No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Tailoring of the Tell-us Card communication tool for nurses to increase patient participation using Intervention Mapping
Journal of Clinical Nursing
Abstract
Aims and objectives:
To describe the tailoring of the Tell-us Card intervention for enhanced patient participation to the Dutch hospital setting using Intervention Mapping as a systematic approach.
Background:
Even though patient participation is essential in any patient-to-nurse encounter, care plans often fail to take patients' preferences into account. The Tell-us Card intervention seems promising, but needs to be tailored and tested before implementation in a different setting or on large scale.
Design:
Description of the Intervention Mapping framework to systematically tailor the Tell-us Card intervention to the Dutch hospital setting.
Methods:
Intervention Mapping consists of: (i) identification of the problem through needs assessment and determination of fit, based on patients and nurses interviews and focus group interviews; (ii) developing a logic model of change and matrices, based on literature and interviews; (iii) selection of theory-based methods and practical applications; (iv) producing programme components and piloting; (v) planning for adoption, implementation and sustainability; and (vi) preparing for programme evaluation.
Results:
Knowledge, attitude, outcome expectations, self-efficacy and skills were identified as the main determinants influencing the use of the Tell-us Card. Linking identified determinants and performance objectives with behaviour change techniques from the literature resulted in a well-defined and tailored intervention and evaluation plan.
Conclusions:
The Tell-us Card intervention was adapted to fit the Dutch hospital setting and prepared for evaluation. The Medical Research Council framework was followed, and the Intervention Mapping approach was used to prepare a pilot study to confirm feasibility and relevant outcomes.
Relevance to clinical practice:
This article shows how Intervention Mapping is applied within the Medical Research Council framework to adapt the Tell-us Card intervention, which could serve as a guide for the tailoring of similar interventions.
... Simultaneously with the implementation of the Tell-us card in Flemish hospital wards, the tool was also implemented in Dutch hospital wards (van Belle et al., 2018). As the projects were closely intertwined, it was decided to also validate the ICS for the Dutch hospital context and to include the Dutch data in the comparison of nurses' and patients' perceptions of patient-centred care. ...
... A secondary analysis of a cross-sectional study in which data were collected on wards participating in two studies focussing on improvement projects to enhance patient participation in hospitals (i.e. a study on the implementation of Bedside shift reporting and a study on the implementation of the Tellus card; a communication tool that patients can use to report what is important for them during their hospital admission and before discharge (Malfait, Eeckloo, Lust, Van Biesen, & Van Hecke, 2017;Theys, Van Hecke, Akkermans, & Heinen, 2021;van Belle et al., 2018). ...
... This cross-sectional study presents the secondary analysis of data collected in nine regional hospitals and one university hospital in Flanders participating in a governmental programme starting two improvement projects to enhance patient participation in hospitals (the implementation of bedside shift reporting and the implementation of the Tell-us card) (Malfait, Eeckloo, Lust, Van Biesen, & Van Hecke, 2017a;van Belle et al., 2018). Quality coordinators, chief nursing officers, and chief medical officers from all Flemish hospitals received information sessions on the improvement projects. ...
... Simultaneously with the implementation of the Tell-us card in Flemish hospital wards, the tool was also implemented in Dutch hospital wards (van Belle et al., 2018). As the projects were closely intertwined, it was decided to also validate the ICS for the Dutch hospital context and to include the Dutch data in the comparison of nurses' and patients' perceptions of patient-centred care. ...
... A secondary analysis of a cross-sectional study in which data were collected on wards participating in two studies focussing on improvement projects to enhance patient participation in hospitals (i.e. a study on the implementation of Bedside shift reporting and a study on the implementation of the Tellus card; a communication tool that patients can use to report what is important for them during their hospital admission and before discharge (Malfait, Eeckloo, Lust, Van Biesen, & Van Hecke, 2017;Theys, Van Hecke, Akkermans, & Heinen, 2021;van Belle et al., 2018). ...
... This cross-sectional study presents the secondary analysis of data collected in nine regional hospitals and one university hospital in Flanders participating in a governmental programme starting two improvement projects to enhance patient participation in hospitals (the implementation of bedside shift reporting and the implementation of the Tell-us card) (Malfait, Eeckloo, Lust, Van Biesen, & Van Hecke, 2017a;van Belle et al., 2018). Quality coordinators, chief nursing officers, and chief medical officers from all Flemish hospitals received information sessions on the improvement projects. ...
... Permission to use the Tell-us Card was obtained from the original researcher (17). The card was translated to Dutch by the authors and slightly modified based on input from the wards' nurses (20). ...
... In line with the MRC framework (21), the implementation of the Tell-us Card was systematically tailored using the Intervention Mapping framework (22). As described in (20) van Belle et al. 2018, focus group meetings were conducted after T0 assessment to identify the nurses' knowledge, skills, attitude, self-efficacy and outcome expectations regarding the intervention, which was used in the training. Nurses were trained by means of an elearning and group discussion. ...
... At both wards, a core group of nurses was formed to guide implementation by stimulating the use of the Tell-us Card, addressing questions from the nurses and providing feedback. Additional strategies during the intervention period included educational and feedback visits to the wards' nurses where the study procedures were repeated, questions from nurses answered and progress on received questionnaires was shared (20). The patient questionnaires were piloted with four patients and deemed understandable and acceptable in length. ...
Background:
Patient participation is fundamental to nursing care and has beneficial effects on patient outcomes. However, it is not well embedded yet and little is known on how nurses could effectively stimulate patient participation in hospital care. The Tell-us Card is a communication tool for inviting patients to talk about their preferences and needs, and to increase patient participation in daily care.
Objectives:
To assess feasibility and early effectiveness of the Tell-us Card communication tool for enhanced patient participation during hospitalisation.
Design and method:
A pilot cluster randomised controlled study design was used including four nursing wards. Effectiveness was measured with the Individualized Care Scale (ICS) and the Quality from the Patients' Perspective (QPP) questionnaire. Linear mixed model analysis was used for analysis. Feasibility was assessed with an evaluative questionnaire for patients and nurses and by reviewing the content of Tell-us Cards using the Fundamentals of Care Framework (FOCF) for analysis. Ethical approval was attained.
Results:
Data of 265 patients showed a significant increase at one intervention ward on the ICS (effect size 0.61, p = 0.02) and most ICS subscales. No effect was visible on the QPP. The majority of patients regarded the intervention as beneficial; nurses however experienced barriers with incorporating the Tell-us Card into daily care. Analysis of the Tell-us Card content showed many elements of the FOCF being mentioned, with most patients indicating psychosocial needs like being involved and informed.
Conclusions:
This pilot study showed a positive early effect of the Tell-us Card communication tool on patient participation, although integration in daily nursing care appeared to be complex and an optimal fit has not yet been reached. Patients were positive about the intervention and wrote meaningful issues on the Tell-us Cards. More research is needed on how to incorporate patient participation effectively in complex hospital care.
... The present study is embedded in the preimplementation development phase of a larger implementation study of the Tell-us card communication tool in Flemish hospitals and aimed to investigate potential barriers and enablers prior to the implementation of the tool. This is essential to enhance the possibility of successful implementation (Jangland et al., 2012;Purvis, Moss, Denisenko, Bladin, & Cadilhac, 2014;Van Belle et al., 2017). An example of the Tell-us card is provided in Figure 1. ...
... The increasing workload can reinforce their need to feel in control over the provision of care and sustain to their fixed planning of care (Vandecasteele et al., 2015). The need to maintain control over care may impede patient participation, as this may indicate that nurses and midwives prefer routines rather than incorporating patients' preferences into care plans (Tobiano, Marshall, Bucknall, & Chaboyer, 2016a;Van Belle et al., 2017). A review conducted by Suhonen, Valimaki, and Leino-Kilpi (2009) identified the need to get the work done efficiently irrespective of the patients' situation as an impeding factor for individualised nursing care. ...
... To accomplish a successful and sustainable implementation of the Tell-us card, developing implementation strategies that match theory-based behavioural determinants associated with the identified barriers will be crucial (Grol & Wensing, 2017;Van Belle et al., 2017). In Table 5, examples of determinants and examples of the implementation strategies for the identified barriers are shown. ...
Aims and objectives:
To investigate potential barriers and enablers prior to the implementation of the Tell-us card.
Background:
Patient participation has the potential to improve quality of care and has a positive effect on health outcomes. In order to enhance participation of patients, adequate communication between patients, their relatives and healthcare professionals is vital. Communication is considered as a fundament of care according to the Fundamentals of Care Framework. A strategy to improve patient participation is the use of the Tell-us card; a communication tool that patients and relatives can use during hospitalization to point out what is important for them during their admission and before discharge. Investigating barriers and enablers is needed before implementation.
Design:
A qualitative study.
Methods:
Semi-structured, individual interviews with (head)nurses, nurse assistants and midwifes. Interviews were audio-recorded, transcribed and analysed using the framework analysis method. The COREQ checklist has been used.
Results:
The need to maintain control over care, reluctance to engage in in-depth conversations, fear of being seen as unprofessional by patients, fear of repercussions from physicians, the lack of insight in the meaning of patient participation, and the lack of appreciation of the importance of patient participation appeared to be majors barriers. Participants also elaborated on several prerequisites for successful implementation and regarded the cooperation of the multidisciplinary team as an essential enabler.
Conclusion:
The identified barriers and enablers revealed that nurses and midwives are rather reluctant towards patient participation and actively facilitating that by using the Tell-us card communication tool.
Relevance to clinical practice:
A number of issues will have to be factored into the implementation plan of the communication tool. Tailored implementation strategies will be crucial to overcome barriers and to accomplish a successful and sustainable implementation of the Tell-us card.
... show that there was plenty of opportunity within the nurse-patient interaction to do so, confirming that such care does not take up more time or resources (McCabe, 2004). Even though nurses perceive a lack of time as a barrier for patient involvement (van Belle et al., 2018;Tobiano et al., 2015) and integrated care (Conroy, 2018), McCabe (2004) further demonstrated that nurses do not communicate sufficiently in a patient-centred way even when they have the opportunity to do so, and that patients perceive nurses in general as being more aimed at task completion than on communicating (McCabe, 2004). Physical care then becomes more of an act, rather than an opportunity to connect with a patient as a means to provide patient-centred care (Feo & Kitson, 2016), even though the quality of the relationship between the nurse and the patient is significantly linked to improved health outcomes such as symptom relief and improvements in clinical and functional status (Safran, Miller, & Beckman, 2006). ...
... A recent study, however, demonstrated that for older patients, dignity and respect are core values that need to be met in the interpersonal care relationship(Riviere et al., 2019). In previous studies, nurses indicated that they were hindered in having conversations with patients because they were busy and were called away often, and would like to have more time to talk to patients(van Belle et al., 2018). Studies confirm that nursing care is often interrupted, with research indicating that on average there are 2-5.6 interruptions an hour per nurse ...
Objective:
To explore how nurses in hospitals enact person-centred fundamental care delivery.
Background:
Effective person-centred care is at the heart of fundamental nursing care, but it is deemed to be challenging in acute health care as there is a strong biomedical focus and most nurses are not trained in person-centred fundamental care delivery. We therefore need to know if and how nurses currently incorporate a person-centred approach during fundamental care.
Design:
Focused ethnography approach.
Methods:
Observations of 30 nurses on three different wards in two Dutch hospitals during their morning shift. Data were collected through passive observations and analysed using framework analysis based on the fundamentals of care framework. The COREQ guideline was used for reporting.
Results:
Some nurses successfully integrate physical, psychosocial and relational elements of care in patient interactions. However, most nurses were observed to be mainly focused on physical care and did not take the time at their patients' bedside to care for their psychosocial and relational needs. Many had a task-focused way of working and communicating, seldom incorporating patients' needs and experiences or discussing care planning, and often disturbing each other.
Conclusions:
This study demonstrates that although some nurses manage to do so, person-centred fundamental care delivery remains a challenge in hospitals, as most nurses have a task-focused approach and therefore do not manage to integrate the physical, relational and physical elements of care. For further improvement, attention needs to be paid to integrated fundamental care and clinical reasoning skills.
Relevance to clinical practice:
Although most nurses have a compassionate approach, this study shows that nurses do not incorporate psychosocial care or encourage patient participation when helping patients with their physical fundamental care needs, even though there seems to be sufficient opportunity for them to do so.
... All rights reserved. To evaluate feasibility and effectiveness of the Tell-us-card communication tool for improved patient participation To evaluate feasibility and effectiveness of a combined intervention of the Tell-us-card communication tool and goal setting for improved patient participation Patient participation, content of cards and outcomes of goal setting Verbal and nonverbal communication Jangland et al 2012Van Belle et al., 2017Jangland et al 2012Van Belle et al., 2017Sloane et al. 2004 Nutrition Hospital To evaluate the feasibility and effectiveness of an early Nursing Nutrition Intervention (NNI) in outpatients planned for surgery Pilot Randomised controlled trial Nutritional intake Ravasco, et al. 2005. Silvers et al. 2014. ...
... All rights reserved. To evaluate feasibility and effectiveness of the Tell-us-card communication tool for improved patient participation To evaluate feasibility and effectiveness of a combined intervention of the Tell-us-card communication tool and goal setting for improved patient participation Patient participation, content of cards and outcomes of goal setting Verbal and nonverbal communication Jangland et al 2012Van Belle et al., 2017Jangland et al 2012Van Belle et al., 2017Sloane et al. 2004 Nutrition Hospital To evaluate the feasibility and effectiveness of an early Nursing Nutrition Intervention (NNI) in outpatients planned for surgery Pilot Randomised controlled trial Nutritional intake Ravasco, et al. 2005. Silvers et al. 2014. ...
Aims:
The aim of this paper is to describe and discuss the 'Basic Care Revisited' (BCR) research programme, a collaborative initiative that contributes to evidence-based basic nursing care and raises awareness about the importance of basic nursing care activities.
Background:
While basic nursing care serves nearly all people at some point in their lifetime, it is poorly informed by evidence. There is a need to prioritize and evaluate basic nursing care activities to improve patient outcomes and improve the quality of care.
Design:
Discussion paper.
Method:
The discussion presented in this paper is based on nursing literature and theory and supported by the authors' clinical and research experiences. We present the developmental process and content of a research programme called 'Basic Care Revisited' (BCR) as a solution to move forward and improve basic nursing care.
Discussion:
To prioritise basic nursing care, we propose a research programme entitled 'Basic Care Revisited' that aims to create awareness and expand knowledge on evidence-based basic nursing care by addressing four basic nursing care themes (bathing and dressing, communication, mobility, and nutrition) in different settings. The paper discusses a pathway to create a sustainable and productive research collaborative on basic nursing care and addresses issues to build research capacity.
Relevance to clinical practice:
Revaluation of these important nursing activities will not only positively influence patient outcomes, but also have an impact on staff outcomes and organisational outcomes. This article is protected by copyright. All rights reserved.
... The use of the 'Tell-us' card as a tool for patients to communicate their needs and wishes regarding personal care was implemented in a Dutch hospital setting. The 'Tell-us' card was found to facilitate respectful and empathetic client centred care, with the researchers noting that enhanced patient participation positively influences clinical outcomes by lowering patient anxiety, increasing patient safety and enhancing adherence to treatment and advice (Van Belle et al. 2017). Similar tools have been utilised to identify triggers and care needs for supporting clients with Autism spectrum disorders (Nicolaidis et al. 2015) and communicating medical information for people with cognitive impairment and specific intellectual disability (Loo et al. 2019). ...
Aim(s)
To explore the acceptability and feasibility of using a trauma‐informed communication tool to convey client needs to health professionals; and to understand the barriers and enablers for clients using the tool.
Design
Mixed methods design pilot study conducted by nurses from a regional community health service in Victoria, Australia, of purposively sampled clients who have a history of sexual assault and/or family violence and clinicians from a primary care service.
Methods
The investigators developed a pocket‐sized communication card to convey clients' history of trauma and the clients' emotional and physical needs to health care providers.
Pre‐intervention and post‐intervention surveys using validated scales (‘Acceptability of Intervention Measure’ and ‘Intervention Appropriateness Measure’) were administered via anonymous online or paper‐based survey.
Results
Sixteen clients completed the pre‐intervention survey and 12 clients completed the post‐intervention client survey. Seven Nurses and three Social Workers completed the clinician survey.
Both clients and clinicians reported high rates of acceptability and appropriateness of the tool on the outcome measures. The most commonly reported barriers to using the tool were clients forgetting to use the card and concern about how health professionals may respond.
Content analysis of qualitative data revealed themes categorised as positive impacts (prevention of re‐traumatisation), negative impacts (negative response from health professionals) and suggestions for improvement of the tool (developing a digital version, raising clinicians' awareness of the tool).
Conclusion
This novel tool has demonstrated a high degree of acceptability and applicability in a sample of clients with a history of trauma secondary to sexual assault and/or family violence, and community health clinicians, and several positive and negative impacts have been identified. Further research should focus on larger participant numbers and include developing a digital version and a clinician education component.
Implications for the Profession and/or Patient Care
Use of a tool to communicate impacts of trauma may prevent re‐telling of traumatic stories by clients and enhance quality of care delivery.
Reporting Method
The Good Reporting of a Mixed Methods Study (GRAMMS) has been used to report the results of this study.
Patient or Public Contribution
During development of the tool, it was reviewed by a lived experience consumer representative, the health organisations' consumer advisory panel, and a small sample of clients.
... By means of this card, patients' preferences and needs can be elicited and acted upon. N = 1 [65] Therapeutic alliance through low threshold contact possibility with provider Electronic appointment systems Electronic appointment systems allow patients to easily book an appointment with their healthcare providers and support patients use of healthcare services. N = 3 [48] x Teleconsultations N = 5 x Teleconsultations with the healthcare provider can be a tool to improve patient's accessibility to care and improve overall efficiency. ...
Patient engagement is a cornerstone of high-quality care and essential for patients with chronic diseases to achieve improved health outcomes. Through digital transformation, possibilities to engage patients in their personal healthcare have multiplied. However, the exploitation of this potential is still lagging. To support the transmission of patient engagement theory into practice, this paper's objective is to give a state-of-the-art overview of patient engagement tools and methods. A systematic literature review was conducted. Overall, 56 tools and methods were extracted and synthesized according to the four attributes of patient engagement, i.e., personalization, access, commitment, and therapeutic alliance. The results are discussed in terms of their potential to be implemented in digital health solutions under consideration of the "computers are social actors" (CASA) paradigm. It is concluded that digital health can catalyze patient engagement in practice, and a broad future research agenda is formulated.
... This is not surprising as nurses themselves asses their EBP skills as below average and often encounter difficulties integrating EBP into their daily routine, resulting in experiencing resistance to working with EBP principles (Kerr & Rainey, 2021;Lehane et al., 2019;. In addition, nurses base their practice too much on traditions and intuition and struggle with incorporating patient preferences in daily practice (van Belle et al., 2018;Zwakhalen et al., 2018). Two systematic reviews confirmed and identified further barriers nurses encounter while using EBP. ...
Background:
Transformation of healthcare is necessary to ensure patients receive high-quality care. Working with the evidence-based practice (EBP) principles enables nurses to make this shift. Although working according to these principles is becoming more common, nurses base their actions too much on traditions and intuition. Therefore, to promote EBP in nursing practice and improve related education, more insight into nurses' needs is necessary to overcome existing EBP barriers.
Objective:
To identify the current needs to work with EBP principles among hospital and community care nurses and student nurses.
Design:
A qualitative, exploratory approach with focus group discussions.
Methods:
Data was collected between February and December 2020 through 5 focus group discussions with 25 nurses and student nurses from a hospital, a community care organisation, and nursing education schools (bachelor and vocational). Data were analysed using reflexive thematic analysis, and the main themes were synchronised to the seven domains from the Tailored Implementation for Chronic Diseases (TICD) checklist.
Results:
Nurses and student nurses experience EBP as complex and require more EBP knowledge and reliable, ready-to-use evidence. They wanted to be facilitated in access to evidence, the opportunity to share insights with colleagues and more time to work on EBP. The fulfilment of these needs serves to enhance motivation to engage with evidence-based practice (EBP), facilitate personal development, and empower nurses and student nurses to take more leadership in working according to EBP principles and improve healthcare delivery.
Conclusion:
Nurses experience difficulties applying EBP principles and need support with their implementation. Nurses' and student nurses' needs include obtaining more EBP knowledge and access to tailored and ready-to-use information. They also indicated the need for role models, autonomy, incentives, dedicated time, and incorporation of EBP in daily work practice.
... However, this is also challenging given that medical-technical skills are still valued more highly when assessing the quality of care [30]. In addition, previous studies have revealed that nurses face challenges communicating with patients due to their busy schedules, frequent interruptions and desire for more time to engage in meaningful patient conversations [31]. In addition, nurses need to know their patients, take time, empathise with patients and create a safe and trusted environment [32]. ...
Background
Patient participation is fundamental in nursing care and has yielded benefits for patient outcomes. However, despite their compassionate care approach, nurses do not always incorporate patients' needs and wish into evidence‐based practice, quality improvement or learning activities. Therefore, a shift to continuous quality improvement based on evidence‐based practice is necessary to enhance the quality of care. The patient's opinion is an essential part of this process. To establish a more sustainable learning culture for evidence‐based quality improvement, it is crucial that nurses learn alongside their patients. However, to promote this, nurses require a deeper understanding of patients' care preferences.
Objective
To explore patients' needs and wishes towards being involved in care processes that nurses can use in developing an evidence‐based quality improvement learning culture.
Methods
A qualitative study was conducted in two hospital departments and one community care team. In total, 18 patients were purposefully selected for individual semi‐structured interviews with an average of 15 min. A framework analysis based on the fundamental of care framework was utilised to analyse the data deductively. In addition, inductive codes were added to patients' experiences beyond the framework. For reporting this study, the SRQR guideline was used.
Results
Participants needed a compassionate nurse who established and sustained a trusting relationship. They wanted nurses to be present and actively involved during the care delivery. Shared decision‐making improved when nurses offered fair, clear and tailored information. Mistrust or a disrupted nurse–patient relationship was found to be time‐consuming and challenging to restore.
Conclusions
Results confirmed the importance of a durable nurse–patient relationship and showed the consequences of nurses' communication on shared decision‐making. Insights into patients' care preferences are essential to stimulate the development of an evidence‐based quality improvement learning culture within nursing teams and for successful implementation processes.
... low risk (well-nourished), medium risk (at risk for malnutrition) or high risk (malnutrition). The development of a complex nursing nutritional intervention to counteract malnutrition requires a systematic approach while both patients and nurses may have to change behaviour routines (Roberts et al., 2020;van Belle et al., 2018;van Noort et al., 2020). In our project, the Medical Research Council framework (Craig et al., 2013) and the Intervention Mapping approach are used to develop and adapt an intervention based on theoretical, empirical and practical information (Kok et al., 2016). ...
Objectives:
To describe an insight into nursing nutritional care delivery in the hospital from the perspectives of observed nursing care and an exploration of multidisciplinary attitudes and experiences with patient participation in nutritional care.
Background:
The prevalence of malnutrition in hospitalised patients continues to be high. Nurses' essential role in the identification and treatment of malnutrition is an important aspect of the fundamentals of care. Nurses have a key role in providing optimal nutritional care in the hospital. A systematic nursing approach, combined with an active role for patients, is required to effectively counteract malnutrition.
Design:
A multicentre qualitative study using ethnographic observations and focus groups.
Methods:
Direct observation of nutritional care was conducted on two nursing wards; nurses and inpatients were observed; and data were thematically analysed based on the fundamentals of care framework. Subsequently, six focus groups were held on three nursing wards with nurses, dietitians and nutrition assistants (n = 34). Data were analysed using open, axial and selective coding. The COREQ guidelines were used for reporting the study.
Results:
During 54 days, representing 183 h, 39 nurses were observed in two medical wards. Three activities in nutritional care delivery were identified from observing nurses and patients: (1) screening and assessment/at-risk determination, (2) nutritional care plans and (3) monitoring and evaluating outcomes and transition-of-care planning. In addition, the focus groups identified barriers, facilitators, needs and expectations for optimal nursing nutritional care delivery.
Conclusions:
This study provides an understanding of the difficulties in the delivery of nursing nutritional care. Patient participation in the nutritional care process is rare. Evidence-based strategies are required to improve the knowledge and skills of nurses and patients to participate in (mal)nutrition care.
Relevance:
The findings of this study are used for the development of a nursing nutrition intervention to optimise patient participation in (mal)nutrition care.
Patient or public contribution:
During the study, patients were not involved with the observations of care and/or with the interviews; the researchers observed the nutritional care delivery at medical wards acting as passive participants. Nurses, nutrition assistants and dietitians were after the focus groups asked for feedback on the transcripts of the interviews.
... Nurses also had a role in development and tailoring of the best practice. As the included studies were conducted in different clinical contexts, with different resources, using a variety of implementation strategies, a needs assessment and intervention mapping -which refers to planning the implementation of best practices based on using theory and evidence -could assist in systematically tailoring a best practice for both nurses and patients and their families (Van Belle et al. 2018). ...
Nurses play an important role in the implementation of best practices. However, the role of
nurses in changing practice by implementing best practices requires further exploration. No
systematic review was found that summarised the best available evidence on the roles of
nurses in changing practice through the implementation of best practices. This study
summarised the best available evidence on the roles of nurses in changing practice through the
implementation of best practices. A systematic review was used to search for studies in the
English language, where a best practice was implemented in a clinical context and which
included findings regarding the roles of nurses when implementing best practices. Scopus,
EBSCOhost (Academic Search Ultimate, APA PsycInfo, CINAHL with Full Text, ERIC, Health
Source: Nursing/Academic Edition, MasterFILE Premier, MEDLINE Complete), PUBMED,
and ScienceDirect databases were searched from January 2013 to June 2021. The search
generated 1343 citations. After removing duplicates and applying eligibility criteria, 27 studies
were included. Five definite roles were identified as follows: leadership, education and
training, collaboration, communication and feedback and development and tailoring of the
best practice. These roles are interrelated, but equally crucial in order to implement best
practices. This study found five interrelated but equally crucial nurse roles in changing practice
through the implementation of best practices.
Contribution: The study’s findings and gaps identified can be used for further nursing
research, improving practice change and health outcomes through the implementation of best
practices and the role nurses can play in this process.
Keywords: best practices; changing practice; implementation; nurses; roles; systematic review
... It is difficult to provide person-centred fundamental care without giving the patient attention; therefore, extra focus is needed on how person-centred fundamental care can be promoted after initial care in the emergency room. For instance, van Belle, Huisman-de Waal [23] found that RNs did not feel that they work in conditions that promote communicating with the patient effectively, as they were often busy and were interrupted. Our findings further show that more fundamental care needs were met when the RN created a relationship and communicated with the patient. ...
Background
There is a strong biomedical focus within emergency care. However, while failure to meet patients’ fundamental care needs has severe consequences for the patient, there is limited knowledge on how nursing care is provided in emergency rooms and the related implications for patients.
Aim
This study aims to explore how fundamental care needs of critically ill patients are met in emergency rooms.
Methods
Non-participant observations at an emergency department in Sweden included 108 observations and field notes (150 h). Data were analysed using descriptive statistics.
Results
Observations showed that registered nurses (RN) identified patients’ fundamental care needs and provided nursing care. However, the RNs’ focus on the patient decreased over time. When the RN communicated with the patient, the patients’ physical needs were met to a greater extent. The organisational structure and physical environment of emergency rooms limit RNs’ ability to meet patients’ fundamental care needs.
Conclusion
Not all patients had their fundamental care needs optimally met. This study highlights the importance of RNs working in an integrated manner; an RN working bedside is crucial for establishing a patient–nurse relationship to meet the patient’s physical, psychosocial, and relational needs.
... was performed (i.e. a study on the implementation of Bedside shift reporting and a study on the implementation of the Tell-us card; a communication tool that patients can use to report what is important for them during their hospital admission and before discharge) [18][19][20][21]. Nurses who worked on the participating wards were invited to participate if they had direct patient contact and work experience of at least 6 months on the hospital ward [21]. ...
Background
Patient-centred care has been recognised as vital for today's healthcare quality. This type of care puts patients at the centre, contributing to positive patient outcomes such as patient autonomy. Empirical research comparing nurses’ and patients’ perceptions of the support and provision of patient-centred care is limited and focuses solely on nurses and patients working and staying on surgical wards.
Aims and objectives
Comparing patients’ and nurses’ perceptions of patient-centred care on different types of hospital wards, and exploring if patient empowerment, health literacy, and certain sociodemographic and context-related variables are associated with these perceptions.
Design
Cross-sectional design.
Methods
Data were collected in ten Flemish (February–June 2016) and two Dutch (December 2014–May 2015) hospitals using the Individualised Care Scale (ICS). A linear mixed model was fitted. Data from 845 patients and 569 nurses were analysed. As the ICS was used to measure the concept of patient-centred care, it is described using the term ‘individualised care.’
Results
Nurses perceived that they supported and provided individualised care more compared with patients as they scored significantly higher on the ICS compared with patients. Patients with higher empowerment scores, higher health literacy, a degree lower than bachelor, a longer hospital stay, and patients who were employed and who were admitted to Dutch hospitals scored significantly higher on some of the ICS subscales/subsections. Nurses who were older and more experienced and those working in Dutch hospitals, regional hospitals and maternity wards scored significantly higher on some of the ICS subscales/subsections.
Conclusion
Nurses perceived that they supported and provided individualised care more compared with patients.
Relevance to clinical practice
Creating a shared understanding towards the support and provision of individualised care should be a priority as this could generate more effective nursing care that takes into account the individuality of the patient.
... This cross-sectional study presents the secondary analysis of data collected in nine regional hospitals and one university hospital in Flanders participating in a governmental programme starting two improvement projects to enhance patient participation in hospitals (the implementation of bedside shift reporting and the implementation of the Tell-us card) [25,26]. Quality coordinators, chief nursing officers and chief medical officers from all Flemish hospitals received information sessions on the improvement projects. ...
Objective: Measuring empowerment of patients on Flemish hospital wards by the short form of the Patient Activation Measure (PAM-13) and exploring the association between patient empowerment and patient-centred care, health literacy, patient- and context-related characteristics.
Methods: Secondary analysis of data collected in nine regional hospitals and one university hospital in Flanders between February and June 2016. Patients needed to be admitted for a least 1 day, aged 18 years or over, and mentally competent with adequate ability to speak and read the Dutch language. Independent t-tests, one-way ANOVA and multivariable regression analysis were performed.
Results: Mean empowerment was 58. Of the 670 patients, 22.7% tended to be unprepared to play an active role in their health care, 22.2% were struggling to manage own health, 39.4% reported to take action to maintain and improve own health, and 15.7% reported having confidence to perform adequate behaviours in most circumstances. Multivariable analysis showed that patients living together with family, a partner or a friend (p = 0.018), with higher health literacy (p < 0.001), and with higher perceptions of individuality in patients’ care (p < 0.001) had higher empowerment scores.
Conclusion: The multivariable analysis found three variables associated with patient empowerment and provided empirical evidence for the interrelatedness between patient-centred care and patient empowerment. Future research should use a clear framework to make sure that all relevant determinants of patient empowerment are included. Interventions to improve patient empowerment should incorporate patient characteristics and elements of both health literacy and patient-centred care.
... Intervention Mapping is a framework [17] that includes a systematic, iterative six-step process, which helps researches and healthcare professionals to develop or adapt an intervention based on theoretical, empirical, and practical information [16]. This framework has been used widely for health promotion, e.g., nutrition [18,19], as well as in other basic nursing care programs [20,21]. The steps in IM are as follows: 1) Logic Model of the Problem; 2) Program outcomes and Objectives -Logic Model of Change; 3) Program Design; 4) Program Production; 5) Program implementation plan; and 6) Evaluation plan [16] (see Fig. 1 and Table 1). ...
Background:
Undernutrition in surgical patients leads to a higher risk of postoperative complications like infections and delayed recovery of gastrointestinal functions, often resulting in a longer hospital stay and lower quality of life. Nurses at outpatient clinics can deliver nutritional care during outpatient preoperative evaluation of health status to ensure that patients are properly fed in preparation for hospital admission for surgery. However, nutritional nursing care was not determined in research yet. This paper describes the structural development of an Outpatient Nursing Nutritional Intervention (ONNI).
Methods:
A project group followed the steps of the Intervention Mapping. The needs assessment included assessment of delivery of nutritional care and nutritional care needs at two anaesthesia outpatient clinics of an academic and a teaching hospital. Also, outpatient clinic nurses and patients at risk for undernutrition were interviewed. Determinants resulted from these methods were matched with theories on behaviour change and nutritional support.
Results:
Both patients and nurses were unaware of the consequences of undernutrition, and nurses were also unaware of their roles with regard to nutritional support. The intervention goals were: 1) enabling surgical patients to improve or maintain their nutritional status before hospital admission for surgery, and 2) enabling nurses to deliver nutritional support. The ONNI was developed for outpatients at risk for or with undernutrition. A training was developed for nurses. The ONNI included the five following components: 1) identification of the causes of undernutrition; 2) provision of a nutritional care plan including general and individually tailored advice; 3) self-monitoring of nutrient intake; 4) counselling and encouragement; and 5) support during a telephone follow-up meeting. The intervention and training were tested. A multifaceted implementation strategy was used to deliver the intervention in daily practice.
Conclusions:
Despite the unique position of the nurses at outpatient clinics, nurses were unaware of their role with regard to nutritional care. The ONNI was developed and implemented along with a training program for nurses. The test confirmed that the training can improve nurses' knowledge, skills, and sense of responsibility for nutritional support. The intervention may empower patients to actively improve their nutritional status.
... Achteraf hebben patienten op alle afdelingen (n=123) nogmaals een vragenlijst ingevuld. Ook is aan patiënten en verpleegkundigen gevraagd naar het gebruik van de vertelkaart en is geïnventariseerd wat pen.6 In de ontwikkelfase is aan de hand van stappen van het Intervention Mapping framework systematisch de interventie aangepast aan de Nederlandse praktijk. ...
... Achteraf hebben patienten op alle afdelingen (n=123) nogmaals een vragenlijst ingevuld. Ook is aan patiënten en verpleegkundigen gevraagd naar het gebruik van de vertelkaart en is geïnventariseerd wat pen.6 In de ontwikkelfase is aan de hand van stappen van het Intervention Mapping framework systematisch de interventie aangepast aan de Nederlandse praktijk. ...
... The Tell-us Card is a tool, which facilitates communication between nurses and patients by inviting patients to write on the Tell-us Card what is important for them concerning hospital discharge. The card offers the possibility to identify patients' preferences and needs to be acted upon by nurses [17][18][19][20]. Admitted patients and nurses were selected in each setting to participate in the co-design trajectory to tailor the tool for the local context. ...
Background
An important—and often missing—element of person‐centred care is the inclusion of individual patients' values and preferences. This is challenging but especially important for high‐burden fertility treatments. We describe the development of a clinical tool that aims to facilitate the delivery of person‐centred fertility care by giving insight into the patients' values and preferences.
Methods
We developed the Tell me tool following the three principles of user‐centred design: (1) early and continual focus on users; (2) iterative design; (3) measurement of user behaviour. Accordingly, our methods consisted of three phases: (1) conducting semi‐structured interviews with 18 couples undergoing fertility treatment, followed by a consensus meeting with relevant stakeholders; (2) performing seven iterative improvement rounds; (3) testing the feasibility of the tool in 10 couples.
Results
The Tell me tool consists of a ranking assignment of 13 themes and two open‐ended questions. These themes relate to the couples' wellbeing and experience of the treatment, such as mental health and shared decision making. The open‐ended questions ask them to write down what matters most to them. The field test showed variation between the individual patients' answers. The tool proved to highlight what is important to the individual patient and gives insight into patients' personal contexts.
Conclusions
We developed a tool that gives insight into the values and preferences of the individual patient. The tool seems feasible for facilitating person‐centred fertility care.
Patient or Public Contribution
The tool was developed with a user‐centred design that strongly involved patients.
Background
Conceptual clarity for the term patient engagement is growing. However, there is variability in patient engagement in healthcare, which could be due to the absence of models to guide practice or a myriad of organisational, nurse and patient factors. The recently developed ‘Interactive Care Model’ provides guidance on how to genuinely promote individualised patient engagement. An understanding of how to action this model in nursing is required.
Aims
The aim of this scoping review was to examine actions in the published scientific literature that align with the Interactive Care Model, in the context of nursing care of hospitalised patients.
Data sources
In 2018, searches of CINAHL, Cochrane Library, MEDLINE and PsycInfo were undertaken, for literature published between 2008 and 2018. This was followed by citation tracking.
Review methods
Two researchers screened and selected studies using prespecified criteria. Data were charted into a pre‐established tool and collated and summarised using numerical summaries and deductive content analysis. For content analysis, categories were generated from the ‘Interactive Care Model’.
Findings
Forty‐three studies were included in the review, 33 noninterventional and 10 interventional studies. Publications on the topic are increasing in number over time, with most conducted in Europe with patient or nurse participants. Forty‐two actions were found in the literature that aligned with the ‘Interactive Care Model’. The actions uncovered differed between intervention and noninterventional studies; in interventional studies actions were formalised.
Conclusions
This review provides an overview of actions that promote patient engagement and could inform implementation of the Interactive Care Model and the design and testing of patient engagement interventions to support the model. There are opportunities to explore latter phases of the Interactive Care Model to foster patient engagement in self‐management and to motivate patients’ management of healthcare beyond hospitalisation. Further, there is a need to rigorously evaluate patient engagement interventions.
Background
Health care innovations tailored to stakeholder context are more readily adopted. This study aimed to describe how Intervention Mapping (IM) was used to design health care innovations and how stakeholders were involved.
Methods
A scoping review was conducted. MEDLINE, EMBASE, Cochrane Library, Scopus and Science Citation Index were searched from 2008 to November 2017. English language studies that used or cited Intervention Mapping were eligible. Screening and data extraction were done in triplicate. Summary statistics were used to describe study characteristics, IM steps employed, and stakeholder involvement.
Results
A total of 852 studies were identified, 449 were unique, and 333 were excluded based on title and abstracts, 116 full-text articles were considered and 61 articles representing 60 studies from 13 countries for a variety of clinical issues were included. The number of studies published per year increased since 2008 and doubled in 2016 and 2017. The majority of studies employed multiple research methods (76.7%) and all 6 IM steps (73.3%). Resulting programs/interventions were single (55.4%) or multifaceted (46.4%), and 60.7% were pilot-tested. Programs or interventions were largely educational material or meetings, and were targeted to patients (70.2%), clinicians (14.0%) or both (15.8%). Studies provided few details about current or planned evaluation. Of the 4 (9.3%) studies that reported impact or outcomes, 3 achieved positive improvements in patient or professional behaviour or patient outcomes. Many studies (28.3%) did not involve stakeholders. Those that did (71.7%) often involved a combination of patients, clinicians, and community organizations. However, less than half (48.8%) described how they were engaged. Most often stakeholders were committee members and provide feedback on program or intervention content or format.
Conclusions
It is unclear if use of IM or stakeholder engagement in IM consistently results in effective programs or interventions. Those employing IM should report how stakeholders were involved in each IM step and how involvement influenced program or intervention design. They should also report the details or absence of planned evaluation. Future research should investigate how to optimize stakeholder engagement in IM, and whether use of IM itself or stakeholder engagement in IM are positively associated with effective programs or interventions.
Recent kwam de Beter Laten-lijst uit met 66 handelingen die verpleegkundigen beter kunnen laten. Op deze lijst komen opvallend veel handelingen voor die onder de categorie basiszorg vallen, zoals eten en drinken. Eveneens bevat de lijst handelingen die palliatieve zorg betreffen. In dit artikel lichten we deze twee eruit. Ze kunnen als voorbeeld kunnen dienen om zelf korte Beter Laten-lijsten te maken die passend zijn in de eigen situatie.
Background
Estimates suggest that, in NHS hospitals, incidents causing harm to patients occur in 10% of admissions, with costs to the NHS of > £2B. About one-third of harmful events are believed to be preventable. Strategies to reduce patient safety incidents (PSIs) have mostly focused on changing systems of care and professional behaviour, with the role that patients can play in enhancing the safety of care being relatively unexplored. However, although the role and effectiveness of patient involvement in safety initiatives is unclear, previous work has identified a general willingness among patients to contribute to initiatives to improve health-care safety.
Aim
Our aim in this programme was to design, develop and evaluate four innovative approaches to engage patients in preventing PSIs: assessing risk, reporting incidents, direct engagement in preventing harm and education and training.
Methods and results
We developed tools to report PSIs [patient incident reporting tool (PIRT)] and provide feedback on factors that might contribute to PSIs in the future [Patient Measure of Safety (PMOS)]. These were combined into a single instrument and evaluated in the Patient Reporting and Action for a Safe Environment (PRASE) intervention using a randomised design. Although take-up of the intervention by, and retention of, participating hospital wards was 100% and patient participation was high at 86%, compliance with the intervention, particularly the implementation of action plans, was poor. We found no significant effect of the intervention on outcomes at 6 or 12 months. The ThinkSAFE project involved the development and evaluation of an intervention to support patients to directly engage with health-care staff to enhance their safety through strategies such as checking their care and speaking up to staff if they had any concerns. The piloting of ThinkSAFE showed that the approach is feasible and acceptable to users and may have the potential to improve patient safety. We also developed a patient safety training programme for junior doctors based on patients who had experienced PSIs recounting their own stories. This approach was compared with traditional methods of patient safety teaching in a randomised controlled trial. The study showed that delivering patient safety training based on patient narratives is feasible and had an effect on emotional engagement and learning about communication. However, there was no effect on changing general attitudes to safety compared with the control.
Conclusion
This research programme has developed a number of novel interventions to engage patients in preventing PSIs and protecting them against unintended harm. In our evaluations of these interventions we have been unable to demonstrate any improvement in patient safety although this conclusion comes with a number of caveats, mainly about the difficulty of measuring patient safety outcomes. Reflecting this difficulty, one of our recommendations for future research is to develop reliable and valid measures to help efficiently evaluate safety improvement interventions. The programme found patients to be willing to codesign, coproduce and participate in initiatives to prevent PSIs and the approaches used were feasible and acceptable. These factors together with recent calls to strengthen the patient voice in health care could suggest that the tools and interventions from this programme would benefit from further development and evaluation.
Trial registration
Current Controlled Trials ISRCTN07689702.
Funding
The National Institute for Health Research Programme Grants for Applied Research programme.
Background:
There are mounting calls for robust, critical evaluation of the impact of patient and public involvement (PPI) in health research. However, questions remain about how to assess its impact, and whether it should be assessed at all. The debate has thus far been dominated by professionals.
Objective:
To explore the views of PPI contributors involved in health research regarding the impact of PPI on research, whether and how it should be assessed.
Design:
Qualitative interview study.
Setting and participants:
Thirty-eight PPI contributors involved in health research across the UK.
Results:
Participants felt that PPI has a beneficial impact on health research. They described various impactful roles, which we conceptualize as the 'expert in lived experience', the 'creative outsider', the 'free challenger', the 'bridger', the 'motivator' and the 'passive presence'. Participants generally supported assessing the impact of PPI, while acknowledging the challenges and concerns about the appropriateness and feasibility of measurement. They expressed a range of views about what impacts should be assessed, by whom and how. Individual feedback on impact was seen as an important driver of improved impact and motivation to stay involved.
Conclusions:
While there appears to be widespread support for PPI impact assessment among PPI contributors, their views on what to assess and how are diverse. PPI contributors should be involved as equal partners in debates and decisions about these issues. Individual feedback on impact may increase PPI contributors' potential impact and their motivation to stay involved.
Purpose:
To describe and understand activities patients and nurses undertake to enact patient participation in nursing care.
Design:
This observational study was conducted on two medical units at a public hospital in Australia. Twenty-eight nurse-patient dyads were observed for at least 4 hr. Data were collected from November 2013 to February 2014.
Methods:
Field notes were collected and were analyzed both inductively and deductively.
Findings:
Nurse-patient interactions promoted patient participation through dialogue and knowledge sharing. Less evident was patient involvement in planning or self-care. Nurses exerted control over patient care, which influenced the extent of patient participation.
Conclusions:
Patient participation appears to be difficult to enact. Nurses' controlling approach, influenced by organizational issues, was in conflict with a patient-centered approach to care. Nurse-patient communication is one aspect of patient-centered care enacted more frequently.
Clinical relevance:
Nurses may benefit from strategies at the individual and organizational level to enhance their patient-centered practices. Fostering nurses' communication may enhance patient-centered practices in hospitals.
In this paper, we introduce the IM taxonomy of behavior change methods and its potential to be developed into a coding taxonomy. That is, although IM and its taxonomy of behavior change methods are not in fact new, because IM was originally developed as a tool for intervention development, this potential was not immediately apparent. Second, in explaining the IM taxonomy and defining the relevant constructs, we call attention to the existence of parameters for effectiveness of methods, and explicate the related distinction between theory-based methods and practical applications and the probability that poor translation of methods may lead to erroneous conclusions as to method-effectiveness. Third, we recommend a minimal set of intervention characteristics that may be reported when intervention descriptions and evaluations are published. Specifying these characteristics can greatly enhance the quality of our meta-analyses and other literature syntheses. In conclusion, the dynamics of behavior change are such that any taxonomy of methods of behavior change needs to acknowledge the importance of, and provide instruments for dealing with, three conditions for effectiveness for behavior change methods. For a behavior change method to be effective: 1) it must target a determinant that predicts behavior; 2) it must be able to change that determinant; 3) it must be translated into a practical application in a way that preserves the parameters for effectiveness and fits with the target population, culture, and context. Thus, taxonomies of methods of behavior change must distinguish the specific determinants that are targeted, practical, specific applications, and the theory-based methods they embody. In addition, taxonomies should acknowledge that the lists of behavior change methods will be used by, and should be used by, intervention developers. Ideally, the taxonomy should be readily usable for this goal; but alternatively, it should be clear how the information in the taxonomy can be used in practice. The IM taxonomy satisfies these requirements, and it would be beneficial if other taxonomies would be extended to also meet these needs. IM_Taxonomy_-_Tables_and_Figure.pdf.
To explore nurses' views of patient participation in nursing care on medical wards.
Nurses have frequent contact with patients, highlighting their potential role in enabling patient participation. However, some nurses' actions and attitudes act as barriers, failing to achieve core requirements of patient participation. Discovering nurses' views may assist in developing strategies to encourage patient participation in hospitals.
Interpretive study.
Twenty nurses were recruited from four medical wards, located in two Australian hospitals. In-depth semi-structured interviews were conducted between November 2013-March 2014 and analysed using content analysis.
Five categories emerged from the nurses' views. The first category, acknowledging patients as partners, showed nurses respected patients as legitimate participants. In the second category, managing risk, nurses emphasized the need to monitor participation to ensure rules and patient safety were maintained. Enabling participation was the third category, which demonstrated nurses' strategies that enhanced patients' participation. The fourth category was hindering participation; encapsulating nurses' difficulty in engaging patients with certain characteristics. In the final category, realizing participation, nurses believed patients could be involved in physical activities or clinical communication.
Nurses have a crucial role in promoting patient participation. Through acknowledging and enabling participation, nurses may facilitate patient participation in a range of nursing activities. The nurse's role in enacting participation is complex, having to accommodate each patient's risks and characteristics, highlighting the need for good assessment skills. Education, policy and research strategies are essential to foster nurses' pivotal role in patient participation.
© 2015 John Wiley & Sons Ltd.
Costs of care for patients with chronic heart failure have been estimated at between 1% and 2% of the total health care expenditure in Europe and North America. Two-thirds are for inpatient care. Person-centred care (PCC) asserts that patients are persons and should not be reduced to their diseases alone.
The aim of this study was to estimate the cost-utility of PCC when compared with conventional care in patients hospitalized for worsening chronic heart failure.
Data for the cost-utility analysis were collected alongside a prospective clinical intervention study with a controlled before and after design from 2008 to 2010. Patient-specific resources used and preference-based health status data were collected at an individual level. Only 63% received PCC as intended illustrating the difficulties of introducing new methods in established organizations. The group intended to have PCC yielded higher costs in comparison with the conventional care group. The incremental cost was estimated as €98. The costs for those who actually received PCC, per protocol (PP) (63%) were significantly (p=0.026) lower than for those in the conventional care group, with an incremental cost-saving of €863. For the first three months, patients in the conventional care group showed decreasing health-related quality of life, with a corresponding improvement in the PCC(PP) group.
It must be emphasized, however, that these positive effects, both cheaper and somewhat better, were obtained only among those receiving the PCC intervention in its intended form, PCC(PP).
© The European Society of Cardiology 2015.
Purpose
The aim of this study was to assess the measurement properties of the 5-level classification system of the EQ-5D (5L), in comparison with the 3-level EQ-5D (3L).
Methods
Participants (n = 3,919) from six countries, including eight patient groups with chronic conditions (cardiovascular disease, respiratory disease, depression, diabetes, liver disease, personality disorders, arthritis, and stroke) and a student cohort, completed the 3L and 5L and, for most participants, also dimension-specific rating scales. The 3L and 5L were compared in terms of feasibility (missing values), redistribution properties, ceiling, discriminatory power, convergent validity, and known-groups validity.
Results
Missing values were on average 0.8 % for 5L and 1.3 % for 3L. In total, 2.9 % of responses were inconsistent between 5L and 3L. Redistribution from 3L to 5L using EQ dimension-specific rating scales as reference was validated for all 35 3L–5L-level combinations. For 5L, 683 unique health states were observed versus 124 for 3L. The ceiling was reduced from 20.2 % (3L) to 16.0 % (5L). Absolute discriminatory power (Shannon index) improved considerably with 5L (mean 1.87 for 5L versus 1.24 for 3L), and relative discriminatory power (Shannon Evenness index) improved slightly (mean 0.81 for 5L versus 0.78 for 3L). Convergent validity with WHO-5 was demonstrated and improved slightly with 5L. Known-groups validity was confirmed for both 5L and 3L.
Conclusions
The EQ-5D-5L appears to be a valid extension of the 3-level system which improves upon the measurement properties, reducing the ceiling while improving discriminatory power and establishing convergent and known-groups validity.
BACKGROUND: Effective communication is an interaction between two or more people that produces a desired effect and is a key element of quality of care for patients with advanced and serious illness and their family members. Suboptimal provider-patient/family communication is common, with negative effects on patient/family-centered outcomes. OBJECTIVES: To systematically review the evidence for effectiveness of communication-related quality improvement interventions for patients with advanced and serious illness and to explore the effectiveness of consultative and integrative interventions. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, Cochrane, and DARE from 2000 through December 2011 and reference list of eligible articles and reviews. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Prospective, controlled quality improvement studies in populations with life-limiting or severe life-threatening illness with a primary intervention focus of improving communication with patients and/or families. STUDY APPRAISAL AND SYNTHESIS METHODS: Two investigators independently screened and abstracted data on patient/family-centered outcomes. RESULTS: We included 20 studies; 13 (65 %) were in intensive care. We found four intervention types: (1) family meetings with the usual team (11 studies, 77 % found improvement in healthcare utilization), (2) palliative care teams (5 studies, 50 % found improvement in healthcare utilization), (3) ethics consultation (2 studies, 100 % found improvement in healthcare utilization), and (4) physician-patient communication (2 studies, no significant improvement in healthcare utilization). Among studies addressing the outcomes of patient/family satisfaction, 22 % found improvement; among studies addressing healthcare utilization (e.g., length of stay), 73 % found improvement. Results suggest that consultative interventions, as opposed to integrative ones, may be more effective, but more research is needed. LIMITATIONS: Study heterogeneity did not allow quantitative synthesis. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Communication in the care of patients with advanced and serious illness can be improved using quality improvement interventions, particularly for healthcare utilization as an outcome. Interventions may be more effective using a consultative approach.
Background
Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient’s needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1) examining the effects of the intervention on patients’ quality of life, depression, satisfaction with care, and agitation; and (2) examining the extent to which the intervention improves staff’s attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study.
Methods/design
A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1) development of an individualized patient communication care plan; (2) a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3) a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient.
Discussion
The Patient-Centred Communication Intervention will provide staff with strategies to facilitate interactions with patients and to minimize agitation associated with considerable stress. The improvement of these interactions will lead to a reduction of agitation, which has the additional significance of increasing patients’ well-being, quality of life, and satisfaction with care.
Trial registration
ClinicalTrials.gov Identifier NCT01654029
INTRODUCTIONCommunication and teamwork failures are a common cause of adverse events. Residency programs, with a mandate to teach systems-based
practice, are particularly challenged to address these important skills.
AIMTo develop a multidisciplinary teamwork training program focused on teaching teamwork behaviors and communication skills.
SETTINGInternal medicine residents, hospitalists, nurses, pharmacists, and all other staff on a designated inpatient medical unit
at an academic medical center.
PROGRAM DESCRIPTIONWe developed a 4-h teamwork training program as part of the Triad for Optimal Patient Safety (TOPS) project. Teaching strategies
combined didactic presentation, facilitated discussion using a safety trigger video, and small-group scenario-based exercises
to practice effective communication skills and team behaviors. Development, planning, implementation, delivery, and evaluation
of TOPS Training was conducted by a multidisciplinary team.
PROGRAM EVALUATIONWe received 203 evaluations with a mean overall rating for the training of 4.49 ± 0.79 on a 1–5 scale. Participants rated
the multidisciplinary educational setting highly at 4.59 ± 0.68.
DISCUSSIONWe developed a multidisciplinary teamwork training program that was highly rated by all participating disciplines. The key
was creating a shared forum to learn about and discuss interdisciplinary communication and teamwork.
There is a growing awareness that patients should be more active and effective managers of their health and health care. Recent studies have found patient activation--or having the knowledge, skills, and confidence to manage one's health, to be related to health-related outcomes. These studies have often relied on self-reported outcomes and often have used small samples.
To examine the degree to which patient activation is related to a broad range of patient health and utilization outcomes in a large, insured population.
Cross-sectional study of patients at Fairview Health Services in Minnesota. Data on patient activation and patient outcomes were derived from the electronic health record, abstracted in December 2010.
A total of 25,047 adult patients were included in the analysis. They all had a primary care visit in the prior six months and completed the patient activation measure as part of an office visit.
The key independent measure was the Patient Activation Measure. We examined 13 patient outcomes across four areas: prevention, unhealthy behaviors, clinical indicators, and costly utilization.
In multivariate models, patient activation was related to 12 of 13 patient outcomes in the expected direction. For every additional 10 points in patient activation, the predicted probability of having an ED visit, being obese, or smoking was one percentage point lower. The likelihood of having a breast cancer screen or clinical indicators in the normal range (A1c, HDL, and triglycerides) was one percentage point higher.
This cross sectional study finds that patient activation is strongly related to a broad range of health-related outcomes, which suggests improving activation has great potential. Future work should examine the effectiveness of interventions to support patient activation.
Person-centred care (PCC) emphasizes a partnership in care between patients and healthcare professionals and is advocated by WHO as a key component of quality health care. We evaluated outcomes of PCC in hospitalized patients with chronic heart failure (CHF) with respect to the length of hospital stay (LOS), activities of daily living (ADL), health-related quality of life (HRQL) and 6-month readmission rate.
During 2008-2010, 248 consecutive patients hospitalized for symptoms of worsening CHF were enrolled in a controlled before and after designed study. A Usual care group (n= 123) was recruited according to pre-defined criteria to map usual CHF care and assess outcomes at five designated hospital wards. Based on the mapping, a panel of in-house clinicians and researchers developed measures aimed at aligning usual care with basic PCC principles. These measures were incorporated into a study protocol to guide care procedures at the same five wards. Person-centred care was then implemented at these wards and evaluated in 125 patients. Both length of hospital stay and 6-month readmission were extracted from patient records. Activities of daily living were evaluated at baseline and discharge and HRQL was evaluated at baseline and after 3 months. In the analysis of all patients, the LOS was reduced by 1 day (P = 0.16) while retaining ADL (P = 0.07). When PCC was fully implemented (per protocol analysis), LOS was reduced by 2.5 days (P = 0.01) and the ADL-level better preserved (P = 0.04). Health-related quality of life and time-to-first readmission did not differ.
In this proof-of-concept study, our findings suggest that a fully implemented PCC approach shortens hospital stay and maintains functional performance in patients hospitalized for worsening CHF, without increasing risk for readmission or jeopardizing patients' HRQL.
Without standardized definitions of the techniques included in behavior change interventions, it is difficult to faithfully replicate effective interventions and challenging to identify techniques contributing to effectiveness across interventions. This research aimed to develop and test a theory-linked taxonomy of generally applicable behavior change techniques (BCTs).
Twenty-six BCTs were defined. Two psychologists used a 5-page coding manual to independently judge the presence or absence of each technique in published intervention descriptions and in intervention manuals.
Three systematic reviews yielded 195 published descriptions. Across 78 reliability tests (i.e., 26 techniques applied to 3 reviews), the average kappa per technique was 0.79, with 93% of judgments being agreements. Interventions were found to vary widely in the range and type of techniques used, even when targeting the same behavior among similar participants. The average agreement for intervention manuals was 85%, and a comparison of BCTs identified in 13 manuals and 13 published articles describing the same interventions generated a technique correspondence rate of 74%, with most mismatches (73%) arising from identification of a technique in the manual but not in the article.
These findings demonstrate the feasibility of developing standardized definitions of BCTs included in behavioral interventions and highlight problematic variability in the reporting of intervention content.
Objectives:
The concepts of patient empowerment, patient participation and patient-centeredness have been introduced as part of the trend towards a more participatory health care and have largely been used interchangeably. Although these concepts have been discussed for a number of years, their exact meaning in hospital care remains somewhat unclear. This absence of theoretical and conceptual clarity has led to (1) poor understanding and communication among researchers, health practitioners and policy makers and (2) problems in measurement and comparison between studies across different hospitals.
Methods:
This paper examines all three concepts through a concept analysis based on the method of Avant and Walker (2005) [1] and the simultaneous concept analysis of Haase et al. (1992) [2].
Results:
Through these methods, the antecedents, attributes, consequences and empirical referents of each concept are determined. In addition, similarities and differences between the three concepts are identified and a definition offered for each concept. Furthermore, the interrelatedness between the key concepts is mapped, and definitions are proposed.
Conclusions:
It can be concluded that patient empowerment is a much broader concept than just patient participation and patient-centeredness.
Practice implications:
The present study may provide a useful framework that researchers, policy makers and health care providers can use to facilitate patient empowerment.
Patient participation is a way for patients to engage in their nursing care. In view of the possible link between patient participation and safety, there is a need for an updated review to assess patient participation in nursing care.
To investigate patients' and nurses' perceptions of and behaviours towards patient participation in nursing care in the context of hospital medical wards.
Integrative review.
Three search strategies were employed in August 2013; a computerised database search of Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Medline and PsychINFO; reference lists were hand-searched; and forward citation searching was executed.
After reviewing the studies, extracting study data and completing summary tables the methodological quality was assessed using the Mixed-Methods Assessment Tool by two reviewers. Reviewers met then to discuss discrepancies as well as the overall strengths and limitations of the studies. Discrepancies were overcome through consensus or a third reviewer adjudicated the issue. Within and across study analysis and synthesis of the findings sections was undertaken using thematic synthesis.
Eight studies met inclusion criteria. Four themes were identified - enacting participation, challenges to participation, promoting participation and types of participation. Most studies included were conducted in Europe. The majority of studies used qualitative methodologies, with all studies sampling patients; nurses were included in three studies. Data were largely collected using self-reported perceptions; two studies included observational data. Methodological issues included a lack of reflexivity, un-validated data collection tools, sampling issues and low response rates.
On medical wards, patients and nurses desire, perceive or enact patient participation passively. Challenging factors for patient participation include patients' willingness, nurses' approach and confusion around expectations and roles. Information-sharing was identified as an activity that promotes patient participation, suggesting nurses encourage active communication with patients in practice. Involving patients in assessment and care planning may also enhance patient participation. For education, enhancing nurses' understanding of the attributes of patient participation, as well as patient-centred care approaches may be beneficial for medical ward nurses. From here, researchers need to examine ways to overcome the barriers to patient participation; further nurse participants and observational data is required on medical wards.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Aims and objectivesThis systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives.Background
Ambiguities remain about how patients participate in routine measures designed to promote patient safety.DesignSystematic review using integrative methods.Methods
Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: “patient”, “healthcare provider”, “task”, “work environment”, “organisation & management”.ResultsWe identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives.Conclusions
Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are ‘allowed’ to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures.Relevance to clinical practicePatients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety.
What would fit in a "basic nursing care" special issue of the Journal of Nursing Scholarship?After the call for manuscripts for this special issue, many nurse scientists asked for guidance on the suitability of their potential contributions. Most of their questions were on content, i.e., whether or not a certain topic would be considered within the scope of basic nursing care. Together, these questions illustrate a degree of uncertainty on the topic. So, what is basic and what can be considered basic within nursing care?General guidance can be found in landmark reports of the Institute of medicine (Institute of Medicine, 2001) and the World Health Organisation (WHO; 2006). Together, these reports underline that, regardless of medical conditions and context, health care should be client centred, safe, effective, efficient, accessible, timely and non-discriminative. Though not specific for any discipline, these basic traits of good quality health care are fully applicable to nursing care. Also they illustrate how "basic" can be used to refer to what is generic, regardless of context and health conditions.With a view to nursing, several authors tried to identify what is generic across populations and healthcare settings. The work of Virginia Henderson (1964) can be seen as a major contribution in this respect. Henderson identified the core of nursing care, as care focused on fourteen fundamental or basic human needs, being the need to breath normally, sleep and rest, eat and drink, eliminate body wastes, dress, maintain body temperature, keep clean, avoid dangers, communicate with others, worship, work, play, and learn. Of more recent date is the work of Kitson, Conroy, Wengstrom, Profetto-McGrath, and Robertson-Malt (2010), who describe the fundamentals of care as care for communication, breathing, eating and drinking, elimination, cleanliness and dressing, mobility, activities, rest, sleep, body temperature, working and playing, expressing sexuality, safety, and death care.These two largely overlapping overviews of the (care for) fundamental or basic human needs together indicate how basic nursing care serves human needs in the context of healthcare, yet not focusing on needs belonging to a specific health problem or care setting.Nonsimplistic Common GroundThough generic and nonspecialist, basic care should not be mistaken for simple care requiring low educational levels. The complexity of providing basic nursing care will vary with many individual and situational factors such as comorbidity, care dependency, social support, health care setting, and available resources.Following reports on harmfully poor, or even lacking, nursing care in UK hospitals (Francis, 2013; Keogh, 2013), it has been suggested that all nurses should spend a year of their initial training on providing basic nursing care. Though perhaps a welcome plea for reinvesting in care that serves fundamental needs, the discussions on this were partly condescending towards basic nursing care as well. Politicians asking nurses to "step down to the level of care assistants" and "do the hands on work," implicitly also send out a message that basic care is the simple, dirty work that comes with the job.With this special issue, the Journal of Nursing Scholarship purposefully revisits basic nursing care. As nurses' common ground, informing and improving basic nursing care deserves our full attention and scholarly activities in this area deserve to be highlighted. …
Kitson A, Conroy T, Wengstrom Y, Profetto‐McGrath J, Robertson‐Malt S. International Journal of Nursing Practice 2010; 16 : 423–434
Defining the fundamentals of care
A three‐stage process is being undertaken to investigate the fundamentals of care. Stage One (reported here) involves the use of a met a‐narrative review methodology to undertake a thematic analysis, categorization and synthesis of selected contents extracted from seminal texts relating to nursing practice. Stage Two will involve a search for evidence to inform the fundamentals of care and a refinement of the review method. Stage Three will extend the reviews of the elements defined as fundamentals of care. This introductory paper covers the following aspects: the conceptual basis upon which nursing care is delivered; how the fundamentals of care have been defined in the literature and in practice; an argument that physiological aspects of care, self‐care elements and aspects of the environment of care are central to the conceptual refinement of the term fundamentals of care; and that efforts to systematize such information will enhance overall care delivery through improvements in patient safety and quality initiatives in health systems.
The study's rationale: Patients’ influence in health care through participation, freedom of choice and information, is laid down in laws, national and local directives. In nursing care situations, the degree to which a patient participates depends on the nursing staff. Accordingly, hindrances for patient's participation during nursing care is an important question for the nursing profession.
Aims and objectives: The aim was to focus on Swedish Registered Nurses opinion of hindrances for patient participation in nursing care and to uncover the informants’ perspectives in depth.
Methodological design and justification: The study was limited to inpatient somatic care and has a qualitative approach. Data were collected through seven focus group interviews with 31 Registered Nurses from five hospitals. An analysis of the tape-recorded interview material was made, combining elements of content analysis with aspects of the Grounded Theory approach.
Ethical issues and approval: The ethics of scientific work was followed. The participants gave informed consent. Verbal and written information was given as a guarantee that all information would be treated confidentially outside the focus group. Formal approval by ethical committee was not required according to national and local directives.
Results: Hindrance for patient participation in nursing care comprised three themes: Competence, Influence of significant others and Organization and work environment, and their seven underlying subthemes.
Conclusions: The study clarified factors, which individually or combined may be hindrance for patient participation in nursing practice. Professional nurses must be able to find a balance for their patients’ participation in nursing care activities through identification and coping with the hindrances. The three themes and seven subthemes here identified, can be used in patient care and its’ evaluation, like also quality assurance of care and work organization and in nursing education. For further development replication studies are needed, like additional studies of patients and significant others.
• Patients' views on the quality of care are important and it is desirable that these can be assessed using short, yet valid and reliable instruments.
• The aim of the work reported here was to develop and test a short version of an established questionnaire: Quality from the Patient's Perspective (QPP).
• Patients (n=162, 79% response rate) receiving care at medical and surgical departments in two Swedish hospitals responded to the original QPP as well as to a newly developed short version. An ethical research committee approved the study.
• Pearson correlations were computed between the long and short forms and differences between means were analysed with t-tests. Reliability was estimated by computing Cronbach alpha coefficients.
• Correlations of acceptable size were found between the short form and the original QPP. The short form also had acceptable reliability coefficients.
• The strengths of the work are that the items in the short version are derived from a patient perspective and are formulated in words used by patients; the items still have a theoretical foundation, which makes the interpretation of results more meaningful; global formulations such as `What do you think about your care?' have been avoided; the short format should make the questionnaire more attractive for many patients to respond to.
• Limitations are that results indicate that the short form does not fully measure what the long form does. Therefore, when the short form is used in practice, a two-step procedure is suggested, where a follow-up is done with a selection of items from the original long form. This selection could be restricted to areas where problems may be suspected, based on the results from the short form.
Aim. To identify the common, core elements of patient-centred care in the health policy, medical and nursing literature.
Background. Healthcare reform is being driven by the rhetoric around patient-centred care yet no common definition exists and few integrated reviews undertaken.
Design. Narrative review and synthesis.
Data sources. Key seminal texts and papers from patient organizations, policy documents, and medical and nursing studies which looked at patient-centred care in the acute care setting. Search sources included Medline, CINHAL, SCOPUS, and primary policy documents and texts covering the period from 1990–March 2010.
Review methods. A narrative review and synthesis was undertaken including empirical, descriptive, and discursive papers. Initially, generic search terms were used to capture relevant literature; the selection process was narrowed to seminal texts (Stage 1 of the review) and papers from three key areas (in Stage 2).
Results. In total, 60 papers were included in the review and synthesis. Seven were from health policy, 22 from medicine, and 31 from nursing literature. Few common definitions were found across the literature. Three core themes, however, were identified: patient participation and involvement, the relationship between the patient and the healthcare professional, and the context where care is delivered.
Conclusion. Three core themes describing patient-centred care have emerged from the health policy, medical, and nursing literature. This may indicate a common conceptual source. Different professional groups tend to focus on or emphasize different elements within the themes. This may affect the success of implementing patient-centred care in practice.
Organizational changes in surgical care are requiring patients to become more responsible for their own care, both before and after surgery, and also during recovery. Involving patients in their care is vital to improving quality of care and patient safety.
The aim of this study was to investigate the impact of the 'Tell-us' card on patients' perceptions of quality of care, with a specific focus on patient participation. Another aim was to evaluate the use of the Tell-us card from the patients' perspective.
A quasi-experimental design with an intervention group and control groups was used. The patient's self-written Tell-us card was introduced as the intervention.
The study was conducted in two surgical care units at a Swedish university hospital.
A consecutive sample of patients admitted from the waiting list and from the emergency department was included (n=310). The inclusion criteria were surgical patients with a hospital stay of at least one day. Patients who were younger than 18 years, not able to speak or write in Swedish, or unable or unwilling to give informed consent to participate were excluded.
Quality of care was assessed using the questionnaire 'Quality from the Patient's Perspective'. The patients included in the intervention group were asked to write what was most important for them during the day or just before discharge on patient-written Tell-us cards.
The use of the Tell-us card resulted in significant improvements (5 out of 17 items) in patients' abilities to participate in decisions about their nursing and medical care. The patients found the Tell-us card more useful in their interaction with registered nurses and assistant nurses than with physicians.
The use of the Tell-us card improved patients' participation in some areas of nursing and medical care in the surgical care units. The Tell-us card is an uncomplicated and inexpensive tool that could be an important step towards improved patient participation in the surgical care unit. More research is needed to evaluate the use of the Tell-us card in different hospital units and over a longer period of time.
When entering a consulting room a person becomes a patient with double needs, that is, the need to feel known and understood and the need to know and understand, also referred to as affective and instrumental needs, respectively. The fulfilment of these needs highly depends on the communication skills of both doctor and patient, which help to bridge the inherent distance that exists between these two persons. There is ample evidence that this bridge becomes stronger the more the communication is tailored to the person behind the patient. Besides, such tailored communication may also prove to be effective for reaching favourable health outcomes.
Descriptive study focusing on the value of tailored communication in promoting person-centred instrumental and affective health outcomes.
Research shows that tailored communication contributes to health outcomes known to be crucial for recovery and quality of life, that is, information recall, medication adherence, reassurance and need fulfilment.
There is empirical evidence for the value of tailored communication for person-centred outcomes. Communicating in a purposeful way while at the same time respecting patients' values and feelings should therefore become the standard in health care practice.
Patient whiteboards can serve as a communication tool between hospital providers and as a mechanism to engage patients in their care, but little is known about their current use or best practices.
We surveyed bedside nurses, internal medicine housestaff, and hospitalists from the medical service at the University of California, San Francisco. A brief survey about self-reported whiteboard practices and their impact on patient care was administered via paper and a commercial online survey tool.
Surveys were collected from 104 nurse respondents (81% response rate), 118 internal medicine housestaff (74% response rate), and 31 hospitalists (86% response rate). Nurses were far more likely to use and read whiteboards than physicians. While all respondents highly valued the utility of family contact information on whiteboards, nurses valued the importance of a "goal for the day" and an "anticipated discharge date" more than physicians. Most respondents believed that nurses should be responsible for accurate and updated information on whiteboards, that goals for the day should be created by a nurse and physician together, and that unavailability of pens was the greatest barrier to use.
Despite differences in practice patterns of nurses and physicians in using whiteboards, our findings suggest that all providers value their potential as a tool to improve teamwork, communication, and patient care. Successful adoption of whiteboard use may be enhanced through strategies that emphasize a patient-centered focus while also addressing important barriers to use.
Nurses' work is inextricably linked to the evaluation of the quality of care provision in health care. Within this evaluation, individualized care is a topical theme in western countries. Currently, there is no suitable instrument to measure the level of individualized care from the nurses' point of view.
To report the development process of the individualized care scale - nurse (ICS-Nurse) and to ensure its validity and reliability.
A methodological design was used. Data were obtained from 544 nurses (N = 923, response rate 59%) from inpatient wards in one university, two regional and two psychiatric hospitals as well as four health centres. Three expert analyses were used to ensure content validity. Cronbach's alpha coefficients and item analysis were used to examine internal consistency reliability. A principal components analysis, Spearman's correlation coefficients, multiple regression analysis and structural equation modelled by LISREL were conducted to evaluate construct validity.
The expert analyses provided good content validity evidence. The ICS-Nurse was easy to administer and able to be completed quickly. There were few missing data. Cronbach's alpha coefficients ranged 0.72-0.84. All item-to-total correlations were acceptable (>0.30), but some of the inter-item correlations were high. The principal components analysis supported the three-component structure explaining 52% of the variance in ICS-A-Nurse and 56% in ICS-B-Nurse. LISREL supported the theoretical model.
The ICS-Nurse is a valid and reliable instrument that can be used to measure nurses' perceptions of individualized nursing care in inpatient wards. There is a need to test instrument further, both nationally and internationally.
The Patient's Charter identifies the need for nurses to respect patients' rights to influence their care, and contemporary nursing practice advocates that nurses work in partnership with patients. Hence nurses are encouraged to share their power and facilitate empowerment in their patients by giving them information and support.
• However, the literature indicates that nurses are not very successful in making patients feel empowered to make informed decisions. This study, conducted in 1998, provides some answers as to why this may be the case.
• The aim of the study was to explore and describe nurses' and patients' views regarding partnership in care in hospital.
• Using the grounded theory approach, participants were drawn from four hospitals in Western Australia. A purposive sample of 33 nurses and 32 patients were interviewed in‐depth. Participant observation was also conducted and field notes were written. The interviews were transcribed verbatim and analysed using the constant comparative method.
• The findings showed that nurses viewed involving patients in care as requiring them to give patients information and to share their decision‐making powers with them. With the exception of a few, the majority of nurses were unwilling to share their decision‐making powers.
• This created a situation of power imbalance with subsequent little patient input. Factors identified included nurses' beliefs that they ‘know best’, the view that patients lacked medical knowledge and the perceived need for nurses to hold onto their power and maintain control.
• If nurses and patients are to work as partners, it is important that nurses make every effort to equalize the power imbalance. One way to do this is for nurses to share and give information to patients readily and to be open in their communication with them.
Consumer partnerships have been embraced as an important component of building high quality health care services. While nurses have the greatest contact with clients in hospital, little is known of their views about consumer participation or how they facilitate that participation at the bedside. Using focus group interviews and participant observation methods, this project explored nurses' approaches to working with consumers to support their participation in health care delivery. Findings indicate a sharp contrast between the ideas that nurses expressed and the actions observed in practice. It was clear from the interviews that nurses had adopted the rhetoric surrounding consumer participation, yet observational data revealed nursing practices that excluded active participation by consumers. Factors influencing nurses' facilitation of consumer participation were identified as the division of nursing labour in the setting, limited communication between nurses and patients and environmental constraints.
In this study we describe the development of the Individualized Care Scale (ICS) and evaluate its validity, psychometric properties and feasibility. The ICS was designed to measure patients' views on how individuality is supported through specific nursing interventions (ICA) and how they perceive individuality in their own care (ICB) during hospitalization.
Three different data sets were collected among patients being discharged from hospital (n1 = 203, n2 = 279, n3 = 454). This bipartite 38-item ICS promises to be a brief, timely, easy to administer and useful self-completion measure for evaluating clinical nursing practice from the patient's point of view.
The findings supported the internal consistency reliability of the ICS (alpha 0.94 for ICA and ICB 0.93) and the three subscales (alphas 0.85-0.90). Item analysis supported the item construction of each scale. Content validity was furthered by a critical literature review and four expert analyses. Principal component analysis (Promax with Kaiser normalization) among earlier factor analyses supported construct validity by generating a three-factor solution which accounted for 65% of the variance in the ICA and 61% in the ICB. Pearson's correlation coefficients were at least 0.88 between the subscales and the total domain ICA or ICB.
The ICS has demonstrated promise as a tool for measuring patients' evaluations of their hospital experience and individuality in care.
The paper reports a study whose aims were to explore the meaning of participation for older people in hospital and their health care workers and ways in which staff can enhance patient participation in their care.
Participation in care is a concept that is central to nursing practice. However, little is known about patient and staff views of participation and how it takes place in practice.
Action research was used, and data were collected by means of focus groups and in-depth interviews. Three focus groups and 24 interviews were undertaken with staff, and 19 interviews were undertaken with patients. The main action undertaken with staff aimed at raising their awareness of participation. In addition small changes in practice were introduced, such as the use of a patient biographical booklet.
The findings suggest that participation is a dynamic process that is integral to the work of nurses and carers. The process is enacted through the themes of facilitation, partnership, understanding the person, and emotional work.
The study demonstrates how nurses can become increasingly aware of the potential for facilitation and creation of opportunities for participation. It is crucial that practitioners working with older people develop a deeper understanding of participation and are also empowered to act in ways that fit with the needs of this specific client group.
Process evaluation is used to monitor and document program implementation and can aid in understanding the relationship between specific program elements and program outcomes. The scope and implementation of process evaluation has grown in complexity as its importance and utility have become more widely recognized. Several practical frameworks and models are available to practitioners to guide the development of a comprehensive evaluation plan, including process evaluation for collaborative community initiatives. However, frameworks for developing a comprehensive process-evaluation plan for targeted programs are less common. Building from previous frameworks, the authors present a comprehensive and systematic approach for developing a process-evaluation plan to assess the implementation of a targeted health promotion intervention. Suggested elements for process-evaluation plans include fidelity, dose (delivered and received), reach, recruitment, and context. The purpose of this article is to describe and illustrate the steps involved in developing a process evaluation plan for any health promotion program.
The legislation of many Western countries emphasizes active patient participation. Patients with chronic heart failure (CHF), however, have experienced participation differently from the general interpretation of legal definitions. Education improves uptake of self-management strategies yet knowledge is lacking about support of patients' own resources in CHF.
To explore the phenomena of patient participation and non-participation as shown in patient visits to a nurse-led clinic for CHF and as experienced by the patients and nurses.
Data triangulation of field notes from participatory observations and texts from narrative interviews with the patients and assigned nurse specialists. Data were analyzed according to the phenomenological hermeneutic tradition.
Patients' experience of participation and non-participation was interpreted as "Being responsible and accepting responsibility" and "Lacking an equal relationship while being controlled", respectively. Nurses experienced patient participation as "Getting information and security to act" and patient non-participation as "Not accepting".
Conflicting values of patients and nurses, which were interpreted with respect to participation and non-participation, presumably might influence patient information and education negatively. The issue of participation should be raised as a means of attaining concordance and to facilitate patient participation with education specifically tailored to the individual patient's needs.
Implementatie, 6 edn
- R Grol
- M Wensing
Grol R & Wensing M (2015) Implementatie, 6 edn. Springer Media B.V..
NANDA Internatnional Nursing Diagnosis, Definitions and Classifications
- T Herdman
Herdman T (2012) NANDA Internatnional Nursing Diagnosis, Definitions and Classifications 2012-2014. Wiley-Blackwell, Oxford.
Hindrance for patient participation in nursing care
- M J Sahlsten
- I E Larsson
- K A Plos
- C S Lindencrona
Sahlsten MJ, Larsson IE, Plos KA & Lindencrona CS (2005): Hindrance for patient participation in
nursing care. Scand J Caring Sci 19, 223-229.
Exploring patient participation in reducing health-care-related safety risks
World Health Organization (2013) Exploring patient participation in reducing health-care-related
safety risks (Europe ROf ed.), Copenhagen Ø, Denmark.
The value of tailored communication for person-centred outcomes
- T Van Achterberg
van Achterberg T (2014): Revisiting basic nursing care. J Nurs Scholarsh 46, 1-2.
van Dulmen S (2011): The value of tailored communication for person-centred outcomes. J Eval
Clin Pract 17, 381-383.
Essential nursing care: Most provided, least evidence based. The basic care revisited program
- Hamers J. P. H.