Communication barriers to patient education in cardiac inpatient care: a qualitative study of multiple perspectives

Growing evidence in a variety of health-care settings supports the need to strengthen nurse-physician communication and interprofessional collaboration to optimize patient-health outcomes. The objective of this study is to explore communication barriers from the perspective of nurses themselves, as well as physicians, patients and families in a hospital-based cardiac care setting. Qualitative analysis of individual interviews with 35 participants was taken in two hospitals in Tehran, Iran. Interview questions asked about experiences with patient education and communication barriers among physicians, nurses and patients. The three major themes identified were: (i) lack of collegiality and communication between nurses and physicians; (ii) problematic communication between the health-care team, patients and their families; and (iii) cultural challenges. Findings from this study support the need for health-care organizations to be more collaborative and inclusive of nursing professionals.     

Information technology-based standardized patient education in psychiatric inpatient care

Title. Information technology‐based standardized patient education in psychiatric inpatient care Aim. This paper is a report of a study to describe nurses’ experiences of information technology‐based standardized patient education in inpatient psychiatric care. Background. Serious mental health problems are an increasing global concern. Emerging evidence supports the implementation of practices that are conducive to patient self‐management and improved patient outcomes among chronically ill patients with mental health problems. In contrast, the attitude of staff towards information technology has been reported to be contradictory in mental health care. Method. After 1 year of using an Internet‐based portal (Mieli.Net) developed for patients with schizophrenia spectrum psychosis, all 89 participating nurses were asked to complete questionnaires about their experiences. The data were collected in 2006. Fifty‐six participants (63%) returned completed questionnaires and the data were analysed using content analysis. Findings. Nurses’ experiences of the information technology‐based standardized patient education were categorized into two major categories describing the advantages and obstacles in using information technology. Nurses thought that it brought the patients and nurses closer to each other and helped nurses to provide individual support for their patients. However, the education was time‐consuming. Conclusion. Systematic patient education using information technology is a promising method of patient‐centred care which supports nurses in their daily work. However, it must fit in with clinical activities, and nurses need some guidance in understanding its benefits. The study data can be used in policy‐making when developing methods to improve the transparency of information provision in psychiatric nursing.     

Patients' perceptions of seclusion: a qualitative investigation

Twelve patients receiving acute in-patient psychiatric care in Queensland, Australia, participated in semi-structured interviews to elicit their perceptions of seclusion. All respondents had experienced time in seclusion within the 7 days prior to interview. Interviews were audiotaped, transcribed and analysed using content analysis. Five major themes emerged: use of seclusion, emotional impact, sensory deprivation, maintaining control and staff-patient interaction. The prevailing negativity towards seclusion underscores the need for ongoing critical review of its use. In particular, the relationship between patient responses to seclusion and the circumstances in which seclusion takes place requires greater consideration. Interventions such as providing information to patients about seclusion, increased interaction with patients during seclusion, attention to privacy and effective debriefing following seclusion may help to reduce the emotional impact of the practice.     

A study of collaboration inpatient treatment between the community psychiatric health services and a psychiatric hospital in Norway

The aim of this study was to examine factors that may have an influence on the collaboration between the health-care professionals in a psychiatric hospital and two communities' psychiatric health service departments. Interviews were conducted with three psychiatric nurses, one medical practitioner, one health and social manager and one cultural worker; thus a total of nine informants. The transcribed interview texts were analysed by means of qualitative content analysis. The main results showed that the community psychiatric nurses felt a need for more systematic interdisciplinary collaboration. The existing collaboration was characterized by ad hoc meetings. In addition, the need for information about their colleagues' professional competence was reported. The respondents called for a more regular forum for professional guidance and coordination in relation to particular client cases in order to improve the quality of psychiatric care. There was also a need for collaboration within community health care and a link to psychiatric hospital care in order to better evaluate the outcomes of care provided. In conclusion, the lack of continuity in the collaboration between health-care professionals may affect the quality of community health services because continuity is a vital component of care.     

Training in cognitive behavioural interventions on acute psychiatric inpatient wards

There has been a drive towards addressing the types of care and therapeutic interventions available to people with serious mental illness, which is reflected in the latest government mental health policy initiatives. Recent evidence strongly supports the implementation of psychological and social interventions for people with psychosis, and in particular the use of cognitive behavioural techniques. Until now, the main focus has been on people living in the community. This study examines the delivery of psychosocial interventions training to qualified psychiatric nurses and unqualified staff on seven acute psychiatric admission wards in London, UK. The approach had the strength of on-site delivery, follow-up role modelling of the interventions and clinical supervision. Despite this, in some cases the training was less successful, mainly because of staffing and leadership weaknesses. The impact of training in these methods and the implications for mental health education and practice development are discussed.     

Patients' and nurses' perspectives on oxygen therapy: a qualitative study

Title.  Patients' and nurses' perspectives on oxygen therapy: a qualitative study.
Aim.  This paper is a report of a study to describe patients' and nurses' perspectives on oxygen therapy.
Background.  Failure to correct significant hypoxaemia may result in cardiac arrest, need for mechanical ventilation or death. Nurses frequently make clinical decisions about the selection and management of low-flow oxygen therapy devices. Better understanding of patients' and nurses' experiences of oxygen therapy could inform clinical decisions about oxygen administration using low-flow devices.
Methods.  Face-to-face interviews with a convenience sample of 37 adult patients (17 cardio-thoracic: 20 medical surgical) and 25 intensive care unit nurses were conducted from February 2007 to September 2007. Interviews were audio-taped, transcribed verbatim and then analysed using a thematic analysis approach.
Findings.  The patients identified three key factors that underpinned their compliance with oxygen therapy: (i) device comfort; (ii) ability to maintain activities of daily living; and (iii) therapeutic effect. The nurses identified factors, such as: (i) therapeutic effect, (ii) issues associated with compliance, (iii) strategies to optimize compliance, (iv) familiarity with device, (v) triggers for changing oxygen therapy devices, as being key to the effective management of oxygen therapy.
Conclusion.  Differences between the patients' and nurses' perspective of oxygen therapy illustrate the variety of factors that impact on effective oxygen administration. Further research should seek to provide a further in-depth understanding of the current oxygen administration practices of nurses and the patient factors that enhance or hinder effectiveness of oxygen therapy. Detailed information about nurse and patient factors that influence oxygen therapy will inform a sound evidence base for nurses' oxygen administration decisions.     

Nurses' perceptions of mental health assessment in an acute inpatient setting in New Zealand: a qualitative study

This qualitative study explores the perceptions of mental health nurses regarding assessment in an acute adult inpatient setting in Central Auckland. Fourteen mental health nurses took part in semistructured interviews answering five open-ended questions. The analysis of data involved a general inductive approach, with key themes drawn out and grouped into four categories (roles, attitudes, skills and knowledge) in order to explore the meaning of information gathered. The outcome of the study acknowledged the importance of contextual factors such as the physical environment and bureaucratic systems, as well as values and beliefs present within the unit. The participants expressed concern that their input to assessment processes was limited, despite belief that 24-hour care and the nature of mental health nursing generally suggested that a crucial role should exist for nurses. In order for nurses to be established as central in the assessment process on the unit the study concludes that a nursing theoretical framework appropriate for this acute inpatient setting needs to be developed.     

Patients' perceptions of nursing practice. A rationale for a qualitative research approach.

The discipline of nursing is, in Sweden, in the early stages of discovering and expanding specific knowledge embedded in nursing practice. This is a challenging as well as a problematic venture. It is important to evaluate nursing practice within the specific cultural context before applying terminology and meaning of concepts used. The purpose of this paper is to present a basis for the study of perceptions of nursing practice as experienced by the patient himself in a specific cultural context. The historical context, the terminology commonly used, and relevant research in this domain of inquiry is critically examined as a means of determining appropriate research methods for further study in the domain of nursing practice.     

A new paradigm in patient education: a four-part model using videotape production

In this article, the effectiveness of an instructional videotape for newly admitted hospitalized psychiatric patients is discussed and evaluated. It is suggested that by using 'actors' with whom the patient is familiar (hospital staff), the educational and therapeutic benefit of the video is enhanced. This paper provides a method for pre-production planning of an effective videotape based on a four-part model. In this model, the educational subject matter is divided into four categories; facts, procedures, support, and mastery. An attempt is made to match various styles of presentation by each member of the treatment team to the nature of the part being presented. The short attention span common to newly admitted depressed patients, for example, is remedied by the use of concise messages delivered by each treatment team member. Although videotapes are not a substitute for one-to-one professional interaction, they can provide some basic understanding of the therapeutic environment and allay some of the fears that often plague the newly admitted patient. This paper also demonstrates how the use of videotaped instruction allows the treatment team to administer organized information using unlicensed personnel or the patient himself, thus conserving the professional staff's time.