Valuing people as individuals: development of an instrument through a survey of person-centredness in secondary care

Valuing people as individuals: development of an instrument through a survey of person‐centredness in secondary care Background. Person‐centred care is regarded as the optimum way of delivering health care and is defined as valuing people as individuals ( 51 ). So how can practitioners find out if their service ‘values people as individuals’? Serious doubts have been expressed about the validity of the concept of patient satisfaction and the ability of instruments to measure patients’ views of care. However, qualitative research among people who had experienced problems with their health care has identified an alternative concept better able to articulate patient’s complex experiences ( 10 ). The study found that that patients’ identity was threatened by experiences perceived as dehumanizing, objectifying, disempowering and devaluing. Thus the concept of ‘personal identity threat’ showed the extent to which people felt valued (or not) as individuals. Aim of the study. The aim of the research reported in this paper is to build upon the earlier qualitative work and to identify the frequency and distribution of inpatients’ experiences of ‘personal identity threat’. Design/Methods. The study adopted a cross‐sectional survey design. Ninety‐seven patients from general medical, surgical and otolaryngology wards completed a questionnaire developed from the qualitative study containing items on dehumanization, objectification, disempowerment and devaluation. Findings. Although many patients expressed positive sentiments about their care, problems were highlighted around power/control, involvement in care, and the approachability and availability of staff. The findings also revealed that women were more at risk than men of ‘threats to identity’ in health care settings. Conclusions. Improvements are suggested to help promote a service that truly values people as individuals. These include improving health practitioners’ understanding of the impact of illness on everyday life, promoting practitioners’ listening and enquiring skills, and increasing the ‘visibility’ and availability of staff. Further research should also explore gender and age differences in perceptions of the lay–practitioner relationship.     

Linkage to medical services in the Drug Abuse Treatment Outcome Study

BACKGROUND: An episode of substance abuse treatment is an opportunity to link substance-abusing patients to medical care at a time when management of medical problems might stabilize recovery and long-term health. However, little is known about the ability of organizational linkage mechanisms to facilitate the delivery of medical care to this population. OBJECTIVES: The goal of this study was to examine whether organizational linkage mechanisms facilitate medical service utilization in drug abuse treatment programs. RESEARCH DESIGN: This was a prospective secondary analysis of the Drug Abuse Treatment Outcome Study, a national longitudinal study of drug abuse treatment programs and their patients from 1991 to 1993. Hierarchical linear models evaluated the effect of on-site delivery, formal and informal referral, case management emphasis, and transportation on the log-transformed number of medical visits at the 1-month in-treatment patient interview. MEASURES: Program directors' surveys provided organizational information, including the linkage mechanism used to deliver medical care. Patients reported the number of medical visits during the first month of drug abuse treatment. RESULTS: Exclusive on-site delivery increased medical utilization during the first month of drug abuse treatment (beta estimate, 0.22; standard error [SE], 0.06; P <0.001). Transportation services also increased 1-month medical utilization (beta estimate, 0.13; SE, 0.03; P <0.001). CONCLUSIONS: Exclusive on-site delivery of medical services increased drug abuse treatment patients' utilization of medical services in the first month of treatment. Transportation assistance warrants strong policy consideration as a facilitator of medical service delivery. Future research should clarify whether program-level linkage to medical services improves the patient-level outcomes of drug abuse treatment.     

The effect of personal use and family history on the attitudes of medical students toward alcohol and drug users

Objective: To investigate the effects of the personal exposure/usage of alcohol and drugs in medical students on their attitudes toward alcohol and drug users. Negative attitudes in health care practitioners about alcohol and drug users may lead to poor patient care. Personal experience on alcohol and drug use can influence the attitudes of health care professionals.

Method: This study used a quantitative cross-sectional methodology, utilizing a self-report survey on the personal use of alcohol and drug use, and the family history of alcohol and tobacco use. The “Substance Abuse Attitude Survey” (Chappel J. N., Veach, T. L., & Krug, R. S. (1985). The Substance Abuse Attitude Survey: An instrument for measuring attitudes. Journal of Studies on Alcohol, 46, 48–52.) measured attitudes (n = 417).

Results: The attitudes of medical students towards alcohol and drug users were weakly linked to their own personal use, and family history of alcohol and drug use. Increased use of alcohol was positively correlated with non-stereotyping. Length of time in medical school, number of years drinking alcohol, and high frequency of binge drinking were negatively correlated with non-moralism.

Conclusions: This study demonstrated that the attitudes of future medical professionals are fairly neutral toward alcohol and drug users. Given that alcohol and drug abuse are now considered medical illnesses health professionals themselves may attach fewer stigmas and stereotypes to the use and abuse of alcohol.     

Second victim phenomenon: Is ‘just culture’ a reality? An integrative review

BackgroundDespite rigorous and multiple attempts to establish a culture of patient safety and a goal to decrease incidence of patient deaths in the health care, estimations of preventable mortality due to medical errors varied widely from 44,000 to 250,000 in hospital settings. This magnitude of medical errors establishes patient safety as being at the forefront of public concerns, healthcare practice and research. In addition to the potential negative impact on patients and the healthcare system, medical errors evoke intense psychological responses in health care providers' responses that threaten their personal and professional selves, and their ability to deliver high quality patient care. Studies show half of all hospital providers will suffer from second victim phenomena at least once in their careers. Health care institutions have begun a paradigm shift from blame to fairness, referred to as ‘just culture’. ‘Just culture’ better ensures that a balanced, responsible approach for both providers who err and healthcare organizations in which they practice, and shifts the focus to designing improved systems in the workplace.ObjectivesThe aim of this review was to identify: how medical errors affect health care professionals, as second victims; and how health care organizations can make ‘just culture’ a reality.DesignAn integrative review was performed using a methodical three-step search on the concept of second victims' perceptions and responses, as well as ‘just culture’ of health care institutions.ResultsA total of 42 research studies were identified involving health care professionals: 10 qualitative studies; eight mixed-method studies; and 24 quantitative studies. Second victims' perceptions of the current ‘just culture’ included: 1) fear of repercussions of reporting medical errors as a barrier; 2) supportive safety leadership is central to reducing fear of error reporting; 3) improved education on adverse event reporting, developing positive feedback when adverse events are reported, and the development of non-punitive error guidelines for health care professionals are needed; and 4) the need for development of standard operating procedures for health care facility peer-support teams.ConclusionsSecond victims' perceptions of organizational and peer support are a part of ‘just culture’. Enhanced support for second victims may improve the quality of health care, strengthen the emotional support of the health care professionals, and build relationships between health care institutions and staff. Although some programs are in place in health care institutions to support ‘just culture’ and second victims, more comprehensive programs are needed.     

Understanding patient satisfaction with family doctor care

Rationale, aims and objectives Patient satisfaction is receiving increased attention in the evaluation of health care quality. However, qualitative methods have seldom been used to study patient satisfaction. The purpose of this study was to explore how satisfaction is understood from the perspective of patients receiving care from family doctors. Method We used a qualitative approach consisting of in‐depth interviews with 36 patients attending clinics in Poland. Interviews were audiotaped and transcribed, and content analysis performed. Results There was no single definition of satisfaction among study participants; however, some core characteristics of satisfaction emerged. These characteristics were: (1) good doctor–patient interaction; (2) health improvement or resolution of health problems; (3) fulfilment of prior expectations; (4) availability of health care; (5) combination of multiple characteristics; and (6) absence of dissatisfaction. Conclusion Because patients have differing concepts of satisfaction with health care provided by family doctors, quality assessments should focus on components of satisfaction whereas questions about satisfaction itself should be avoided.     

The role of psychiatric diagnosis in satisfaction with primary care: data from the department of veterans affairs

BACKGROUND: Although patient satisfaction is widely used as a quality indicator, most such measures do not account for patient subgroups such as those with psychiatric illness. There is also very little data on satisfaction of psychiatric patients with their medical care. OBJECTIVE: The objective of this study was to assess the role of psychiatric illness in satisfaction with outpatient primary care services in the Department of Veterans Affairs (VA). METHOD: Data from the VA Customer Feedback Survey (n = 50,532) were merged with administrative data to determine diagnoses and other characteristics. Satisfaction ratings were compared across psychiatric diagnoses and across various aspects of satisfaction with care. RESULTS: After controlling for patient characteristics (eg, gender, age, disability, acute vs. routine visit) and subjective health, patients with schizophrenia, posttraumatic stress disorder, drug abuse, depression, and other psychiatric disorders reported significantly lower satisfaction with their outpatient primary care. Dissatisfaction was particularly reported for access to care and overall coordination of care. CONCLUSIONS: Despite VA characteristics that might be thought to improve satisfaction (eg, easier access to specialty mental health services as a result of the integrated VA system), patients with psychiatric disorders are significantly less satisfied than patients without such disorders. Possible explanations include both lower technical quality of care and poorer interpersonal communication between providers and patients with mental illness, including the negative effects of stigma. These findings highlight the need for satisfaction ratings to be case-mix-adjusted, including the incorporation of health and mental health diagnoses, and the need for further research that elucidates the reasons behind lower satisfaction ratings.     

Concept analysis: abuse of ageing caregivers by elderly care recipients

PURPOSE: The purpose of this article is to clarify the concept of abuse within the context of ageing women who are at risk for or experiencing physical or emotional injury inflicted by elderly family members for whom they provide care. BACKGROUND: The study of abuse of ageing individuals in family caregiving situations has traditionally focused on abuse of the dependent care receiver. However, evidence supports the health risks related to abuse of ageing caregivers as well. Women, usually spouses, daughters, or daughters-in-law, most frequently assume the caregiver role. METHODS: A modification of the strategies for concept analysis proposed by Walker and Avant (1995) is used to clarify the concept of caregiver abuse. Searches of the professional literature reveal that caregiver abuse is rarely addressed; therefore, the broader concept of elder abuse is reviewed and then placed within the general context of family caregiving. Audiotapes of the first session of a community based intervention research study entitled Intervention for the Abuse of Ageing Caregivers (Phillips et al., NIH Grant No. R01 DA-AG11155-01, 1996), in which ageing women caregivers described abusive caregiving situations, were analysed qualitatively using the principles of concept analysis. The audiotapes serve as a second source of data for the concept analysis process. FINDINGS: Antecedents, defining characteristics, and consequences of abuse of ageing caregivers were identified through the process of concept analysis. Model, contrary, and borderline cases are presented to illustrate the findings. CONCLUSIONS: Findings supported the need for awareness that ageing caregivers can be placed at risk by verbally and physically abusive behaviours of the elders for whom they provide care. Use of the term 'abuse' by health care professionals has potentially negative consequences for identification and intervention in cases of potential or actual caregiver abuse.     

Patient satisfaction with nursing care: a concept analysis within a nursing framework

Title.  Patient satisfaction with nursing care: a concept analysis within a nursing framework.
Background.  Patient satisfaction is an important indicator of quality of care, and healthcare facilities are interested in maintaining high levels of satisfaction in order to stay competitive in the healthcare market. Nursing care has a prominent role in patient satisfaction. Using a nursing model to measure patient satisfaction with nursing care helps define and clarify this concept.
Data sources.  Rodgers' evolutionary method of concept analysis provided the framework for this analysis. Data were retrieved from the Cumulative Index of Nursing and Allied Health Literature and MEDLINE databases and the ABI/INFORM global business database. The literature search used the keywords patient satisfaction, nursing care and hospital. The sample included 44 papers published in English, between 1998 and 2007.
Results.  Cox's Interaction Model of Client Health Behavior was used to analyse the concept of patient satisfaction with nursing care. The attributes leading to the health outcome of patient satisfaction with nursing care were categorized as affective support, health information, decisional control and professional/technical competencies. Antecedents embodied the uniqueness of the patient in terms of demographic data, social influence, previous healthcare experiences, environmental resources, intrinsic motivation, cognitive appraisal and affective response. Consequences of achieving patient satisfaction with nursing care included greater market share of healthcare finances, compliance with healthcare regimens and better health outcomes.
Conclusion.  The meaning of patient satisfaction continues to evolve. Using a nursing model to measure patient satisfaction with nursing care delineates the concept from other measures of patient satisfaction.     

责任制整体护理模式在儿童医院特需留察输液区的应用

目的探讨责任制整体护理模式在儿童特需门诊留察输液区的应用及效果。方法采取整群抽样法将2013年1月～2014年12月在本科输液的患者作为观察组,将2011年1月～2012年12月在本科输液的患者作为对照组。针对患者从就诊流程、环境介绍、输液过程的病情观察、疾病的健康宣教、婴儿喂养指导、心理支持等全面实施责任制整体护理,比较实施前后的医嘱执行错误率及随机调查的患者满意度。结果实施责任制整体护理两年来,与未实施前相比患者满意度提高(P0.05),医嘱执行错误率下降(P0.05)。结论在儿童特需留察输液区应用责任制整体护理能有效提高患者满意度、降低医嘱执行错误率,更及时地发现患者的病情变化,其连续、全程的护理服务得到了更好的落实。     

基于家庭医护平台延续性护理模式的构建及应用

目的 基于家庭医护信息化管理平台（以下简称平台）,构建居家延续性护理模式,并评价其应用效果,以期提高出院患者居家护理质量。 方法 平台由监控平台和操作平台构成。操作平台包括：①患者端APP,包括服务项目页面和个人信息页面,支持用户注册、项目选择、项目预约和评价;②护士端APP,包括提供服务项目、服务申请显示、安全中心及个人信息页面,支持护士注册、接单和安全监控。监控平台负责用户管理、服务项目维护、数据管理及安全监控。利用平台实施出院后患者居家护理服务。调取2018年10月—2019年3月患者满意度和健康知识掌握率等数据,评价平台效果。结果 共231名护士、109例患者完成注册,进行居家护理164次,陪诊8次;接受延续性护理服务后,患者满意度为93.9%,明显高于出院时患者86.2%的满意度（χ ²=4.623,P=0.032）;接受延续性护理服务后,患者对健康知识掌握率为97.7%,明显高于住院患者87.6%的健康知识掌握率（χ ²=14.545,P<0.001）,无投诉和不良事件发生。 结论 家庭医护信息化管理平台可充分发挥临床护士的专业价值,为出院患者提供系统、规范、安全、优质的居家护理服务,明显提高了居家患者满意度和健康知识掌握率,为患者提供了高效、便捷的就医途径。     

Clarifying self‐harm through evolutionary concept analysis

Scand J Caring Sci; 2010; 24; 610–619
Clarifying self‐harm through evolutionary concept analysis Clarification of the concept self‐harm is needed in order to enable research and theory development and facilitate the development and evaluation of medical interventions and nursing care for individuals who self‐harm. This study presents such a conceptual analysis. Articles from 1997 to 2007 were sought from the Medline, PubMed, Cinahl, and PsychINFO search engines by entering the search words ‘self‐harm’, ‘self‐harming’, and ‘psychiatric care’. 25 medicine and 23 nursing science articles were chosen for inclusion and analysed. Rodgers’ evolutionary concept analysis process was used to delineate and clarify the concept’s context, surrogate terms, antecedents, attributes, and consequences, as well as to determine implications for further research. Attributes of self‐harm may include repetitive injury of mouth or exterior body, that is to say the infliction of physical pain to alleviate mental pain, and time spent self‐harming. Antecedents may be gender, mental pain, substance abuse and relational problems. Consequences often include the need for medication and help with altering coping behaviour. Some self‐harm patients met with negative attitudes from nurses. Individualized care and treatment is recommended. Accordingly, inter‐professional collaboration and postgraduate education is needed in order to provide better care and treatment for self‐harm patients. Furthermore, better understanding is needed to help enable health care personnel understand why individuals self‐harm. The conceptual analysis presented in this study may be helpful as regards theory development within this still rather unexplored field.     

Perceptions of experiences of graft rejection among organ transplant recipients striving to control the uncontrollable

Aim. To investigate perceptions of graft rejection and different methods to obtain knowledge about graft rejection among adult organ transplant recipients. Background. Rejection is the most common cause of graft loss and graft dysfunction in clinical transplantation. Little is known about the recipients’ own explanation models related to graft rejection. Design. Phenomenography. Method. A strategic selection included patients who had undergone a kidney, liver, heart or lung transplant. Sixteen patients, six males and 10 females, aged 21–63 years with a follow‐up time of between three months and 10 years were interviewed. Results. The result comprised five domains of variations in perceptions of graft rejection: the abstract threat to life; the concrete threat to health; trust in the body; striving to control the threat; and one’s identity. The inner perspective and personal explanation models involved threat, fear, trust, control and identity adjustment. Different approaches had the same purpose; ‘striving to control the uncontrollable’. Conclusion. Learning about graft rejection revealed security, lack of security and uncertainty. Relevance to clinical practice. The inner perspective of graft rejection in this result leads to several clinical implications in terms of patient education and recipients’ differing ways of obtaining knowledge about graft rejection. We suggest that patient’s education should be tailored in a different way, offering support and advice in line with their personal models of explanation of graft rejection as a complement to the explanation from the biomedical model of disease.     

Measuring patient assessments of the quality of outpatient care: a systematic review

Rationale, aims and objectives The aim of the study was to answer three questions: first, what methods have been used to measure patient assessments of the quality of care? Second, how do outpatients rate their care? And third, what needs to be taken into account in measuring patient assessments of the quality of care? Methods Systematic review of the literature. Electronic searches were conducted on Medline, CINAHL and the Cochrane Database of Systematic Reviews. To be included, articles were to deal with patients’ assessments of health care in ambulatory units for somatic adult patients. They were to have been published between January 2000 and May 2005, written in English, Swedish or Finnish with an English abstract, and the research was to have been conducted in Europe. The search terms used were: ambulatory care, ambulatory care facilities, outpatient, outpatients, patient satisfaction and quality of health care. The articles were screened by two independent reviewers in three phases. Results Thirty‐five articles were included. The quality of care was measured using both quantitative and qualitative methods. Only a few studies relied on the single criterion of patient satisfaction for quality measurements. It is easy to identify common sources of dissatisfaction in different studies. Sources of satisfaction are more closely dependent on the target population, the context and research design. Conclusion Patient satisfaction is widely used as one indicator among others in assessing the quality of outpatient care. However, there is no single, universally accepted method for measuring this.     

Unpacking the concept of patient satisfaction: a feminist analysis

AIM: The aim of this paper is to present a feminist critique of the concept of patient satisfaction. BACKGROUND: Fiscal restraint, health care restructuring, shifting demographics, biomedical technological advances, and a significant shortage of health care professionals are stretching health care systems across North America to the breaking point. A simultaneous focus on consumerism and health service accountability is placing additional pressure on the system. The concept of patient satisfaction, with roots in the consumer movement of the 1960s, has both practical and political relevance in the current health care system and is commonly used to guide research related to consumer experiences of health care. Because the quality of health care encounters may lead to treatment-seeking delays, patient satisfaction research may be an effective vehicle for addressing this public health issue. However, there is wide agreement that patient satisfaction is an under-theorized concept. Using current conceptualizations of patient satisfaction, we end up all too often producing a checklist approach to 'achieving' patient satisfaction, rather than developing an understanding of the larger issues underlying individual experiences of health care. We focus on the symptoms rather than the problems. DISCUSSION: Without further theoretical refinement, the results of research into patient satisfaction are of limited use. To push forward theoretical development we might apply a variety of theoretical lenses to the analysis of both the concept and the results of patient satisfaction research. Feminism, in particular, offers a perspective that may provoke further refinement of patient satisfaction as a concept. CONCLUSIONS: Without a deeper understanding of the values and beliefs (or the worldview) that informs our approaches to researching patient satisfaction, researchers will be reacting to the most obvious indicators and failing to address the underlying issues related to individual experiences of health care.     

应用Rodgers演化概念分析法界定慢性心力衰竭患者的自我管理

目的运用Rodgers演化概念分析法界定慢性心力衰竭患者自我管理的概念。方法系统检索Pubmed、CINAL、PsycINFO和万方数据知识服务平台,根据有关标准纳入了36篇文献进行概念分析,从概念的演变史、定义性特征、先决条件、结局、同义词与近义词、测评指标等方面,对当前慢性心力衰竭自我管理的概念进行了分析。结果慢性心力衰竭患者自我管理涉及一个递进的自我调节过程,包括5个定义性特征:疾病知识、寻求支持、自我效能、行为表现和自我感知。其先决条件包括个体因素和环境资源,结局关注再住院率(病死率)、医疗费用、生活质量和自我管理。结论澄清慢性心衰患者自我管理概念有助于临床开发慢性心力衰竭自我管理支持项目,编制有效评价慢性心衰患者自我管理的测评工具是未来的研究方向之一。     

A Comparison of Three Measures of Elder Abuse

PURPOSE: To present a comparison of three measures for assessing elder abuse. DESIGN AND METHODS: Three measures for assessing elder abuse were identified through a literature review. The characteristics and uses of each measure were reviewed and evaluated. FINDINGS: The Indicators of Abuse (IOA) is a 22-item tool for discriminating abuse and nonabuse cases; it is completed by a health care professional after a home assessment is conducted. The Elder Abuse and Neglect Assessment (EAI) is a 44-item scale comprised of seven sections to review signs, symptoms, and subjective complaints of elder abuse, neglect, exploitation, and abandonment; it can be used by health care providers in all clinical settings. The Elder Abuse Screening Test (EAST) is a 15-item tool to be completed by a health care provider based on the patient's responses. This screening tool is limited because of the small unrepresentative samples used to test it, the low internal consistency, and a relatively high false-negative rate. CONCLUSIONS: An instrument to accurately assess elder abuse in long-term care is needed. Proper identification of elder abuse is the first step in assisting victims in dealing with abusive situations.     

临床护理路径在急性心肌梗死冠状动脉介入术患者中的应用

目的:探讨临床护理路径(CNP)在急性心肌梗死(AMI)行冠状动脉介入术患者中的应用方法及临床效果.方法:将64例AMI患者随机分为实验组和对照组各32例,对照组进行常规护理,实验组按CNP进行护理,比较两组住院天数、医疗费用、并发症发生率及患者满意度.结果:实验组住院天数、并发症发生率、患者的满意度与对照组比较差异有统计学意义(P<0.05).结论:将CNP应用于AMI行冠状动脉介入术患者,可提高护士的工作效率和患者的满意度,控制医疗成本,保证护理质量,值得临床推广.