Patient information and participation still in need of improvement: evaluation of patients' perceptions of quality of care

Fröjd c ., Swenne c.l ., Rubertsson c ., Gunningberg l . & Wadensten b. (2011) Journal of Nursing Management 19, 226–236
Patient information and participation still in need of improvement: evaluation of patients’ perceptions of quality of care Aims To identify areas in need of quality improvement by investigating inpatients’ perceptions of quality of care, and to identify differences in perceptions of care related to patient gender, age and type of admission. Background Nursing managers play an important role in the development of high-quality care. Methods Quality of care was assessed using the Quality from the Patients’ Perspective (QPP). In all, 2734 inpatients at a Swedish university hospital completed the QPP. Results Inadequate quality was identified for 15 out of 24 items, e.g. information given on treatment and examination results, opportunities to participate in decisions related to care and information on self-care. Patients with emergency admissions reported lower scores for quality of information and doctors’ care than did patients with planned admissions. Conclusion Results from the present survey identified areas in need of quality improvement and differences in perceived care quality between patients. Quality of care must be developed in close collaboration with other healthcare professionals; in this respect, nursing managers could play an important role. Implications for nursing management Nursing managers could play a more active part in measuring quality of care, and in using results from such measurements to develop and improve quality of care.     

Oncology patients' perceptions of quality nursing care

The purpose of this study was to analyze theoretically oncology patients' perceptions of the attributes and outcomes of quality nursing care. The grounded theory method as described by Strauss and Corbin (1998) was used. The purposive sample comprised 22 oncology patients being treated at an urban medical center; they were interviewed using a semistructured schedule. Eight attributes of quality nursing care emerged from the data. From the patient's perspective, excellent care was characterized by professional knowledge, continuity, attentiveness, coordination, partnership, individualization, rapport, and caring. In addition, two outcomes of quality care included increased fortitude and a sense of well-being with its constituents of trust, optimism, and authenticity. These findings can inform investigations of how oncology patients may experience "being well cared-for by nurses. Copyright John Wiley & Sons, Inc.     

Stroke patients' perceptions of hospital nursing care

? While nursing remains uncertain about the nature of its role in stroke rehabilitation, recent research by social scientists re-affirms its importance. ? This study explored a small number of stroke patients' perceptions of hospital nursing care in order to illuminate the meaning of the role in practice. ? Informants' early experiences of nursing care in general medical and care of the elderly assessment wards were dominated by having the necessary done, while nursing in the Stroke Rehabilitation Unit was characterized by a do it yourself approach. ? These two concepts are explored in detail and related to the existing literature, suggesting some specific areas for practice development and research.     

Nurses' and patients' perceptions of expert palliative nursing care

AIM: This paper reports a study of the perceptions of patients and nurses of palliative care and, in particular, the concept of the expert palliative nurse. BACKGROUND: Palliative care is a growing specialty and is practised globally. There is, however, limited information on patients' views about palliative care. While the idea of expertise in nursing is not new, few studies have explored the concept of the expert nurse in palliative care. Some evidence exists on palliative nurses' perceptions of their care, that it is supportive and involves maintaining therapeutic relationships with patients. Facing a terminal illness has been identified as a stressful and fearful experience that affects all aspects of life. It has also been revealed that dying patients may have unmet care needs, mainly in the areas of pain and symptom control, emotional support, and spending time alone. METHODS: A phenomenological study was carried out, using in-depth interviews and thematic content analysis. A convenience sample of 22 Registered Nurses and 22 dying patients was interviewed in 1996-1997. FINDINGS: Dying patients had a desire to maintain independence and remain in control. Palliative care nurses experienced both effective and ineffective interpersonal communication, the building of therapeutic relationships with dying patients and attempting to control patients' pain and distressing symptoms. Patients and nurses agreed that the two most important characteristics of an expert palliative nurse were interpersonal skills and qualities such as kindness, warmth, compassion and genuineness. CONCLUSION: Although the study was conducted in the United Kingdom, the findings have relevance for palliative care practice globally in terms of dependence, issues of patient choice, nurses being interpersonally skilled and building therapeutic relationships with patients.     

Correlates of hospitalized patients' perceptions of service quality

The purpose of this study was to examine hospital patients' perceptions of service quality in relation to four independent variables: (a) nurses' perceptions of human resource practices, (b) nurses' perceptions of autonomy in practice, (c) patient satisfaction with nursing care, and (d) patients' perceptions of organizational climate for service. The sample consisted of 102 nurse–patient dyads in an acute care hospital. Patients responded to the Modified Health Care Service Performance Instrument, the revised LaMonica–Oberst Patient Satisfaction Scale, and the Organizational Climate for Service Semantic Differential. Nurses responded to the Employee Turnover Diagnostic and the Dempster Practice Behaviors Scale. Two of the four correlational hypotheses were supported. Patient satisfaction with nursing care and patients' perceptions of organizational climate for service were each positively related to patients' perceptions of service quality. A multivariate regression hypothesis was not supported. Failure to support two theoretically based correlational hypotheses may be related to methodological problems experienced with dyadic research. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 339–349, 1998     

肠造口病人的分期护理

从术前、恢复期、康复期对肠造口病人的常见心理问题、并发症及护理进行了综述     

Q群在肠造口术后病人延续护理中的应用研究

目的:探讨Q群在肠造口术后病人延续护理中的应用效果。方法:选取在我院因结直肠癌行肠造口(包括永久性造口及临时性造口)手术的病人95例,将病人随机分为观察组53例和对照组42例。两组病人住院期间及出院前均进行相同的护理和健康教育,出院后对照组给予常规书面指导、电话回访、定期复查;观察组利用Q群互动、定期复查。评价两组病人术后1个月、3个月、6个月的生活质量得分、造口适应得分及造口周围皮肤并发症的发生率。结果:术后1个月、3个月、6个月观察组造口适应得分高于对照组,术后3个月、6个月生活质量总分高于对照组,造口周围皮肤并发症发生率低于对照组,差异均有统计学意义(P<0.05)。结论:利用Q群进行延续护理可以有效提高肠造口病人的适应水平及生活质量,降低并发症发生率。     

Hospitals' organizational variables and patients' perceptions of individualized nursing care in Finland

Aim  To examine the association between hospitals' organizational variables and patients' perceptions of individualized care.
Background  There is lack of evidence related to the effects that the hospital environment has on patient perceptions of the individuality of care they receive.
Methods  A cross-sectional design was used. The questionnaire survey data were obtained from 861 (response rate 82%) hospital patients and 35 (100%) nurse managers in Finland.
Results  An inverse relationship between the size of the hospital and ward and patients' perceptions of individualized care was found. Increased staffing or skill mix failed to predict a higher patient perception of individualized care, but primary nursing care delivery did.
Conclusions  Instead of increasing the amount of nursing staff, there is a need to improve the quality of the nurse–patient interactions to facilitate individualized care. The generalizability of the study is limited by the regional nature of the setting.     

肠造口护理进展

从心理护理、造口护理、康复期护理方面综述了近年来我国肠造口病人护理的发展，并提出今后要重视造口治疗师的培养、社区护理及家庭护理干预。     

Nurses', midwives' and patients' perceptions of trained health care assistants

AIM: This paper reports on part of a larger study and outlines Registered Nurses' and Midwives' perceptions of, and satisfaction with, trained health care assistants in a regional hospital setting in the Republic of Ireland. BACKGROUND: An increased reliance upon health care assistants in the clinical setting has highlighted the need to consider how staff and patients perceive the health care assistant role. FINDINGS: Nurses were satisfied with the work undertaken by trained health care assistants and considered that they contributed positively to patient care and supported nurses/midwives by undertaking non-professional duties. However, maternity clients reported that health care assistants were mostly giving direct care, and their availability was perceived to be better than that of qualified staff. Some nurses/midwives were reluctant to assume responsibility for delegation of direct care duties to health care assistants. CONCLUSION: The employment of health care assistants yields positive outcomes for staff and female clients but consideration must be given to role clarity. Further research into how qualified staff perceive health care assistants is important as such perceptions influence delegation, integration, role development and acceptance of health care assistants.     

Patients' perceptions of barriers for participation in nursing care

Scand J Caring Sci; 2011; 25; 575–582
Patients’ perceptions of barriers for participation in nursing care Background: In many Western countries as in Sweden, patients have legal right to participate in own care individually adjusted to each patient’s wishes and abilities. There are still few empirical studies of patients’ perceptions of barriers for participation. Accordingly, there is a need to identify what may prevent patients from playing an active role in own nursing care. Such knowledge is highly valuable for the nursing profession when it comes to implementation of individual patient participation. Aim and objective: To explore barriers for patient participation in nursing care with a special focus on adult patients with experience of inpatient physical care. Methodological design and justification: Data were collected through 6 focus groups with 26 Swedish informants recruited from physical inpatient care as well as discharged patients from such a setting. A content analysis with qualitative approach of the tape‐recorded interview material was made. Ethical issues and approval: The ethics of scientific work was adhered to. Each study participant gave informed consent after verbal and written information. The Ethics Committee of Göteborg University approved the study. Results: The barriers for patient participation were identified as four categories: Facing own inability, meeting lack of empathy, meeting a paternalistic attitude and sensing structural barriers, and their 10 underlying subcategories. Conclusions: Our study contributes knowledge and understanding of patients’ experiences of barriers for participation. The findings point to remaining structures and nurse attitudes that are of disadvantage for patients’ participation. The findings may increase the understanding of patient participation and may serve as an incentive in practice and nursing education to meet and eliminate these barriers, in quality assurance of care, work organization and further research.     

Cancer-related pain in palliative care: patients' perceptions of pain management

BACKGROUND: Pain is still a significant problem for many patients with cancer, despite numerous, clear and concise guidelines for the treatment of cancer-related pain. The impact of pain cognition on patients' experiences of cancer-related pain remains relatively unexplored. AIM: The aim of this study was to describe how patients with cancer-related pain in palliative care perceive the management of their pain. METHOD: Thirty patients were strategically selected for interviews with open-ended questions, designed to explore the pain and pain management related to their cancer. The interviews were analysed using a phenomenographic approach. FINDINGS: Patients described 10 different perceptions of pain and pain management summarized in the three categories: communication, planning and trust. In terms of communication, patients expressed a need for an open and honest dialogue with health care professionals about all problems concerning pain. Patients expressed an urgent need for planning of their pain treatment including all caring activities around them. When they felt trust in the health care organization as a whole, and in nurses and physicians in particular, they described improved ability and willingness to participate in pain management. While the findings are limited to patients in palliative care, questions are raised about others with cancer-related pain without access to a palliative care team. CONCLUSION: The opportunity for patients to discuss pain and its treatment seems to have occurred late in the course of disease, mostly not until coming in contact with a palliative care team. They expressed a wish to be pain-free, or attain as much pain relief as possible, with as few side effects as possible.     

改良造口袋粘贴法在肠造瘘术后患儿造口护理中的应用

目的观察改良造口袋粘贴法在肠造瘘术后患儿造口护理中的应用效果。方法选取我院2011年6月—2013年6月行肠造瘘术后患儿86例,按随机数字表法分为对照组和观察组各43例。对照组采用传统造口袋粘贴法,观察组采用改良造口袋粘贴法,即在粘贴造口袋前先粘贴1张3 M水胶体敷料。比较两组患儿造口周围性皮炎发生率、皮肤损害的程度及造口袋使用时间。结果对照组患儿造瘘口周围皮肤完整7例,轻微红斑15例,明显红斑11例,融合性皮炎6例,溃疡出血4例,周围性皮炎发生率为84%,造口袋使用时间为(2.45±1.68)d。观察组患儿周围皮肤完整40例,轻微红斑3例,周围性皮炎发生率为7%,造口袋使用时间为(6.12±1.05)d。观察组周围性皮炎发生率、皮肤损害程度均低于对照组,造口袋使用时间长于对照组,差异有统计学意义(P<0.05)。结论改良造口袋粘贴法降低肠造口周围性皮炎发生率,减轻造口周围皮肤损害的程度,延长造口袋使用时间,进而减少造口袋更换次数,能有效地保护造瘘肠管及其周围娇嫩的肌肤,值得在临床推广使用。     

Nurse-led intermediate care: patients' perceptions

Intermediate care currently forms one of the UK Government's main initiatives for improving the quality of post-acute care. This paper examines patients' and carers' experiences of a nurse-led unit, which aims to provide intermediate care for people no longer acutely ill. Drawing on findings from qualitative interview data, we demonstrate that patients viewed this model of care as acceptable but that they had markedly inconsistent experiences of care and reported considerable variation in their perceptions of the Unit's purpose. Some possible reasons for this are explored. Implications for the development of good quality nurse-led intermediate care are outlined.     

Nurses' perceptions of quality end-of-life care on an acute medical ward

AIM: This paper reports the findings of a study that generated a conceptual model of the nursing behaviours and social processes inherent in the provision of quality end-of-life care from the perspective of nurses working in an acute care setting. BACKGROUND: The majority of research examining the issue of quality end-of-life care has focused on the perspectives of patients, family members and physicians. The perspective of nurses has generally received minimal research attention, with the exception of those working within palliative or critical care. The vast majority of hospitalized patients, however, continue to be cared for and die on medical units. To date, little research has been conducted examining definitions and determinants of quality end-of-life care from the perspective of nurses working in acute adult medical settings. METHOD: Grounded theory method was used in this study of 10 nurses working on acute medical units at two tertiary university-affiliated hospitals in central Canada. Data were collected during 2002 by interview and participant observation. FINDINGS: The basic social problem uncovered in the data was that of nurses striving to provide high quality end-of-life care on an acute medical unit while being pulled in all directions. The unifying theme of 'Creating a haven for safe passage' integrated the major sub-processes into the key analytic model in this study. 'Creating a haven for safe passage' represents a continuum of behaviours and strategies, and includes the sub-processes of 'facilitating and maintain a lane change'; 'getting what's needed'; 'being there'; and 'manipulating the care environment'. CONCLUSION: The ability of nurses to provide quality end-of-life care on an acute medical unit is a complex process involving many factors related to the patient, family, healthcare providers and the context in which the provision of end-of-life care takes place.     

Patient participation in clinical decision-making in nursing: A comparative study of nurses' and patients' perceptions

Aims and objectives. The aim of this study was to compare the degree of concordance between patients and Registered Nurses’ perceptions of the patients’ preferences for participation in clinical decision‐making in nursing care. A further aim was to compare patients’ experienced participation with their preferred participatory role. Background. Patient participation in clinical decision‐making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients’ preferences. Methods. A comparative design was adopted with a convenient sample of 80 nurse–patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient. Results. A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision‐making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles. Conclusions. Registered Nurses are not always aware of their patients’ perspective and tend to overestimate patients’ willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision‐making in nursing care according to their own perceptions and not even to the patients’ more moderate preferences of participation. Relevance to clinical practice. A thorough assessment of the individual's preferences for participation in decision‐making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.     

An exploratory study of patients' perceptions, memories and experiences of an intensive care unit

In the research reported, 298 patients were asked to describe their memories of the Royal Melbourne Hospital's intensive care unit (ICU). The data were collected by either self-reported questionnaires or structured interviews and examined from a bio-psycho-social perspective using both qualitative and quantitative methods. These recollections demonstrate that the close surveillance by both technological support and health care practitioners provide many patients and their families with a feeling of safety. Patients' memories of ICU also highlighted the presence of power relations which are inherent in clinical practice. This paper provides examples of actions and remarks within ICU that were not only remembered by patients and their families but also continued to effect patients 6 months after their discharge. The data in this research indicate that some of the psychological problems experienced after discharge may have been prevented by improved communication between staff and patients in ICU. This study also demonstrated the importance of providing feedback to the nurses working in ICU. This feedback raised awareness of patients' perceptions of both ICU itself and the behaviour of the staff. It also reminded staff that some patients remember everything about their admission of ICU. The data indicate that while patients found the presence of good communication in ICU both therapeutic and reassuring, they found the lack of good communication distressing. Poor communication not only caused anxiety while the patient was in ICU but also contributed to less than optimal recoveries after discharge. Finally, it will be argued that the provision of information from nurses not only diminished feelings of anxiety but also empowered patients to become involved in decisions about their care.