Associations of nurse education level and nurse staffing with patient experiences of hospital care: A cross sectional study in China

Strengthening the nursing workforce is core to health system reform in China. Patient experiences of hospital care have been recognized as important in this endeavor. Studies exploring the relationships between nursing workforce and patient experiences of hospital care, however, are scarce. The aim of this cross-sectional study was to examine the associations between nurse education level, nurse staffing, and hospitalized patients’ experiences of hospital care. Participants were 1,582 nurses responsible for direct care and 1,305 hospitalized patients from 23 hospitals in Guangdong province, China in 2014. Education level of nurses was measured by the proportion of nurses holding a baccalaureate or higher degree. Nurse staffing was measured by the unit nurse-patient ratio. The Hospital Consumer Assessment of Health care Providers and Systems Scale was used to measure patient experiences of hospital care. Structural equation modeling demonstrated that a higher proportion of nurses holding a baccalaureate or higher degree was related directly to better patient perceptions of communication with nurses, responsiveness of nurses, pain management, and physical environment, and related indirectly to overall hospital ratings and recommendation of the hospital. A higher nurse-patient staffing ratio was associated directly with better patient perceptions of communication with nurses, education about new medications given in hospital, and physical environment, and indirectly with overall ratings and recommendation of the hospital. Our findings add new evidence in the Chinese societal context about the relationship between the nursing workforce and patient experiences of hospital care. Upgrading nurse education level and increasing nurse staffing could potentially improve patient experiences of hospital care.     

QUEST: Questionnaire relating to patients’ Understanding and Expectations of their Symptoms and Treatment

Objectives : To survey patients’ perceptions of illness and their expectations of the emergency department visit in a major tertiary‐referral teaching hospital and to compare these responses with the doctors’ assessment in a major tertiary‐referral teaching hospital. Method : A two‐part survey was conducted. Patient questions focused on patient perception of illness severity, and expectation of process and outcome. Doctor questions focused on the severity of illness and the advice given. Results : Pre‐consultation: Of 141 patients, 94 (67%) were concerned that they were suffering from something serious or dangerous. Eighty‐three of 145 patients (57%) expected an explanation and/or reassurance. Eighty‐four of 145 patients (58%) expected investigation. Twenty‐seven of 135 patients (20%) expected admission to hospital. Post‐consultation: 119/126 patients (94%) who were given an explanation stated that they understood their illness. One hundred and thirteen of 122 patients (93%) felt reassured on departure. Conclusions : In this group of patients, fear of a dangerous or life‐threatening condition not borne out in the doctors’ assessment is common. Present clinical practice, including explanation and reassurance based on clinical and investigation findings, appears sufficient to meet patient expectations.     

Perpetuating ‘New Public Management’ at the expense of nurses' patient education: a discourse analysis

This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could ‘see’ neither their role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for ‘things’ such as cost‐effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice.     

Rheumatoid arthritis: a primary care approach

PURPOSE: To provide primary care providers with guidelines on the evaluation, diagnosis and management of patients with rheumatoid arthritis (RA). DATA SOURCES: Research-based articles in the medical literature, review articles, and clinical practice is a chronic inflammatory disease that affects mainly synovial joints. Diagnosis is based primarily on clinical examination. Clinical criteria developed by the American Rheumatism Association can help the primary care provider recognize this potentially devastating disease and facilitate early referral to a rheumatologist for treatment. IMPLICATIONS FOR PRACTICE: Patients with RA should be treated early and aggressively. Laboratory tests are not essential to confirm the diagnosis of RA. The clinical usefulness of the rheumatoid factor could be increased by restricting the test to patients who have a high probability of RA based on clinical symptoms.     

Clinical effectiveness and cost‐effectiveness of nurse‐led care in Chinese patients with rheumatoid arthritis: A randomized trial comparing with rheumatologist‐led care

Background and aim

The concept of nurse‐led care (NLC) was not familiar in China. This study was designed to evaluate the clinical effectiveness and cost‐effectiveness of NLC versus rheumatologist‐led care (RLC) in Chinese patients with rheumatoid arthritis (RA).

Methods

Patients of either gender (aged ≥18 years) with RA were enrolled at Wenhai Central Hospital, China (January 2015 to December 2015). The participants were then randomized to NLC or RLC. Outcomes of both the groups were compared in terms of effectiveness by measuring the Disease Activity Score 28, visual analogue scores pertaining to pain and fatigue, and duration of morning stiffness. Costs associated with resource use for RA were assessed and compared between both groups.

Results

A total of 214 RA patients in 2 groups (n = 107 in each group) were enrolled and analysed. Improvements in clinical outcomes (disease activity, pain, fatigue, and morning stiffness) over 12 months were significantly greater in the NLC group compared to RLC (P < 0.001). Overall, costs associated with resource use were higher in the RLC group compared to the NLC group (P < 0.05).

Conclusions

Our preliminary finding suggested that RA patients managed by NLC compared to RLC may have better clinical outcomes and more cost‐effective care in China.     

Rheumatoid arthritis and the complement system

Complement activation contributes to a pathological process in a number of autoimmune and inflammatory diseases, including rheumatoid arthritis (RA). In this review we summarize current knowledge of complement contribution to RA, based on clinical observations in patients and in vivo animal models, as well as on experiments in vitro aiming at elucidation of underlying molecular mechanisms. There is strong evidence that both the classical and the alternative pathways of complement are pathologically activated during RA as well as in animal models for RA. The classical pathway can be initiated by several triggers present in the inflamed joint such as deposited autoantibodies, dying cells, and exposed cartilage proteins such as fibromodulin. B cells producing autoantibodies, which in turn form immune complexes, contribute to RA pathogenesis partly via activation of complement. It appears that anaphylatoxin C5a is the main product of complement activation responsible for tissue damage in RA although deposition of membrane attack complex as well as opsonization with fragments of C3b are also important. Success of complement inhibition in the experimental models described so far encourages novel therapeutic approaches to the treatment of human RA.     

Patients assessing students' assignments; making the patient experience real

The care of patients with inflammatory bowel disease (IBD) frequently falls short of the highest standards. This is noted in several publications, including national standards, despite nursing students being taught the importance of listening to and understanding patients. Teaching staff at the University of Glasgow primarily responsible for teaching third year undergraduate nursing students undertook a radical rethink of the planning, delivery and assessment of lectures on IBD. The subject had previously been delivered in a modified lecture format. Although the topic could be included in the end-of-year exams, there was little evidence to show whether this traditional teaching method had any effect on students' clinical practice. In a novel approach to learning and assessment, students were invited to research and produce an information leaflet for newly diagnosed patients with IBD. The leaflets were then assessed and grades awarded by an expert panel of patients and carers. Such enquiry based learning (EBL) intended to demonstrate in practice, the key role patients can play in both undergraduate nurse education and in service planning and delivery in the National Health Service (NHS). The panel found the exercise both interesting and insightful, while the students reported being invigorated and felt the expert assessment meant they were forced to achieve a higher level of work.     

Rheumatology: a study of patient satisfaction with follow-up monitoring care

Background. This paper reports the findings of a quantitative study to determine the satisfaction of rheumatology patients receiving follow‐up monitoring care within primary and secondary locations. Aims and objectives. The aim of the study was to compare and contrast the satisfaction of patients with rheumatoid arthritis following two different routes of care. The objective was to explore the dimensions of care identified in an earlier qualitative study. Design. A convenience sample of 80 participants was used; 40 from each care location. Methods. Data were collected using the Leeds Satisfaction Questionnaire, which explores the dimensions of satisfaction previously identified as being important to this group of patients. Results. The secondary care group showed significantly higher levels of satisfaction in respect of general satisfaction, provision of information and continuity of care and a significant difference in relation to empathy, technical ability and attitude to the patient. Conclusions. While patients from both locations were satisfied with the care they received, those receiving specialist nursing care in the secondary location were more satisfied. Relevance to clinical practice. Increased emphasis on care in the community and the evolution of nurse specialist roles indicate the need for further qualitative work to inform the future planning of care provision for rheumatology patients in this area.     

Contrasts in Patients' and Providers' Explanations of Rheumatoid Arthritis

Purpose: To investigate explanations of rheumatoid arthritis (RA) from young women's perceptions of the illness experience and providers' understanding of the disease.
Design and Methods: This ethnographic study included 17 women from age 26 to 40 years who were under medical care for RA, and five health care providers of these participants.
Findings: Two main themes were identified: (a) having RA 'is a pain' and (b) it changed me. The first theme represented the participants' physical and emotional suffering, interferences in their everyday lives, and aggravations in receiving health care. The second theme represented the life and lifestyle changes the women experienced as a result of having RA. The providers' explanations included two themes: (a) functioning in a normal manner and (b) controlling the disease. The first theme was keeping the women's physical functioning as normal as possible. The second theme was the providers' goal to control the disease, which they believed would lead to the preservation of joint function and manageable pain levels. Regarding results of health care, the participants and providers had comparable beliefs about decreasing the physical pain and improving joint function but they had disparate notions about the participants' being active partners in communication and negotiation processes of their health care.
Conclusions: The findings indicated the importance of discovering potential disparities in patients' and providers' explanations of RA, and revealed the participants' desire for clinical support in becoming partners in their own health care.