Mental health consumer perspectives of a person-centred multidisciplinary care planning meeting on a rehabilitation inpatient unit

Mental health consumers are seeking genuine involvement in the planning regarding their treatment and care; however for many consumers in inpatient mental health settings, there is not the opportunity to participate. Current research evaluating person-centred multidisciplinary care planning initiatives in inpatient settings from the consumer perspective is limited. The aim of this study was to explore the consumer perspective of a person-centred multidisciplinary care planning meeting implemented in an Australian inpatient mental health rehabilitation unit. This study used a focused ethnographic design with data collection including fieldnotes, observations of meetings and interviews. Ten individuals participated in the study, with two participating in meeting observations and eight participating in structured interviews. Participants were consumers with a mental health diagnosis admitted to a mental health rehabilitation unit for assistance with achieving their goals for community living. Findings were analysed utilizing thematic analysis. Findings showed that consumers' experiences of the care planning meetings were positive. Themes included; ‘It's about you’, ‘Making decisions and expressing opinions’, ‘Staff involvement in care planning’ and ‘Supporting consumer recovery’. These findings add the consumer perspective to the existing evidence base and support the implementation of person-centred multidisciplinary care planning meetings in inpatient mental health settings.     

Planning: a necessary step in clinical care

Aim.  The aim of this paper is to highlight the significance of care planning and to encourage the integration of a consistent and systematic planning process into nursing practice. Background.  Many factors contribute to the successful achievement of clinical outcomes, including patient–practitioner rapport, comprehensive client assessment, accurate differential diagnosis, evidence‐based care and the objective evaluation of client progress. One element that is of equal importance to these aforementioned factors is the planning of patient care. However, there are concerns that some practitioners may not be adopting a planned approach to client care, possibly because of a lack of understanding, time, skill or interest in care planning. Method.  This is a position paper on the planning of patient care. Results.  The planning of patient care can be effectively implemented using a two‐stage process. In brief, the first step involves the construction of a general goal, which is the overall, desired outcome of care. The expected outcome, or specific goal, forms the second part of the planning process, which clearly directs clinical care by specifically indicating how and when an individual will achieve the general goal of treatment. Conclusion.  This paper highlights the importance of care planning and that the use of a clear, systematic planning framework may help to deliver a more transparent and consistent approach to patient care, which may greatly improve patient health and well‐being by hastening the achievement of clinical outcomes. Relevance to clinical practice.  The knowledge and strategies contained in this paper can be easily adopted by nurses and other clinicians to modify or build upon existing practice. This knowledge may help foster a more client‐centred, participative, individualised approach to care, which may lead to improvements in patient outcomes.     

A 22 month study of patient complaints at a National Health Service hospital

Patient complaints are an important source of information for service improvements. We audited patient complaints made about medical care in a National Health Service District general hospital over a 22 month period. Complaints were about medical care, nursing care, attitudes of staff, poor communication, clinical delay (9%) and hospital environment. The complaints department closed 66% complaints within 20 days. The majority of the complaints were directly related to clinical care, poor communication, attitudes of staff and nursing care. However, 99% of patients were satisfied with an explanation and an apology indicating that almost all have been due to a lack of good communication than due to real deficiencies in the clinical care. The hospital management has investigated the majority of cases within 20 days and has made several policy changes after the investigations.     

Your ideas about participation and environment: a new self-report instrument

Abstract

Purpose: To examine the meaningfulness, usefulness and acceptability of a new self-report instrument: “your ideas about participation and environment” (YIPE). Method: Cognitive interviewing was employed with 10 adults with disabilities to explore YIPE questions and formatting. Thematic content procedures were used in data analysis. The instrument was revised; participants were re-interviewed and data were re-examined. Results: Participants considered the YIPE as a helpful tool to assist with developing person-centred goals and communicating their needs to health professionals, thus establishing its meaningfulness. They believed it could be useful at various points in the intervention process (e.g. preparation, monitoring, and evaluation). Participants also endorsed the YIPE’s computer-based format, thus confirming its acceptability. Conclusions: The findings support the meaningfulness, acceptability and usefulness of the YIPE and consequently its potential for empowering service users and promoting person-centred care. Using the International Classification of Functioning, Disability and Health as the basis resulted in an instrument that was appropriate for understanding the interrelationship between participation and the supportiveness of the usual environment in which participation generally takes place.

• Implications for Rehabilitation

• The YIPE is a useful tool to assist with developing person-centred goals, communicate needs with health professionals and it can be used at various points in a therapy process (preparation, monitoring or evaluation).

• The interrelationship between participation and the environment is important to consider when measuring functioning.

• Self-report empowers people to play an active role in interactions with health professionals and promote their own care.

     

Patient satisfaction and outcome using emergency care practitioners in New Zealand

Objective: A patient satisfaction survey was undertaken in the Kapiti District of the Wellington Region to ascertain patients' experience and opinions of New Zealand's first extended care paramedic (ECP) service before consideration is given to extending it to other locations within the region. Patient outcomes were also analysed for 1 week following ECP care. Methods: One hundred patients, 50 attended by ECPs and 50 by standard emergency ambulance service paramedics, were interviewed by an independent assessor, either in person or by phone according to patient preference. The questionnaire was aimed at comparing the experience of both groups of patients, dividing them into those treated at home and those transferred to the ED. ED and general practice records were then reviewed to determine whether the ECP‐treated patients attended either facility within 7 days and why. Results: Patients were very satisfied with their experience of both groups of paramedics but expressed a clear desire to be treated at home if possible. Of the 50 ECP‐treated patients, 11 were transferred directly to the ED. Only one clinical complication arose over the next 7 days in those treated in the community: a seizure in a patient with refractory epilepsy. Conclusion: The avoidance of unnecessary transfers to hospital is beneficial to patients, the ambulance service and the ED. This study demonstrates that patients are very satisfied with their assessment and treatment by ECPs, endorsing the proposal that the scheme should be extended across the Wellington Region, and perhaps New Zealand.     

Effect of visit length and a clinical decision support tool on abdominal aortic aneurysm screening rates in a primary care practice

Rationale, aims and objectives In 2005, the US Preventive Services Task Force issued recommendations for one‐time abdominal aortic aneurysm (AAA) screening using abdominal ultrasonography in men aged 65 to 75 years with a history of smoking. However, despite a mortality rate of up to 80% for ruptured AAAs, providers order the screening for a minority of patients. We examined AAA screening rates among providers and investigated the role of visit duration and other factors in whether patients received screening. We also looked for potential interventions to improve compliance. Methods We retrospectively reviewed the records of patients who visited our clinic over a 4‐month period and met the US Preventive Services Task Force criteria for AAA screening when our practice had a real‐time decision support tool implemented to identify patients due for the screening. We also surveyed our clinic's providers about their knowledge and attitudes regarding AAA screening. Results Despite the use of physician reminders, providers ordered screening for only 12.9% of eligible patients. Screening was more likely to be ordered during longer visits versus shorter ones (24% vs. 6%). When surveyed, most providers (70.6%) indicated that a nurse‐directed ordering system would improve compliance. Conclusions This study illustrates that physician reminders alone are not sufficient to improve care and that more time is needed for preventive services. This provides additional support for the use of a multidisciplinary approach to preventive screening, as in a patient‐centred medical home. In a patient‐centred medical home, a care team of physicians, nurses and office staff use technology such as clinical decision support to provide comprehensive, coordinated patient care.     

Sharing specialist skills for diabetes in an inner city: a comparison of two primary care organisations over 4 years

OBJECTIVE: To evaluate the effects of organizational change and sharing of specialist skills and information technology for diabetes in two primary care groups (PCGs) over 4 years. METHODS: In PCG-A, an intervention comprised dedicated specialist sessions in primary care, clinical guidelines, educational meetings for professionals and a shared diabetes electronic patient record (EPR). Comparison was made with the neighbouring PCG-B as control. In intervention and control PCGs, practice development work was undertaken for a new contract for family doctors. Data were collected for clinical measures, practice organizational characteristics and professional and patient views. RESULTS: Data were analysed for 26 general practices including 17 in PCG-A and nine in PCG-B. The median practice-specific proportions of patients with HbA1c recorded annually increased in both areas: PCG-A from median 65% to 77%, while PCG-B from 53% to 84%. For cholesterol recording, PCG-A increased from 50% to 76%, and PCG-B from 56% to 80%. Organizational changes in both PCGs included the establishment of recall systems, dedicated clinics and educational sessions for patients. In both PCGs, practices performing poorly at baseline showed the greatest improvements in organization and clinical practice. Primary care professionals' satisfaction with access and communication with diabetes specialist doctors and nurses increased, more so in the intervention PCG. Only 16% of primary care professional respondents used the diabetes EPR at least monthly. Patient satisfaction and knowledge did not change. CONCLUSIONS: Improvements in practices' organizational arrangements were associated with improvements in clinical care in both PCGs. Sharing specialist skills in one PCG was associated with increased professional satisfaction but no net improvement in clinical measures. A shared diabetes EPR is unlikely to be used, unless integrated with practice information systems.     

Failure to report poor care as a breach of moral and professional expectation

Cases of poor care have been documented across the world. Contrary to professional requirements, evidence indicates that these sometimes go unaddressed. For patients, the outcomes of this inaction are invariably negative. Previous work has either focused on why poor care occurs and what might be done to prevent it, or on the reasons why those who are witness to it find it difficult to raise their concerns. Here, we build on this work but specifically foreground the responsibilities of registrants and students who witness poor care. Acknowledging the challenges associated with raising concerns, we make the case that failure to address poor care is a breach of moral expectation, professional requirement and, sometimes, legal frameworks. We argue that reporting will be more likely to take place if those who wish to enter the profession have a realistic view of the challenges they may encounter. When nurses are provided with robust and applied education on ethics, when “real‐world” cases and exemplars are used in practice and when steps are taken to develop and encourage individual moral courage, we may begin to see positive change. Ultimately however, significant change is only likely to take place where practice cultures invite and welcome feedback, promote critical reflection, and where strong, clear leadership support is shown by those in positions of influence across organisations.     

老年患者心理护理路径表的设计与应用

目的探讨老年患者心理护理路径表的应用方法与效果。方法根据老年内科患者住院特点及心理需求设计开发临床心理护理路径表,分7个步骤指导责任护士开展心理护理。结果 100.00%的护士认为心理护理路径表能够有效帮助护士开展心理护理服务;观察组96.67%的患者认为责任护士能够积极关注自己的情绪变化;100.00%的患者感受到护士的心理支持,因而对护理服务满意度提高,与对照组比较差异具有统计学意义(P<0.01或P<0.05)。结论心理护理路径表有助于提高老年病房心理护理服务质量。     

癌症病人的临终关怀与护理

简要阐明了临终关怀护理的发展及其服务机构的形式 ,综述了癌症病人临终关怀护理的重点是控制症状、给予病人及其家属心理支持 ,提出护理人员有责任开展和宣传临终关怀的意义 ,提高临终关怀的护理质量。     

The Newcastle Satisfaction with Nursing Scales: a valid measure of maternal satisfaction with inpatient postpartum nursing care

AIM: To test the validity of The Newcastle Satisfaction with Nursing Scales as measures of patient satisfaction with nursing care in an inpatient postpartum unit. BACKGROUND: The Newcastle Satisfaction with Nursing Scales (Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale) were developed to measure the satisfaction of medical-surgical inpatients with nursing care. METHODS: The Newcastle Satisfaction with Nursing Scales were administered by interviewers to 189 postpartum women prior to hospital discharge. We tested the construct validity of the scales by making five a priori predictions: mothers who were more satisfied would be more likely to have one nurse caring for them and to recommend the postpartum unit to a friend. We also predicted that the Experience of Nursing Care and Satisfaction with Nursing Care Scales would be positively correlated with each other, with a global question about satisfaction with nursing care, and with a global question about satisfaction with overall postpartum stay. RESULTS: Four of the five a priori predictions were supported by the data. The mean Newcastle Satisfaction with Nursing Scale scores of mothers who would recommend the unit to a friend were higher (more satisfied) than those who would not (P < 0.001). The Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale were positively and significantly correlated with each other (r = 0.9, P < 0.001). There was a positive and significant correlation between the scales and global ratings of nursing care (Experience Scale r = 0.79, P < 0.001; Satisfaction Scale r = 0.82, P < 0.001) and overall postpartum stay (Experience Scale r = 0.64, P < 0.001; Satisfaction Scale r = 0.68, P < 0.001). CONCLUSION: The Newcastle Satisfaction with Nursing Scales are valid measures of maternal satisfaction with inpatient postpartum nursing care.