Patients' experiences with self-referral to in-patient rehabilitation: A qualitative interview study

Purpose. To describe objectives, experiences and satisfaction among subjects referring themselves to in-patient rehabilitation.

Method. Persons suffering from stroke or multiple sclerosis were invited to refer themselves to a specialised rehabilitation department. Ten patients referred themselves within the study period, of whom two were excluded. The remaining eight underwent qualitative semi-structured in-depth interviews, focusing on the decision of self-referral, the personal goals for the rehabilitation, and the satisfaction with the stay. The interviews were tape-recorded and subjected to content analysis. As an underlying theoretical framework, we applied Antonovsky's Sense of Coherence model.

Results. Half of the patients had not written the application themselves and did not know which grounds had been put forward in the application. Nevertheless, all the patients were able to formulate their personal goals for the rehabilitation stay. These were distributed in three main categories: those who recently had got a progressive disability wanted education and improved knowledge on their disease; those who had had an acute, traumatic change of health status wanted training in order to improve muscular strength or everyday skills; and those who had been disabled for several years wanted inspiration for further life.

Conclusions. Patients may put forward other reasons to apply for rehabilitation than health personnel. Does the Sense of Coherence Model seems applicable to describe these reasons.     

The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis

Johnson KL, Yorkston KM, Klasner ER, Kuehn CM, Johnson E, Amtmann D. The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis. Arch Phys Med Rehabil 2004;85:201-9.

Objective

To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace.

Design

Qualitative research methodology comprising a series of semistructured interviews.

Setting

Community-based setting.

Participants

Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews.

Interventions

Not applicable.

Main outcome measure

Accounts of personal experiences related to employment.

Results

Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working.

Conclusions

Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.     

Patients' experiences with lifestyle counselling in general practice: a qualitative study

OBJECTIVE. (1) To elucidate the relevance of Habermas's theory as a practical deliberation procedure in lifestyle counselling in general practice, using a patient perspective. (2) To search for topics which patients consider of significance in such consultations. DESIGN. Qualitative observation and interview study. SETTING. General practice. Subjects. A total of 12 patients were interviewed after lifestyle consultations with their GPs. MAIN OUTCOME MEASURES. How the patients perceived the counselling, how it affected them, and what they wanted from their GP in follow-up consultations. RESULTS. The GP should be a source of medical knowledge and a caretaker, but also actively discuss contextual reasons for lifestyle choices, and be a reflective partner exploring values and norms. The patients wanted their GP to acknowledge emotions and to direct the dialogue towards common ground where advice was adjusted to the concrete life situation. A good, personal doctor-patient relationship created motivation and obligation to change, and allowed counselling to be interpreted as care. CONCLUSION. The findings underscore the necessity of a patient-centred approach in lifestyle counselling and support the relevance of Habermas's theory as practical guidance for deliberation. IMPLICATIONS. The findings suggest that GPs should trust the long-term effects of investing in a good relationship and personalized care in lifestyle consultations. The study should incite the GP to act as an encouraging informer, an explorer of everyday life and reasons for behaviour, a reflective partner, and a caretaker, adjusting medical advice to patients' identity, context, and values.     

Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study

Objective

To identify elements of the physiotherapist–patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings.

Design

A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach.

Setting

Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain).

Participants

Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries.

Results

Patients based their evaluations of quality of care on their assessment of physiotherapists’ willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist–patient interaction emerged under all these themes, except for friendly and respectful communication.

Conclusion

This study identified which elements of the physiotherapist–patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients’ experiences of the physiotherapist–patient interaction in rehabilitation services to provide empirical and quantitative evidence.     

Patients' experiences of learning clean intermittent self-catheterization: a qualitative study

Title. Patients’ experiences of learning clean intermittent self‐catheterization: a qualitative study Aim. This paper is a report of a study to explore the experiences of learning to carry out clean intermittent self‐catheterization and user views of service provision. Background. This treatment imposes a variety of challenges to users, both physical and emotional. Safety, infection rates and complications have been investigated, but the practicalities of learning and performing self‐catheterization have not been addressed. What is currently known about the topic from a user perspective is based on audit, small projects or anecdotal reports provided by continence advisers. Method. In‐depth interviews were carried out in 2006 with eight men and seven women, aged 33–81 years (median 65), and carrying out self‐catheterization for a variety of reasons. A grounded theory framework was used. Findings. Themes identified were psychological issues, physical problems and service interaction. The communication skills of nurses helped facilitate the learning experience. In conjunction with nurses’ skills, a friendly relaxed approach alleviated embarrassment and anxiety, thus facilitating information exchange and retention of information. Conclusion. Adequate information and thorough instruction by healthcare professionals helps empower people to take control and master the treatment, with potential contribution to ongoing compliance and long‐term urinary tract health. Development of a policy supporting evidence‐based care and a consistent teaching programme is highly recommended for use where this treatment is regularly employed.     

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.     

Physicians’ experiences of video consultation with patients at a public virtual primary care clinic: a qualitative interview study

ObjectiveTo describe physicians’ experiences of video consultation with new patients visiting a publicly owned virtual primary care clinic.DesignIn this qualitative study, data were collected from semi-structured individual interviews and analysed by systematic text condensation.SettingA publicly owned virtual primary care clinic in Region Västra Götaland, Sweden.SubjectsTen primary care physicians working at the clinic.ResultsConnecting with a patient over video could be either straightforward or deficient, depending on communication and the patient’s condition. Clinical experience, communication skills, and involving patients throughout the consultation and examination were crucial for assessments over video where patients were guided to perform self-examination. The flexibility of work and the regulated assignment online were positive for the physicians’ work situation and wellbeing. Providing video consultation within the same organisation as the patient’s regular health centre was considered to facilitate patient care and safety. Video consultation was considered suitable for some diagnoses and for some patients not able to reach a primary healthcare centre, though doubts were expressed about the healthcare and social benefits of this virtual care service.ConclusionFor the physicians, video consultation induced changes in the basis for assessment of primary care patients. The limitations on informational exchange demanded an extended form of patient involvement founded upon consultation skills, clinical experience and new skills for virtual examination. Combining virtual care with traditional general practice has the potential to reduce the workload for the individual physician and ensure medical competence in virtual primary care. Video consultation experienced suitable in some situations, but easy access to it expressed problematic in terms of medical prioritisation in healthcare.

KEY POINTS

• Video consultation is suitable for primary care visits for some patients, but physicians’ experiences of this are rarely studied.
• •Clinical experience and consultation skills are important for video assessment of primary care patients which involves physician-guided patient self-examination.
• •Video consultation facilitates care in some situations and could benefit from the provider being connected to patient’s regular health centre.
• •Virtual care offers a flexible way of working but challenges healthcare prioritisation from the primary care physician’s perspective.

     

Exploring physical activity behaviour of persons with multiple sclerosis: a qualitative pilot study

Purpose. Identify facilitators and barriers to physical activity (PA), and explore the utility of Social Cognitive Theory (SCT) and Transactional Model of Stress and Coping (TMSC) in understanding PA behaviour among persons with multiple sclerosis (MS).

Methods. Thirteen participants from a clinical trial were interviewed and classified as physically active, sometimes active or inactive based on the Health-Promoting Lifestyle Profile-II. Interviews were analysed using analytical induction, which consisted of coding data into pre-established categories and then exploring similarities and differences between groups. Pre-established coding categories were constructs from SCT (i.e. environment, expectations, self-efficacy and self-regulation) and TMSC (i.e. stress appraisal and coping style).

Results. Inactive and active participants differed in their self-regulation skills, self-efficacy and coping styles. Common barriers to PA included symptoms and the physical and social environment. Facilitators of PA included strong self-regulation skills, confidence to overcome symptoms to engage in PA (i.e. barrier self-efficacy) and positive coping styles.

Conclusion. Results from this pilot study suggest that PA interventions will need to implement multiple strategies that target self-efficacy, social environment and coping styles. We found SCT and TMSC useful in understanding PA behaviour among persons with MS; however, a limitation to these theories is that they are not explicit in the relationship between health and cognitions. Future research will need to explore how to incorporate models of health and function into existing behaviour change theories.