Patients' experience of privacy and dignity. Part 2: An empirical study

In May-June 2006, a self-report questionnaire was completed by 40 inpatients to assess their experience of privacy and dignity in hospital. The questionnaire comprised closed and open questions, where the latter, among other things, required the patient's own narrative. Results indicate that patients view privacy/dignity as crucial. Although the staff and inadequate ward layouts compromise and conspire against patients' privacy and dignity, patients appear to sympathize with how hospitals are run, even if the caring environment fails to provide full privacy. Women have greater concerns, and both genders indicated how their privacy and dignity could be met. Recognizing problems relating to meeting patients' privacy and dignity, the article challenges clinical staff and hospital designers to address the issue, especially as central government initiatives and law demand serious attention to ensuring patients' privacy and dignity. Research is indicated to ascertain hospital designs, preferred care strategies and education to address the problem.     

Patients' rights to privacy and dignity in the NHS

AIM: To determine the extent to which patients' rights to privacy and dignity are respected in the NHS when judged against the seven factors of 'privacy and dignity' as outlined in the Essence of Care document (Department of Health (DH) 2001a). METHOD: An ethnographic methodology was used. Fieldwork took place over six months in three acute wards with surgical and medical patients in a large district NHS hospital, using non-participant observation, unstructured interviews with patients (n=55) and staff (n=12), and semi-structured interviews with patients (n=18) and staff (n=22). The culture and ward environment experienced by patients and staff in their everyday life were documented. FINDINGS: Medical and nursing staff had little awareness of the importance of the Human Rights Act 1998 and government documents about patients' privacy. They compromised the privacy and dignity of patients when judged against the Essence of Care benchmarks (DH 2001a). CONCLUSION: Educationalists, doctors, nurses and other practitioners should promote the importance of patients' privacy and dignity within the NHS. This issue should be integrated into undergraduate and postgraduate healthcare curricula.     

Care of the body: maintaining dignity and respect

Technology has always been part of nursing. The use of technology now, although it is more advanced and sophisticated than technologies of the past, will remain a crucial component of nursing practice. Nursing has the ability to successfully mediate the effects of technology in nursing practice. Regardless of the technological advancements, there are certain elements of practice in nursing, such as bathing, which have not changed in many was over the years. A reflection on the care of the body, both from a historical perspective and within a caring-healing-health paradigm informs nursing practice. The daily practice of tending to and comforting the patient through preservation of cleanliness requires skilled knowledge and a deliberate choice of action that honours the patient during this sensitive aspect of nursing practice.     

Communication: the key to improving the prostate cancer patient experience

In 2010, an estimated 24,600 Canadian men were diagnosed with prostate cancer (Canadian Cancer Society, 2011). Upon diagnosis, men and their family members begin an arduous journey of information gathering surrounding prostate cancer and its various forms of treatment. Men have to consider the impact a treatment may potentially have on their quality of life and, frequently, they experience decisional conflict and require support. In May 2008, the Prostate Cancer Assessment Clinic opened to receive men for an evaluation of a possible prostate cancer. Our inter-professional model of care provides support, guidance and education to our patients from assessment to diagnosis and treatment planning. A major goal of our diagnostic assessment unit has been to improve the patient experience. Communication is defined as "to make known, to exchange information or opinions" (Cayne, Lechner, et al., 1988). Nursing is the critical link for information exchange that is patient-centred and collaborative. The focus of this paper will highlight the development and implementation of nurse-led initiatives within our program to improve the prostate cancer patient experience. These initiatives include: a patient information guide, prostate biopsy care, patient resources, community links, surgery education classes and implementation of a decision aid. Communication is the key.     

A patient education MAP: an integrated, collaborative approach for rehabilitation.

Because Roosevelt Warm Springs Institute for Rehabilitation has been faced with decreasing patient lengths of stay, increasing patient acuity, and changes in the nurse staffing mix, nurses wanted to ensure that patients and their families were receiving appropriate education and learning the skills required to provide safe and competent self-care in the home. As a result, they developed a patient education action plan. This multidiscipline action plan (MAP) involved changing from a multidisciplinary to an interdisciplinary approach toward patient and family education. This plan provides a framework that is linked to expected outcomes for education during a patient's stay, reduces the redundancy of patient education by professionals from different disciplines, and increases collaboration. Teaching modules that outline and provide all of the information an educator needs to effectively teach a patient or group of patients make up the basis for the MAP system. This article describes the MAP system and the related continuous quality improvement activities, offers documentation forms, and identifies a structural path.     

A relationship-based approach to improving clinical trials: The imCORE research network experience

The rapid evolution of cancer immunotherapies has increased demand for timely introduction of new therapies and subsequently increased the demand on leading cancer research institutions worldwide. As a leader in cancer therapy research, Roche created the immunotherapy Centers of Research Excellence (imCORE) Network, a worldwide research network designed to more closely connect members in an open environment of shared information, expertise, and decisions. This network is dedicated to increasing the understanding of the underlying science in order to prioritize and accelerate the most promising new treatment options for patients. The network consists of two key pillars, Roche-sponsored clinical trials operational excellence and the imCORE network scientific collaborations. This paper focuses on the Roche-sponsored trial clinical operational excellence aspects of the network. This special contribution introduces the rationale, design, and success factors of sponsored trials within the imCORE Network, including critical components and examples of tangible improvements to clinical trial operations between the company sponsor and the trial sites. Pivotal success factors have included relationship architecture and management, transparent communication channels, open information-sharing, and the development of new processes and tools to overcome historical inefficiencies and challenges of all sizes. The shared dedication of stakeholders to cancer therapy innovation, operational improvement of clinical trials, and a durable, sustainable worldwide research collaborative has made this component of imCORE effective to date. The authors share this experience with the broader research community for the first time, in the same spirit of collective advancement of care for patients with cancer.     

Measuring and improving the patient experience in radiology

Recently enacted healthcare legislation and the associated payment reforms have shifted the focus from traditional fee for service models to adding measurable and appreciable value to the patient experience. The value equation links quality to costs, and quality metrics are now directly related to patient outcomes and the patient experience. To participate effectively in this new paradigm requires not only that we provide excellent, timely and appropriate patient-centric care at all times, but that we are able to measure and manage the feedback we obtain from our patients. Of course, in order to provide value-added care, we must know not only who our customers are, but what they value. In this review, we explore factors that impact patient perception and experience with imaging services. We further illustrate different ways that patient feedback can be elicited and provide pros and cons of each approach. Collecting appropriate data is insufficient by itself; such data must be carefully analyzed, and opportunities for improvement must be identified, introduced, and monitored ahead of future surveys.

     

A system-level approach to improving the care of the older critical care patient

As the population continues to age, the specialized needs of older adult patients warrant the close attention of the critical care nurse. The combination of critical illness, age-related changes, multiple comorbidities, and the hospital environment can make the diagnosis and management of the older adult's critical illness challenging. The NICHE (Nurses Improving Care for Healthsystem Elders) program provides a framework to create an aging-sensitive care environment in the critical care setting. The Geriatric Resource Nurse model is the foundation of the program. The goals of NICHE are to support nursing departments to (1) bring evidence-based geriatric practice to the bedside; (2) build patient- and family-centered environments; (3) cultivate healthy and productive practice environments aligned with meeting the specialized needs of older adults and their families ("geriatric nursing practice environments"); and (4) conduct comprehensive measurement of geriatric initiatives.     

Enhancing patient safety: improving the patient handoff process through appreciative inquiry

Patient transfers from one care giver to another are an area of high safety consequence, as is evident by many studies and the Joint Commission on Accreditation of Healthcare Organization's Patient Safety Goals. The authors describe how one hospital made measurable improvements in a patient handoff process by using an unconventional approach to change called appreciative inquiry. Rather than identifying the root causes of ineffective handoffs, appreciative inquiry was used to engage staff in identifying and building on their most effective handoff experiences.