A dignified approach to improving the patient experience: promoting privacy, dignity and respect through collaborative training

Globally there is a plethora of literature surrounding patients' privacy, dignity and respect, consequently highlighting the need for healthcare professionals to ensure such basic human rights are upheld when delivering care. For qualified practitioners this is further emphasised through the professional bodies and their varying codes of practice. To ensure privacy, dignity and respect move from rhetoric to reality in professional practice many pre-registration programmes promote service user involvement. Evidence suggests that involving service users in the delivery of educational programmes by directly telling their own stories enhances patient centred care. However given a number of recent patient surveys and/or audits reporting the lack of privacy, dignity and respect in health and social care settings there seems to be a growing need to reaffirm practitioners' knowledge, skills and values once qualified and practising in healthcare organisations. This paper reports on a project in a UK NHS Mental health Trust where service users, in collaboration with Trust staff, planned and delivered a series of privacy and dignity workshops to healthcare practitioners with the aim of improving the patient experience. Although the project took place within a Mental Health Trust the issues of privacy, dignity and respect apply to all healthcare sectors.     

Telehealth and Legal Implications for Nurse Practitioners

Telehealth, which uses electronic information and telecommunications technologies to support long-distance clinical healthcare, is a growing trend that offers improved patient access, cost savings, and more engaged patients with better outcomes. For nurse practitioners who deal with patients in a variety of settings, telehealth can help improve healthcare delivery to underserved populations. However, there are challenges including wide variations in the rules, regulations, and practice guidelines surrounding telehealth. Nurse practitioners should implement practical advice and tips for utilizing telehealth, as well as risk management strategies to ensure better patient care and avoid malpractice litigation or licensing issues.     

Survey of Australian practitioners' provision of healthy lifestyle advice to clients who are obese

Obesity is a global issue, with healthcare practitioners increasingly involved in clinical interactions with people who are overweight or obese. These interactions are opportunities to provide evidence-based healthy lifestyle advice, and impact on public health. This study used a cross-sectional survey of Australian healthcare practitioners to investigate what influenced the provision of healthy lifestyle advice to obese and overweight clients. A modified theory of planned behavior was used to explore knowledge translation processes. Knowledge translation was linked to three factors: (i) a healthcare practitioner's education and confidence in the currency of their knowledge; (ii) personal characteristics - whether they accepted that providing this advice was within their domain of practice; and (iii) the existence of organizational support structures, such as access to education, and best practice guidelines. To fulfill the potential role healthcare practitioners can play in the provision of evidence-based health promotion advice requires organizations to provide access to practice guidelines and to instill a belief in their workforce that this is a shared professional domain.     

The Health Insurance Portability and Accountability Act Privacy Rule: a practical guide for researchers

BACKGROUND: The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, intended to address potential threats to patient privacy posed by the computerization and standardization of medical records, provides a new floor level of federal protection for health information in all 50 states. In most cases, compliance with the Privacy Rule was required as of April 2003. Yet considerable confusion and concern remain about the Privacy Rule and the specific changes it requires in the way healthcare providers, health plans, and others use, maintain, and disclose health information. Researchers worry that the Privacy Rule could hinder their access to health information needed to conduct their research. OBJECTIVES: In this article, we explain how the final version of the Privacy Rule governs disclosure of health information, assess implications of the Privacy Rule for research, and offer practical suggestions for researchers who require access to health information. CONCLUSION: The Privacy Rule is fundamentally changing the way that healthcare providers, health plans, and others use, maintain, and disclose health information and the steps that researchers must take to obtain health data. The Privacy Rule requires researchers who seek access to identifiable health information to obtain written authorization from subjects, or, alternatively, to demonstrate that their research protocols meet certain Privacy Rule requirements that permit access without written authorization. To ensure continued access to data, researchers will need to work more closely than before with healthcare providers, health plans, and other institutions that generate and maintain health information.     

Awareness,perception and utilization of a mobile health clinic by people who use drugs

IntroductionPeople who use drugs (PWUD) face a multitude of barriers to accessing healthcare and other services. Mobile health clinics (MHC) are an innovative, cost-effective health care delivery approach that increases healthcare access to vulnerable populations and medically underserved areas. There is limited understanding, however, of how PWUD perceive and experience MHCs.MethodsSemi-structured interviews were conducted with 31 PWUD – 16 who had received care (clients) on an MHC (The Spot) and 15 who had not (non-clients) – to explore their perceptions and utilization of an MHC partnered with a mobile syringe services program in Baltimore, Maryland. Data analysis of the text was conducted using an iterative thematic constant comparison process informed by grounded theory.ResultsClients and non-clients, once aware of the MHC, had positive perceptions of The Spot and its benefits for their individual health as well as for the wellbeing of their community. These sentiments among clients were largely driven by access to low-barrier buprenorphine and service delivery without stigma around drug use. However, lack of general awareness of the spot and specific service offering were barriers to its use among non-clients.DiscussionMHCs provide an important opportunity to engage PWUD in healthcare and to expand buprenorphine use; however, even with accessibility near where PWUD access injection equipment, barriers to its use remain. Peer dissemination may be able to facilitate program information sharing and recruitment.

KEY MESSAGES

• People who use drugs perceive a mobile health clinic in their neighbourhood as a benefit to their communities and themselves by improving access to healthcare services, providing access to low-threshold buprenorphine dispensation, and offering services without drug use stigma.
• People who use drugs learned about a mobile health clinic in their neighbourhood largely through word-of-mouth. As a result, people received limited information about the mobile health clinic services creating a barrier to its use.

     

Maori health issues explored in an interprofessional learning context

In New Zealand there is emphasis on improving access to primary healthcare, particularly for high health need populations such as Maori, the indigenous people of New Zealand. Critical to the development of the primary healthcare environment is building healthcare teams and better utilising health practitioners. This article reports on an interprofessional educational initiative where medical, nursing and pharmacy undergraduates learnt together in order to understand Maori health issues, how these are addressed by health services and also appreciate the contribution of different health professionals within the healthcare team. The educational initiative is described and interprofessional learning issues are explored across the different curricula structures of medicine, nursing and pharmacy.     

Maori health issues explored in an interprofessional learning context

In New Zealand there is emphasis on improving access to primary healthcare, particularly for high health need populations such as Maori, the indigenous people of New Zealand. Critical to the development of the primary healthcare environment is building healthcare teams and better utilising health practitioners. This article reports on an interprofessional educational initiative where medical, nursing and pharmacy undergraduates learnt together in order to understand Maori health issues, how these are addressed by health services and also appreciate the contribution of different health professionals within the healthcare team. The educational initiative is described and interprofessional learning issues are explored across the different curricula structures of medicine, nursing and pharmacy.     

Parkinson's disease and the U.S. health care system.

Parkinson's disease is an expanding healthcare problem in our society. With the burgeoning elderly population in this country, it is important for community health nurses to understand the management of these patients. Although the cause of idiopathic Parkinson's disease is still unknown, there is much new research developing in this area. Local and national foundations are available to assist the patient and caregiver in education, referrals, and support groups. The effects of this disease process on the patient and family are profound. New government legislation may offer a promising link to researchers and practitioners nationwide. Healthcare implications are varied, and nurses need to keep abreast of changes in Medicare and managed care systems to ensure that homebound clients receive needed services. Community health nurses provide a vital link in the healthcare system for the Parkinson's patient.     

Improving mental health care in general hospitals

The mental health needs of older people being cared for within general hospitals and other acute healthcare settings has been specifically identified as a priority for improvement. Yet in reality little has changed. The Department of Health (DH) (2006) has highlighted how many challenges still exist in developing effective integrated care for this patient group and continues to respond with further centrally initiated policy documents. This article explores the relationship between policy and practice and highlights how, despite their importance, policy initiatives alone are unlikely to be enough to ensure the effective delivery of mental health care for older people in general hospitals.     

A Universal Healthcare System: Is It Right for the United States?

The over 45 million Americans who are uninsured speak volumes about the problems with our present healthcare system. Many Americans do not have access to basic health care and it is time to revisit the importance of universal health care for all Americans. PURPOSE: To gain a greater understanding of the facts, figures, and support for universal health care in America. SOURCE OF INFORMATION: A literature review of five research studies. CONCLUSION: The implementation of universal health care in America is a plausible feat, but the support of several facets of society is necessary for this to become a reality.     

Body mass index basics for critical care nurses.

With an increase in the prevalence of overweight and obese youth, practitioners who provide healthcare for children may benefit from the acquisition of knowledge in additional clinical skills, such as calculating and using body mass index-for-age. Coupled with current health screening measures and wellness counseling for children and their families, nurses as healthcare advocates may be able to initiate maximization of health and well-being after discharge.     

Health and Psychiatric Disparities in Children with Cognitive and Developmental Delays: Implications for Health Policy in Quebec

Background Previous research on psychiatric and health disparities according to level of cognitive functioning has focused on adults within an American healthcare context. The current study compares children with and without cognitive and developmental delays in Quebec, Canada, using physician billing data from a longitudinal study of low‐income, francophone families. Canada is an ideal context for studying medical billing data as its equal access healthcare system removes many socioeconomic biases. Methods A large sample (n = 1050) of children is used to describe psychiatric and health disparities, as well as differences in Ambulatory Care Sensitive (ACS) conditions and primary healthcare, between children with (n = 107) and without (n = 943) diagnoses in their billing history indicative of delays. Results The findings demonstrated a relatively high level of psychiatric diagnoses for children with delays. However, no difference was found between children with and without delays in regard to emergency room visits and hospitalizations for ACS conditions and primary healthcare. Conclusions The findings suggest that, within a universal healthcare system, disparities in primary healthcare may not emerge until adulthood in individuals with delay status.     

Special report: silent disasters

Disasters occur not only in war and conflict or after natural events, such as earthquakes or floods. In fact, the death of hundreds of thousands of children in Niger every year, often for treatable conditions, could just as well qualify as a disaster situation. A lack of funding for health care and health-care staff and user fee policies for health care in very poor or unstable settings challenge international agreements that make statements about the right to health and access to health care for all people. This paper argues that although sustainable development is important, today many are without essential health care and die in the silent disasters of hunger and poverty. In other words, the development of health care appears to be stalled for the sake of sustainability.     

From new nurse practitioner to primary care provider: bridging the transition through FQHC-based residency training

Community Health Center, Inc. (CHCI), a multi-site, federally qualified, health center (FQHC) in Connecticut, implemented a one-year-residency program for new nurse practitioners (NPs) in 2007. This residency program is specifically designed for family nurse practitioners intending to practice as primary care providers in federally qualified health centers. These centers comprise the nation's largest safety net setting; they are commonly referred to as community health centers. Supported in part by the Health Resources Service Administration, health centers are private nonprofit or public organizations serving populations with limited access to healthcare. They are located in designated, high need communities; governed by patient-majority boards of directors; and provide comprehensive, primary healthcare services. The author begins by reviewing the background and context for a nurse practitioner residency program, the importance of NP residency programs, and the recruitment and selection of NP residents. She explains how the residents are trained to a model of care and the content of care. She furthers the discussion by addressing program evaluation and outcomes and costs. Implications for national health policy, clinical practice, and nursing and areas for further research are presented. This article is timely in light of recent recommendations in the Institute of Medicine's 2010 report on the future of nursing recommending the development of residency programs for new, advanced practice registered nurses.     

Good practices in migrant health: the European experience

Migrants comprise a growing proportion of European populations. Although many are healthy, those who do need healthcare often face barriers and the care they receive may be inappropriate to their needs. This paper summarises good practices identified in a review of health services for migrants in Europe. Governments should ensure that migrants are entitled to health services, that the services are appropriate to their needs and that data systems are in place to monitor utilisation and detect inequities. Health services should adopt a 'whole organisation approach', in which cultural competence is viewed as much as a task for organisations as for individuals. Health workers should take steps to overcome language, social and cultural barriers to care. In each case, existing examples of good practice are provided. At a time when support is growing in some countries for political parties pursuing anti-immigrant agendas and governments in all countries are pursuing austerity policies, there is a greater need than ever for the public health community to ensure that migrants have access to services that are effective and responsive to their needs.     

Pediatric overweight or obesity: does the label really matter?

PURPOSE: To discuss the issue of early identification of overweight and obesity in infants and young children and provide some clinical recommendations based on the current evidence and the World Health Organization's (WHO) newly released guidelines for growth and development. DATA SOURCES: Comparison of the growth charts from the WHO and the Centers for Disease Control as well as current literature. CONCLUSIONS: Although healthcare providers and the general public recognize overweight and obesity as serious problems, there is still disagreement on what constitutes obesity in infants and young children and when and how to intervene. More research on interventions and outcomes is particularly needed. IMPLICATIONS FOR PRACTICE: The primary care provider deals with the sequelae of obesity on a daily basis. Some recommendations are provided for nurse practitioners who care for infants and children based on current evidence and expert opinion.     

Health insurance for all

It's a pleasure to report that when school nurses in a part of western Massachusetts were asked to identify barriers to healthcare for children, they did not mention health insurance. This was not always the case. Thanks to an innovative collaboration between a community hospital and a regional school district, almost all school children in the three-town area have health insurance. Fewer children are without healthcare, allowing them access to healthcare more freely and minimizing acute and primary care in the local emergency department, which is typically an outcome for the uninsured.     

Continuous peripheral nerve blocks in acute pain management

Continuous peripheral nerve block techniques offer many benefits for the surgical patient in terms of target-specific pain control and avoidance of opioid-related side effects. There are many acceptable techniques for perineural catheter placement and infusion management, and practitioners are encouraged to obtain specialized training to develop a consistent practice and ensure patient safety. Emerging technology in ultrasound guidance may offer advantages in perineural catheter insertion accuracy and procedural efficiency. Various infusion devices are available that permit delivery of a basal rate and patient-controlled bolus for use in the event of breakthrough pain. A successful outpatient continuous peripheral nerve block program should include thorough patient education, detailed written instructions, daily telephone follow-up, and contact information for a healthcare provider familiar with these techniques who can answer questions and intervene when necessary.     

Connecting Kids to Care: Developing a School-Based Telehealth Program

School-based telehealth is an efficient and effective way to overcome barriers to care and improve health equity for children in rural and underserved communities. Empowering health care providers, such as nurse practitioners, to develop successful, sustainable programs may contribute to improved access to care and improved health outcomes for the children served. Using a structured framework for program development is essential to successful implementation when connecting school-age children to care through a school-based telehealth program. The Telehealth Service Implementation Model provides a robust structure with requisite components to develop and implement a successful school-based telehealth program.