2.5, p < 0.005), and significantly higher proportion of "good/very good" responses for 4/9 items. After adjusting for explanatory variables, physicians remained more likely to have higher skillfulness (β = 0.13, p = 0.05). Among all, higher skillfulness was associated with perception/awareness of problems in the following areas: inadequate cross-cultural training (β = 0.14, p = 0.01) and lack of practical experience caring for diverse populations (β = 0.11, p = 0.04). In stratified analyses among physicians alone, having French as a dominant language (β = -0.34, p < 0.005) was negatively correlated with skillfulness.

CONCLUSIONS

Overall, there is much room for cultural competency improvement among providers. These results support the need for cross-cultural skills training with an inter-professional focus on nurses, education that attunes provider awareness to the local issues in cross-cultural care, and increased diversity efforts in the work force, particularly among physicians.

[Redesigning Swiss ambulatory health care system]

Primary care medicine is first in line to meet the necessary changes in our health care system. Innovations in this field pursue three types of objectives: accessibility, quality and continuity of care. The Department of ambulatory care and community medicine of the University of Lausanne (Policlinique médicale universitaire) is committed to this path, emphasizing interprofessional collaboration. The doctor, nurse and medical assistant coordinate their activities to contribute efficiently to meet the needs of patients today and tomorrow. This paper also addresses how our department, as a public and academic institution, might play a major role as a health care network actor. A master degree dissertation in health management has started to identify the critical success factors and the strategic core competencies needed to achieve this development.

[Integrated care: how to support a culture change?]

The primary care center at Lausanne University Hospital trains residents to new models of integrated care. The future GPs discover new forms of collaboration with nurses, pharmacists or social workers. The collaboration model includes seeing patients together or delegating care to other providers, with the aim of improving the efficiency of a patient-centered care approach. The article includes examples of integrated care in consultation for travelers, victims of violence, pharmacist medication adherence counseling, medicosocial team work for alcohol use disorders and nurse practitioners' primary care for asylum seekers.