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Medical information delivered to patients: Discrepancies concerning roles as perceived by physicians and nurses set against patient satisfaction
Abstract
To assess and to compare roles as perceived by physicians and nurses regarding medical information delivered to patients and to set this against patients' opinions on the quality of the medical information delivered to them.
A questionnaire administered to 302 physicians (MDs) and 533 nurses (NUs), and an inpatient satisfaction survey administered to 1246 patients the day before discharge, as a part of a quality improvement program on patient information in a university hospital.
MDs and NUs reported that diagnosis and prognosis announcements were made by MDs alone. Concerning explanations about diagnosis, information on investigations, and benefits and risks of treatment, NUs considered that they provided information in addition to MDs, while MDs considered that it was generally they alone who delivered the information. Patients were generally very satisfied with information delivered, but more than 20% were not satisfied with information on benefits and risks of investigations and treatments. The most important problem underlined by NUs was that they lacked knowledge of the medical information delivered to patients by MDs (55%).
Perceived roles in the transmission of medical information to patients were very different between MDs and NUs. Patient satisfaction seemed to be greater where professional roles were clear-cut. Physicians did not recognise the primary role of the NUs. Lack of MD-NU collaboration affects the quality of patient care.
A better definition of the specific roles of MDs and NUs, their training in effective methods of asserting opinions and knowledge and in conducting collaborative ward rounds would be of benefit to patients.
... Other studies found that doctors and their patients had very different perceptions about doctors' communication skills during clinical interaction (Tran et al., 2020;Kenny et al., 2010). Only one study (Moret et al., 2008), to our knowledge, examined the opinions of all three groups, namely, physicians, nurses and patients and found a discrepancy between physicians and nurses regarding their role in providing information to patients. Nursing staff believed that they play an important role in informing patients about treatment, examinations and clarifications, while doctors consider themselves as the ones in charge for providing information. ...
... For the survey, a structured questionnaire was used with five-point Likert scale questions to measure the satisfaction level. The questionnaire was based on data from studies related to doctor-patient communication (Adler et al., 2009;Moret et al., 2008;Durieux et al., 2004) The questions were adjusted to correspond to the purpose of the study, namely to hospitalized patients of all clinics (not only oncology) and to the Greek environment. The questions that comprised the final questionnaire covered a wide range of themes that are related to information exchange (when to inform, where, for how long, how much, etc.). ...
... Very important is the denoted difference in the overall satisfaction from the communication, with doctors scoring a higher satisfaction rate than patients (78.6% satisfied doctors/nurses vs. 69.4% satisfied patients). Research by Moret et al. (2008) found a divergence between doctors' and nurses' satisfaction level regarding their role in providing information to patients, which was not observed in our study. ...
Purpose:
The purpose of this study is to investigate and compare the views of doctors, nursing staff and hospitalized patients on the level of information they provide and receive respectively in public hospitals, focusing on the factors that affect their communication.
Design/methodology/approach:
The study used a cross-sectional survey with a sample of 426 participants from two general hospitals in Greece-Pella and KAT Attica. Data were collected through a questionnaire in March-May 2020 and was analyzed with mean comparisons and correlations.
Findings:
The results showed discrepancy in the satisfaction rate, with 67.3% satisfied patients from doctors' communication vs. 83.7% satisfied doctors. Improvements in hospital staff - patient communication are required especially on alternative therapies' discussion and time spent on communication. All respondents agreed that staff shortage is a deterrent factor for effective communication. Seamless for all respondents' groups, the factors that affect the communication satisfaction level are the duration of communication, time allowed for expressing questions and interest in patients' personal situation.
Practical implications:
Strengthening the communication skills of medical staff and providing clear guidelines on when and how to inform patients are essential.
Originality/value:
This study contributes to the growing body of research on doctor-patient communication. Its originality lies on the fact that communication satisfaction level was examined simultaneously for doctors, nurses and patients. The study provides additional evidence supporting the link among satisfaction and duration of communication and personalized relationship. The study's findings are important in the training of medical staff and the management of patients' expectations.
... Usually, patients are reluctant to report their needs whereas health professionals fail to encourage patients to express their needs for various reasons such as lack of leisure time, shortage of nursing staff or the nature of the event (acute or chronic). Additionally, the current trend for early hospital discharge, is minimizing the available time for needs' evaluation including the need of information (Sepucha et al., 2010;Chevalier, Lombrail, & Gasquet, 2008;Moret, Rochedreux, Chevalier, Lombrail, & Gasquet, 2008;Ivarsson, Larsson, Lührs, & Sjöberg, 2007;Timmins, 2005;Kelly, 2004;Worth, Tierney, & Watson, 2000). ...
... Usually, patients are reluctant to report their needs whereas health professionals fail to encourage patients to express their needs for various reasons such as lack of leisure time, shortage of nursing staff or the nature of the event (acute or chronic). Additionally, the current trend for early hospital discharge, is minimizing the available time for needs' evaluation including the need of information (Sepucha et al., 2010;Chevalier, Lombrail, & Gasquet, 2008;Moret, Rochedreux, Chevalier, Lombrail, & Gasquet, 2008;Ivarsson, Larsson, Lührs, & Sjöberg, 2007;Timmins, 2005;Kelly, 2004;Worth, Tierney, & Watson, 2000). ...
... Relevant research has shown that lack of information is related to distrust of health professionals' options or uncertainties about the disease. As a consequence, patients experience unwillingness to follow the proposed therapeutic intervention (Polikandrioti & Νtokou, 2011;Sepucha et al., 2010;Moret, Rochedreux, Chevalier, Lombrail, & Gasquet, 2008;Ivarsson, Larsson, Lührs, Sjöberg, 2007;Kelly, 2004;Timmins, 2005;Worth, Tierney, & Watson, 2000). ...
Introduction:
During recent years that life expectancy of heart failure patients has been increased, health professionals put more emphasis on assessing their needs in daily clinical practice. The aim of the present study was to explore the association between characteristics of hospitalized heart failure patients with their needs.
Methods:
A sample of 190 hospitalized patients with HF, recruited from public hospitals in Greece, was enrolled in the study. Data were collected by the completion of a questionnaire which included socio-demographic and clinical characteristics and the questionnaire “Needs of hospitalized patients with coronary artery disease” which is consisted of 6 subscales. Statistical methods used were Kruskal wallis-test or Mann-Whitney test and Spearmans’ rho coefficient. Multiple regression analysis was performed in order to evaluate the association between patients’ characteristics and the significance of their needs.
Results:
124 (65.3%) of hospitalized heart failure participants were men and 89 (46.8%) of participants were more than 70 years old. 145 (76.3%) had prior experience of hospitalization due to heart failure. The need for support and guidance was statistically significantly associated with the degree of information, (p=<0.001). The need for information from the medical and nursing staff was significantly associated with marital status and degree of information (p=0.001 and p<0.001 respectively). The need for need for being in contact with other patient groups, and ensuring communication with relatives was statistically significantly associated with the professional status and degree of information, (p=0.037 and p=<0.001 respectively). The need for individualized treatment and the need for patient’s personal participation to his/her treatment as well as the need to meet the emotional and physical needs were statistically significant associated with the degree of information, (p=<0.001, p=<0.001 respectively). Lastly, the need to trust the medical and nursing staff was statistically significantly associated with the place of residence and the degree of information, (p=0.023 and p<0.001). These results were confirmed by the multiple linear regression after controlling for potential confounders.
Conclusions:
Information seems to be of vital importance when assessing the needs of heart failure patients. Therefore, providing elaborate information should be an integral part of their therapeutic regimen.
... Resultatet visade att det fanns problem i patienters förståelse för läkemedelsinformation vid utskrivning från sjukhuset. Patienter hade bristfällig förståelse för läkemedelsnamn, orsaken till sin läkemedelsbehandling, tid för intag av läkemedel, läkemedelsbiverkningar och försiktighetsåtgärder samt interaktioner mellan olika läkemedel eller mellan läkemedel och mat (21)(22)(23)(24)(25)(29)(30)(31)(32). Patienters förståelse kunde påverkas av ålder (21,(25)(26)(27)(28), kön (21,27), utbildning (27), antal ordinerade läkemedel (22,25,26), om läkemedel var nyordinerat eller tidigare ordinerat (28,29), diagnos (23,24,28), om patienterna själva skötte sina läkemedelsbehandling eller fick hjälp av andra (28) samt hur mycket och vilken information patienterna fick vid utskrivning (22,27,29,(33)(34)(35)37). Det som var mest utmärkande var att förståelsen minskade om patienter använde fler än tre läkemedel (22,25,26) samt ju äldre patienter var (25,26). ...
... Dessutom kan en checklista fokuserad på läkemedelssäkerhet, patientundervisning och uppföljning användas under patientens sjukhusvistelse, där sjuksköterskan kontrollerar att all information givits om patientens diagnos och läkemedelsbehandling och att detta följs upp inför utskrivning. För att ytterligare kontrollera och komplettera patientens förståelse skulle apotekare kunna hjälpa till med uppföljning av läkemedelsinformation när läkemedel lämnas ut.Det framkom i resultatet att det var dålig samverkan mellan vårdpersonalen gällande läkemedelsinformation till patienten(32,33). Vi tycker att ett väl fungerande samarbete mellan sjuksköterska och läkare kan förhindra att missförstånd uppstår om patienten fått läkemedelsinformation eller ej. ...
... De hade även problem med hur förpackningar skulle öppnas, språkförståelse samt sväljningsproblem(22). Några studier visade att förståelsen för biverkningar och det som skulle undvikas i samband med intag av läkemedel var sämre än förståelsen till varför läkemedel togs(21,25,29,32).I en undersökning där patienternas kunskap om sina läkemedel bedömdes, efter muntlig information vid utskrivning, visades det att när patienter tillfrågades om varför de tog sina läkemedel, så svarade en del fel. De trodde att de visste varför den togs, men i själva verket var deras kunskap om detta felaktig (29). ...
... Miscommunication also arises between the doctor and the nurses at a certain stage in delivering the medical information (Moret et al., 2008). Indeed, the training module provided by the medical school creates different values and interests in the professionals. ...
... System arrangement. Moret et al. (2008), Rummery and Coleman (2003) Miscommunication, issue of trust between professionals in health and social care. ...
... Bryan et al. (2006) highlighted various reasons arising from human nature that cause breaches in care services, especially in complex patient pathways in integrated care. These cause other problems in integrated care such as communication, patient pathways, imbalanced supply and demand and many more (Moret et al., 2008;Rummery and Coleman, 2003;Grone and Barbero, 2001;Andersson and Karlberg, 2000). Based on this argument and chain-of-problems situation, it is argued that any tool that is used to model CPP should consider these criteria as any initiative proposed will impact dynamically on the other parts in the system. ...
... The communication with medical staff resulted as a significant dimension of patient satisfaction. A result highlighted also by several studies [16], [37], [64] It is founded that the financial aspects had the higher correlation coefficient related to the other factors (0.539) Numerous studies [24], [65] have shown the impact of financial aspects on patient satisfaction assessment with the healthcare. This dimension is certainly very sensitive and directly related to the patient, especially for those who are not covered by insurance and must pay a large amount of money out of pocket when receiving healthcare services. ...
... Out-of-pocket payments account for nearly half of health-care spending in low-income nations, compared to 30% in middle-income countries and 14% in high-income ones [64]. This means that policies and initiatives should be implemented to reduce the impact of this phenomenon on citizens. ...
... The major theme extracted in this study was the inappropriate organizational culture which includes eight categories listed as follows: Not putting value on education, non-professional activities, physicianoriented atmosphere, conflict and lack of coherence in education, inappropriate communication skills, ignoring patient's right in education, lack of motivation, rewarding system in the organization, and poor supervision and control. Inadequate support of managers, particularly in case of appropriate time allocation for nurses' teaching activities and ineffective coordination of educational responsibilities among disciplines is a barrier to PE. 38,48 Managerial and organizational support is an important element for the implementation of high-quality PE. 49,50 The result of a study that was conducted in Iran showed that nurses were well informed of the importance of patient education and had accepted this role in clinical settings, but no managerial support was available to them for doing this activity. 3 Moreover, other studies showed that hospital managers have less emphasize on PE. 2,51 Modifying administrational support is crucial for effective PE. ...
... Moret et al. found that nurses and physicians did not agree on patient information materials, so that nurses considered their role to be more important than what the physicians gave them. 50 However, this finding is inconsistent with that of Park's study, in which nurses stated that information about medicine and treatment was not their responsibility. 2 On the other hand, there is incongruence between nurses' and patients' perceptions regarding the nurses' role in PE. ...
Objective:
The aim of this study was to present a comprehensive review of the literatures describing barriers and facilitators of patient education (PE) perceived by Iranian nurses in order to explain clinical applicability of patient education.
Methods:
Review of the literature was undertaken using the international databases including PubMed/Medline, Scopus, ScienceDirect, as well as Google Scholar. Also, Persian electronic databases such as Magiran, SID and IranMedex were searched. Electronic databases were searched up from conception to September 2014 using search terms: "patient education", " patients education", "patient teaching", "patient training", "nurse", " nurses", " nursing", " and "Iran". Only studies were included that were related to barriers and facilitators of PE among Iranian nurses.
Results:
Twenty-seven studies were included. The main influential barriers were categorized into three major areas: 1) Nurse-related factors: nursing shortage 2) Administration-related factors: unsupportive organizational culture, and 3) Patient-related factors: low compliance. The most perceived facilitators were recognized as "increasing, selecting and training special nurses for providing PE" and "providing PE courses for nurses and appropriate facilities for PE".
Conclusion:
Iranian nurses encounter barriers in PE, and the most frequently encountered barriers were related to administration factors. These findings have implications for administrators and managers in health settings. In order to promote PE among nurses, administrators should create a supportive environment and use effective strategies to smooth the progress of PE by nurses in their practice in order to ensure optimal outcomes for patients.
... Specifically, lack of coordination and collaboration among health-care member's results in conflicting or erroneous information given to patients and their family members. 7,[22][23][24] The involvement of numerous people who do not always deliver the same message can confuse patients, 7 leaving them unsure about their diagnosis and prognosis, confused about the meaning of and need for further diagnostic tests, unclear about the management plan and uncertain about the true therapeutic intent of treatment. Not surprisingly, conflicting communication can thus result in lack of patients compliance with medical advice. ...
... Specifically, lack of coordination and collaboration among health-care member's results in conflicting or erroneous information given to patients and their family members. 7,[22][23][24] The involvement of numerous people who do not always deliver the same message can confuse patients, 7 leaving them unsure about their diagnosis and prognosis, confused about the meaning of and need for further diagnostic tests, unclear about the management plan and uncertain about the true therapeutic intent of treatment. Not surprisingly, conflicting communication can thus result in lack of patients compliance with medical advice. ...
... Nurses often recognized communication as central to their role, although they acknowledged the need to rely on parents. 24,25 Doctors in our study suggested that time pressures meant they had to prioritize their attention on diagnosis rather than communication. It is possible that this perception may itself be a barrier to effective communication. ...
... 9 Nurses in our study saw mediating between parents and doctors as part of their role, and this has been reported elsewhere. 25 It has been suggested that nurses may take on the role invisibly and that parents may be unaware of this mediation. 26 Parents in our study did not make reference to nurses mediating their relationship with doctors, but do report relying more on nurses than doctors for communication. ...
Background
Communication is a fundamental part of health care, but can be more difficult with disabled children. Disabled children are more frequently admitted to hospital than other children.AimsTo explore experiences of ward staff and families to identify barriers and facilitators to effective communication with disabled children whilst inpatients.DesignThis was an exploratory qualitative study.Methods
We consulted 25 staff working on paediatric wards and 15 parents of disabled children recently admitted to those wards. We had difficulty in recruiting children and evaluating their experiences. Data were collected through interviews and focus groups. A thematic analysis of the data supported by the Framework Approach was used to explore experiences and views about communication. Emerging themes were subsequently synthesised to identify barriers and facilitators to good communication.ResultsBarriers to communication included time, professionals not prioritising communication in their role and poor information sharing between parents and professionals. Facilitators included professionals building rapport with a child, good relationships between professionals and parents, professionals having a family-centred approach, and the use of communication aids.Conclusions
Communication with disabled children on the ward was perceived as less than optimal. Parents are instrumental in the communication between their children and professionals. Although aware of the importance of communication with disabled children, staff perceived time pressures and lack of priority given to communicating directly with the child as major barriers.
... Bu çalışmada, hemşirelerin %37,5'inin her zaman, %25'inin ise bazen doktorla görüştüğü tespit edildi. Akçin'in (2006) çalışmasında hemşirelerin %95,4'ü hastalara eğitim vermeden önce doktordan bilgi aldığını, Moret ve ark.'nın (2008) çalışmasında ise %55'i doktor tarafından verilen bilgiler hakkında yeterince bilgi sahibi olmadığını ve bunun hasta eğitimi verirken karşılaştıkları en önemli sorun olduğunu ifade etmiştir (33,44). Elde ettiğimiz bulgular, Moret ve ark.'nın (2008) çalışması ile uyumlu görünürken Akçin'in (2006) çalışması ile uyumlu değildir. ...
Araştırma cerrahi kliniklerde çalışan hemşirelerin preoperatif hasta eğitimi konusundaki uygulamaları ve yaklaşımlarının değerlendirilmesi amacıyla planlandı. Tanımlayıcı tipteki araştırma, Bitlis Devlet Hastanesi ve Bitlis/Tatvan Devlet Hastanesi’nde yapıldı. Araştırmanın evrenini cerrahi kliniklerde çalışan tüm hemşireler (N:55), örneklemini ise gönüllü toplam 48 hemşire oluşturdu. Verilerin toplanmasında anket formu kullanılmış olup SPSS 20.0 paket programında tanımlayıcı istatistiksel yöntemler kullanılarak analiz edildi. Hemşirelerin yaş ortalamasının 27,29±3,57 yıl, %60,4’ünün kadın, %77,1’inin lisans mezunu olduğu görüldü. Hemşirelerin tamamının preoperatif hasta eğitimi verdiği, %75’inin eğitim vermek için kendini yeterli gördüğü, %20,8’inin ise hasta eğitimini hemşirenin sorumlulukları arasında görmediği saptandı. Hemşirelerin %41,7’sinin hasta eğitimini ameliyattan önceki gün öğleden sonra uyguladığı, %83,3’ünün sadece sözel anlatım yöntemini kullandığı, %33,3’ünün eğitimi uygulamalı olarak yapmadığı saptandı. Hemşirelerin en çok ameliyat sabahı hazırlığı (%97,9), hastaneye gelme zamanı (%95,8), preoperatif oral alımın kısıtlanması ve tetkikler (%93,8) hakkında, en az ise postoperatif derlenme ünitesi/yoğun bakım süreci (%31,3), ameliyathane ortamı (%43,8) ve yatak içi egzersizleri (%56,3) hakkında eğitim verdikleri saptandı. Hemşirelerin eğitim konusunda genellikle olumlu bir tutum sergilediği ve daha çok preoperatif konulara ağırlık verdiği saptandı.
... A weak healthcare system can be attributed to several factors, including inadequate complaint channels, lack of awareness of service entitlements, power asymmetry between consumers and service providers, limited options for provider options, discouragement of complaint culture in the society, and poor responsiveness to patient complaints (Gurung, Derrett, Gauld, & Hill, 2017). Moreover, the rational choice of selecting a reputable healthcare provider and experienced medical professionals significantly impacts the quality of patient treatment (Moret, Rochedreux, Chevalier, Lombrail, & Gasquet, 2008). There is a strong evidence indicating that economic crisis, including the repercussions of COVID-19, have led to reductions in the utilization of regular medical care (Lusardi, Schneider, & Tufano, 2010). ...
The spread of diseases underscores the significance of understanding the patient complaint behaviour in order to deliver a quick responsiveness in a very empathetic, reliable, and courteous manner that helps patient recovering from illness as soon as possible. Our study mainly examines patient complaint behaviour, including the propensity to complain, engage in negative word of mouth, switch healthcare providers, and seek third-party assistance, within private and public hospitals in Damascus, Syria. Convenience sampling method was used to select 446 patients from four hospitals (two private and two public) in the Syrian capital Damascus. Structural equation modelling (SEM) implemented to empirically test the proposed hypotheses and to examine the significance relationship between the constructs. our findings indicate that complaint behaviour among Syrian patients in public hospitals differs significantly from that observed in private hospitals. Besides, in the private healthcare sector, our empirical findings provide substantial evidence of a significant association between price consciousness and the propensity to voice complaints (β= 0.36, P<0.00). However, in the public healthcare sector, the relationship between price consciousness and the propensity to complain is not statistically significant (β= 0.33, P >0.05). The findings of this study will provide valuable insights for policymakers and hospital administrators in mitigating the effects of complaints, minimizing their adverse impact on the quality of care, and improving patients' capacity to express their discontent. To the authors' knowledge, this study represents a distinctive and unique contribution as it explores and compares patient complaint behaviour in public and private hospitals, specifically within the context of developing countries. It provides a valuable contribution by addressing an area that has not been extensively explored.
... In a cross-sectional multi-centered observational study conducted in Nicosia and Ammochostos state hospitals in North Cyprus patients claimed that they were not well informed and were not satisfied with the information they received from the physicians regarding potential difficulties with their asthma management and side effects. 41 This has also been demonstrated in several other studies 42,43 underlying the extent of the problem. ...
Purpose
To estimate the prevalence of asthma in adults, by gender and age, in urban and rural areas of Cyprus.
Patients and Methods
This was a population-based, random-digit dialing, telephone nation-wide survey to recruit patients with asthma. Among 8996 random landline-telephone contacted from the five major urban and rural regions of Cyprus, 1914 were finally met the age criterion of ≥18 years old and 572 completed valid screening for prevalence estimation. The participants filled a short screening questionnaire in order for asthma cases to be recognized. Then, asthma cases filled the main ECRHS II questionnaire and were evaluated by a pulmonary physician. All underwent spirometry. Data on demographic characteristics, educational level, profession, smoking status, Body Mass Index (BMI), Total IgE and Eosinophil Cationic Protein levels were measured.
Results
The overall prevalence of bronchial asthma in adults in Cyprus was 5.57% (61.1% men and 38.9% women). Among the participants with self-reported bronchial asthma 36.1% were current smokers, while 12.3% were obese (BMI >30). A total value of IgE >115 IU and Eosinophil Cationic Protein (ECP) >20 IU was found in 40% of the participants with established bronchial asthma. Wheezing and chest tightness were the most frequently reported symptoms in asthma patients (36.1% and 34.5%, respectively), while 36.5% experienced at least one exacerbation during the last year. Interestingly, most of the patients were under-treated (14.2% were on maintenance asthma treatment, and 18% used solely reliever medication).
Conclusion
This was the first study estimating asthma prevalence in Cyprus. Asthma affects almost 6% of the adult population, with higher prevalence in urban areas and in men compared to women. Interestingly, one-third of the patients were uncontrolled and under-treated. This study revealed that in Cyprus there is space for improvement in the management of asthma.
... 7 Health professionals tend to overestimate the quantity and quality of information provided to patients. 12 However, communication between professionals and patients must adjust according to the patients' needs, with no single model of communication and information exchange. 7,11 Patient satisfaction with the information received about medications can arise with a more focused communication on what the person wants to know and less in relation to what the professional thinks she should know. ...
Objective: To analyze the satisfaction of those responsible for adolescents with information received for the use of psychotropic drugs. Methods: Cross-sectional study carried out in a reference outpatient clinic in Brasília between 2017 and 2019. It involved 173 legal representatives of adolescents diagnosed with Mental and Behavioral Disorders using psychotropic drugs. In order to identify the level of satisfaction about the information received on psychotropic drugs, the Satisfaction with Information about Medicines Scale (SIMS) was used. Results: Most guardians were dissatisfied with the information received on psychotropic drugs (n=112; 64.7%). The dissatisfaction with information about potential problems of medication was the one that stood out the most (n=127; 73.4%) when compared to information about action and usage (n=89; 51.5%). Participants considered information on the impact of medication on the adolescent's sexual life unsatisfactory or nonexistent. Conclusions: The parents' satisfaction with the information received about psychotropic drugs was low. Participants showed dissatisfaction with the information about potential problems, especially related to the impact on the sexual life of their tutored. ABSTRACT Objetivo: Analisar a satisfação dos responsáveis por adolescentes com as informações recebidas para o uso dos medicamentos psicofármacos. Métodos: Estudo transversal realizado em ambulatório de referência entre 2017 e 2019, em Brasília, com 173 responsáveis por adolescentes diagnosticados com transtornos mentais e comportamentais em uso de psicofármacos. O questionário Satisfaction with Information about Medicines Scale (SIMS) foi utilizado para identificar o grau de satisfação em relação às informações recebidas sobre os medicamentos. Resultados: A maioria dos responsáveis estava insatisfeita quanto às informações recebidas sobre psicofármacos (n=112; 64,7%). Destacou-se a insatisfação com as informações sobre potenciais problemas do medicamento (n=127; 73,4%), quando comparada à ação e ao uso (n=89; 51,5%). As informações sobre o impacto do medicamento na vida sexual do adolescente foram consideradas insatisfatórias ou inexistentes. Conclusões: A satisfação dos responsáveis com as informações recebidas sobre psicofármacos foi baixa. Os participantes demonstraram insatisfação com as informações sobre potenciais problemas, especialmente às relacionadas ao impacto na vida sexual dos adolescentes.
... 7 Health professionals tend to overestimate the quantity and quality of information provided to patients. 12 However, communication between professionals and patients must adjust according to the patients' needs, with no single model of communication and information exchange. 7,11 Patient satisfaction with the information received about medications can arise with a more focused communication on what the person wants to know and less in relation to what the professional thinks she should know. ...
Objective:
To analyze the satisfaction of those responsible for adolescents with information received for the use of psychotropic drugs.
Methods:
Cross-sectional study carried out in a reference outpatient clinic in Brasília between 2017 and 2019. It involved 173 legal representatives of adolescents diagnosed with Mental and Behavioral Disorders using psychotropic drugs. In order to identify the level of satisfaction about the information received on psychotropic drugs, the Satisfaction with Information about Medicines Scale (SIMS) was used.
Results:
Most guardians were dissatisfied with the information received on psychotropic drugs (n=112; 64.7%). The dissatisfaction with information about potential problems of medication was the one that stood out the most (n=127; 73.4%) when compared to information about action and usage (n=89; 51.5%). Participants considered information on the impact of medication on the adolescent's sexual life unsatisfactory or nonexistent.
Conclusions:
The parents' satisfaction with the information received about psychotropic drugs was low. Participants showed dissatisfaction with the information about potential problems, especially related to the impact on the sexual life of their tutored.
... 7 Profissionais de saúde tendem a superestimar a quantidade e a qualidade das informações fornecidas aos pacientes. 12 Entretanto, a comunicação entre o profissional e o paciente deve se ajustar conforme as necessidades do paciente, não existindo um modelo único de comunicação e troca de informações. 7,11 A satisfação do paciente com as informações recebidas sobre medicamentos pode surgir com uma comunicação mais direcionada ao que a pessoa quer saber e menos em relação ao que o profissional pensa que ela deve saber. ...
Resumo Objetivo: Analisar a satisfação dos responsáveis por adolescentes com as informações recebidas para o uso dos medicamentos psicofármacos. Métodos: Estudo transversal realizado em ambulatório de referência entre 2017 e 2019, em Brasília, com 173 responsáveis por adolescentes diagnosticados com transtornos mentais e comportamentais em uso de psicofármacos. O questionário Satisfaction with Information about Medicines Scale (SIMS) foi utilizado para identificar o grau de satisfação em relação às informações recebidas sobre os medicamentos. Resultados: A maioria dos responsáveis estava insatisfeita quanto às informações recebidas sobre psicofármacos (n=112; 64,7%). Destacou-se a insatisfação com as informações sobre potenciais problemas do medicamento (n=127; 73,4%), quando comparada à ação e ao uso (n=89; 51,5%). As informações sobre o impacto do medicamento na vida sexual do adolescente foram consideradas insatisfatórias ou inexistentes. Conclusões: A satisfação dos responsáveis com as informações recebidas sobre psicofármacos foi baixa. Os participantes demonstraram insatisfação com as informações sobre potenciais problemas, especialmente às relacionadas ao impacto na vida sexual dos adolescentes.
... Le manque de collaboration entre les professionnels de santé dans les informations données aux patients, a été décrit comme affectant la qualité des soins. Il affectait également la satisfaction des patients, notamment sur la balance bénéfice risque des traitements qui leurs étaient prescrits 161 La place de l'allaitement comme reflet de la parentalité, de la capacité à être une bonne mère, décrite par les femmes allaitantes dans nos résultats et dans la littérature scientifique n'apparait pas dans l'analyse des perceptions des professionnels de santé 27,87 . La prise en compte de cette dimension nous semble pourtant un élément majeur dans les soins qui peuvent être apportés à la mère pendant cette période. ...
L'allaitement maternel est un réel enjeu de santé publique au regard de ces bénéfices pour la santé de la mère comme de son enfant. La prise de médicaments représente un obstacle à l'allaitement et peut conduire à la non initiation de l'allaitement ou à son sevrage prématuré quelques soient les données biomédicales disponibles. La compréhension des comportements maternels face à la prise de médicament est essentielle à explorer pur pouvoir apporter des interventions éducatives adaptées pour répondre à cette problématique [...].
... As a health promotion method, health education help improve people's knowledge of illness, develop their health behavior, increase individual's sense of responsibility for maintaining health and achieve fully informed consent by the providence of health care information [1][2][3][4][5][6]. It was reported that if patients were informed about any side effects, possible complications, and the way treatment might affect their daily life, they might establish healthy behaviors and improve self-e cacy [7,8]. Furthermore, patients can make the right decisions about treatment, correct their wrong beliefs, alleviate psychological comorbidities and thus enhancing their quality of live by being informed about appropriate, valid, and expert health care information [9]. ...
Objectives: To test the psychometric properties of the Chinese version of Miller Behavioral Style Scale(C-MBSS).
Methods: The forward-back-translation procedure was adopted in the translation of the Miller Behavioral Style Scale. Content validity was assessed in a panel of experts. In a sample of 1343 individuals, reliability and construct validity were assessed using Cronbach’s alpha coefficient and factor analysis. For exploratory factor analysis, parallel analysis was used to decide number of factors, principal axis factoring and direct oblimin rotation method were used to select factor. For confirmatory factor analysis, structural equation modelling was established to verify the extracted factor structure.
Results: The C-MBSS achieved conceptual and semantic equivalence with the original scale. The item content validity index(I-CVI) of each item ranged from 0.78 to 1, and the averaging scale content validity index(S-CVI/ Ave) was 0.95. The cronbach`s alpha coefficient for the scale and sub-scales were over 0.6. The exploratory factor analysis resulted in 2-factor assumption for each hypothetical threat-evoking scenario. Confirmatory factor analysis provided confirmatory evidence for the second-order factor structure of 2-factor solution (Monitoring and Blunting) and demonstrated a good fit between theoretical model and data.
Conclusions: This study verified the psychometric properties of the C-MBSS and indicated that the C-MBSS can be used to identify individual`s information-seeking style in Chinese population. With the use of the C-MBSS, health care professionals in China can deliver health education based on patients’ information-seeking behavior, which can improve the effect of health education and patients’ health outcomes.
... Contrary to most [24,26,27] but not all [45] earlier studies, delivering understandable information was successful. Kuosmanen et al. [24] have reported low patient satisfaction with access to information and Siponen and V€ alim€ aki [26] concluded that, although patients were generally satisfied with their outpatient treatment, the process of delivering information to patients was not at a satisfactory level of quality. ...
Aim: The aim of the study was two-fold: first, to assess the efficacy of an electronic real-time feedback system; second, to examine patient satisfaction.
Methods: This was a mixed-method study. Data were collected from two psychiatric outpatient clinics using electronic patient feedback devices. The efficacy of the real-time feedback system was assessed by calculating the overall response rate, and the response rate to each individual five-point Likert scale statement and open-ended question by using descriptive statistics. Patient satisfaction was examined by analyzing the response rate to each statement. Open-ended feedback was analyzed by using inductive qualitative content analysis.
Results: The overall response rate was 21.0% (n = 1658) and response rates varied by statements. Most of the patients saw that they received the appointment to the outpatient clinic quickly enough (n = 1404, 85%), the personnel treated them well (n = 1126, 95%), the information about the care was understandable (n = 1066, 94%), and decisions regarding their care were made together with them (n = 1051, 94%). Of the patients, 94% (n = 1052) would recommend the service. Positive open-ended feedback highlighted good service, skilled staff, perceived benefits and help from care. Critique and development areas dealt with the large number of forms that required filling out beforehand, subjective experience of long waiting times, and having too many collaborative professionals present during treatment.
Conclusions: The real-time feedback system proved to be an efficient method of gathering patient feedback. Patient satisfaction seemed to be high with received care in all fields.
... The service quality has a direct effect on satisfaction, has been widely accepted [8,15]. Some studies also shows that the quality of the relationship between patients and doctors has a considerable impact on the patient satisfaction measure [16,17,4]. For the hospitals, satisfied patients are important because the patients' greater satisfaction with the care would entail the patients' more adherence of the doctor's orders, more loyalty, positive word of mouth by the patient, reducing the number of the patient's complaints, higher profitability, higher rates of the patient return and more patient referrals [11,18,19]. ...
... Misunderstandings about information delivery between health care professionals, may also be an underlying reason for an inequality in patients' communication. Health assistants may be unsure what information has been given to the patients previously or by another healthcare professional, which may have hampered the quality of the information delivered, as described in a French study looking into medical information received from providers and patient satisfaction [23]. ...
Background
Patient satisfaction is an important measure of quality of care and a determinant of health service utilisation and the choice of health facility. Measuring patients’ experiences is important for understanding and improving the quality of care at health facilities. The aim of this study was to assess levels and identify associated factors of caregivers’ satisfaction and provider-caregiver communication within child healthcare in Nepal.
Methods
Secondary analysis of Sick Child Exit Interviews (n = 2092) sourced from 2015 Nepal Health Facility Survey data. Satisfaction was measured through caregivers’ satisfaction with services received and their willingness to recommend the health facility visited. Communication indicators were chosen based on the 2014 WHO IMCI guidelines and aggregate communication scores were calculated based on the number of indicators acknowledged during assessments. Logistic regression was used for analysis.
Results
Although most respondents (82.1%) reportedly were satisfied with the care provided, only 35.9% experienced good communication with their providers. Caregivers who had ever attended school were more likely to be satisfied with services (1.44, CI 95% 1.04–1.99). Type of provider, sex of child or who the caregiver was had no association with caregivers’ satisfaction. Having been given a diagnosis doubled the chances of satisfaction (AOR 2.04, 95% CI 1.38–3.00), as did discussion of the child’s growth (OR 1.71, 95% CI 1.06–2.76) and having discussed any of the included topics (AOR 1.98, CI 95% 1.14–3.45).
Conclusions
Interventions to improve healthcare staff’s communication skills are needed in Nepal to further enhance satisfaction with services and increase quality of care. However, this is an area that need further investigation given the high levels of satisfaction displayed despite poor communication. Other factors in the health care exchange between provider and clients are influencing the level of satisfaction and need to be identified and promoted further. High-quality care is no longer a goal for the future or only for high income settings; it is essential for reaching global health goals.
... 2 Although healthcare providers (HCPs) had been involved in providing medication information, they often overestimate the quality and quantity of information they provide to patients. 3 Patients had reported that they did not have adequate knowledge on the indications, duration, dose and side effects of their medications after discharge from hospital. 4 5 Only a small proportion of patients were educated about medication at discharge, and an even smaller proportion (30%) ...
Objective
Healthcare providers (HCPs) often overestimate the quality and quantity of information they provide to patients. This study aimed to find out inpatients’ satisfaction towards information about medicines provided during inpatient stay.
Methods
This cross-sectional study was conducted at Lewisham Hospital and Queen Elizabeth Hospital in June 2017. Patients’ satisfaction with information about medicines provided during inpatient stay was assessed using a 17-item Satisfaction with Information about Medicines Scale (SIMS).
Results
71 patients completed the questionnaire. The average percentage of patients being satisfied with the information provided in the nine-item ‘action and usage’ subscale of SIMS was 74.4%, compared with the eight-item ‘potential problems’ subscale with an average percentage of 56%. Patients aged 45–64 were more likely to be satisfied with information on ‘how the medicines work’ than the 65 and above as well as the 18–44 age groups (p=0.045). Patients who attended secondary school and below were more likely to be satisfied than those attending college and above towards this information (p=0.002). Patients of white or mixed white and black ethnicity were less satisfied than other ethnic groups of information regarding the impact of medication on sex life (p=0.019). Black or black British were more likely to be satisfied towards information on unwanted medication side effects compared with other ethnic groups (p=0.025).
Conclusions
HCPs could improve on the provision of information on potential problems that patients might experience with their medicines. Patients’ age, educational level and ethnicity should be taken into consideration when providing information about medicines.
... Physician-patient communication also has a positive influence on healthcare service quality. The physician-patient relationship influences patient satisfaction, a crucial indicator for measuring healthcare quality (Lin et al., 2010;Mercer et al., 2008;Moret et al., 2008). Majeed Alhashem et al. (2011) identified Kuwaiti primary care patient satisfaction determinants. ...
Purpose:
Quality issues, increasing patient expectations and unsatisfactory media reports are driving patient safety concerns. Developing a quality and safety culture (QSC) is, therefore, crucial for patient and staff welfare, and should be a priority for service providers and policy makers. The purpose of this paper is to identify the most important QSC drivers, and thus propose appropriate operational actions for Saudi Arabian hospital managers and for managers in healthcare institutions worldwide.
Design/methodology/approach:
Quantitative data from 417 questionnaires were analyzed using structural equation modeling. Respondents were selected from various hospitals and managerial positions at a national level.
Findings:
Findings suggest that error feedback (FAE) and communication quality (QC) have a strong role fostering or enhancing QSC. Findings also show that fearing potential punitive responses to mistakes made on the job, hospital staff are reluctant to report errors.
Practical implications:
To achieve a healthcare QSC, managers need to implement preemptive or corrective actions aimed at ensuring prompt and relevant feedback about errors, ensure clear and open communication and focus on continuously improving systems and processes rather than on failures related to individual performance.
Originality/value:
This paper adds value to national healthcare, as Saudi study results are probably generalizable to other healthcare systems throughout the world.
... The concept of "patient involvement" (PI) has officially evolved in 2001 by the Institute of Medicine (IOM) report "Crossing the Quality Chasm: A New Health System for the 21st Century" ( Wong et al., 2017). Many societal movements and human rights groups recommended a shift from the inactive role of patients to a more active role and to partnership regarding their health issues (Moret et al, 2008;Pryce & Hall, 2012;Wong, et al, 2017). This concept is correlated with other concepts in meaning such as engagement, collaboration, empowerment, partnership and participation (Arnetz, & Zhdanova, 2014;Wong, et al, 2017) PI is defined as "shared perceptions about, and behaviors aimed at, involving patients in decisions and care processes throughout their hospitalization" (Arnetz, & Zhdanova, 2014, p 476). ...
Nurses as key healthcare professionals, have an important role in delivering high quality care, which requires positive perception, adequate knowledge and skills of implementing proper patients’ involvement in all health care aspects. Considering nurses’ perception and experiences, patients’ involvement may improve health outcomes. This integrative
review aims to assess the perception and experiences of nurses regarding patients’ involvement (PI) in health care decisions as reflected in the literature. EBSCO, Science direct, Google Scholar, PubMed, Medline and Jordanian database were searched utilizing PRISMA flow chart to search related studies from 2007 up to 2017. Quality and characteristics of all studies were critically evaluated utilizing specific criteria called the Checklist for Assessing the Quality of Studies (Kmet, Lee, & Cook, 2004). In total, eight relevant studies were included with 3037 nurses as study participants.
The qualitative approach was the dominant approach used, with an average quality assessment of (16/20). The included studies were conducted in Europe, Canada, Australia and Asia. The conclusion derived from the review is that most nurses
have positive perceptions of the importance of patients’ involvement, yet they inadequately reflected that in their clinical practices. Cultural shift through educational interventions is required to change negative attitudes among diverse groups of nurses toward patients’ involvement.
KEYWORDS: Collaboration, Decisions Making, Experiences, HCPs, Nurses, Patient-Centered Care Patients
Involvement, Perception
Article
... Even in this era of impressive progress in prenatal diagnosis, fetal autopsy should be routinely recommended in the management of the detected malformations, since it adds important information in about one quarter of the cases, or even revises the prenatal diagnosis in at least 5% of the cases. Still, there is an alarming decline of autopsy rate [30][31][32][33][34][78][79][80][81][82][83][84][85][86][87][88][89], because of centralization of pathology services [78,79], changes in clinicians' appreciation of the importance of the investigation [79][80][81] -mainly because of the improvements in diagnostic imaging, or because of the poor counseling provided by non-experts in fetal medicine or the non-implication of a pathologist in the counseling team [80,82,[90][91][92][93][94][95]. These facts lead to refusals from parents to consent to a conventional invasive autopsy. ...
Perinatal autopsy remains the gold-standard procedure used to establish the fetal, neonatal or infant abnormalities. Progressively, perinatal pathology has become a specialized field with important roles of audit for fetal prenatal diagnostic tools, in parents counseling regarding future pregnancies, in scientific research, for epidemiology of congenital abnormalities and teaching. The differences between prenatal ultrasound and autopsy reports represent a strong argument for the autopsy examination following termination of pregnancy. The reasons for such discrepancies are related to the ultrasonographic or pathological examination conditions, the type of the anomalies, the expertise and availability of the operators. Several facts led to an undesirable increase of refusals from parents to consent to a conventional invasive autopsy: the centralization of pathology services, the poor counseling provided by non-experts in fetal medicine and the clinicians’ overappreciation of the importance of the ultrasound diagnostic investigation. Although non-invasive alternatives have been tested with promising results, conventional autopsy remains the gold standard technique for the prenatal diagnosis audit. We report and analyze several cases of prenatally diagnosed malformed fetuses with different particularities that underline the necessity of perinatal autopsy. We discuss the antenatal findings and management and post-mortem autopsies in the respective pregnancies.
... However, nurses also reported that they usually did not know what the patients were told by the physicians, which complicated their task and hindered the quality of the information delivered. Physicians, in contrast, had a much more restrictive view of patient information, only considering it during a face-to-face interview [20]. ...
Abstract Background The main objective of this study was to explore the relationships between inpatients’ social differentiation and satisfaction with the medical information delivered by caregivers. Methods In four departments of a teaching hospital, patients were enrolled as well as their attending physician and one of the nurses assigned to them. Structured survey questionnaires were administered face-to-face to patients and caregivers. Patients were asked to rate their satisfaction with the medical information received, the quality and duration of the interactions with the caregivers, and their experience regarding their involvement in medical decision-making. Caregivers were asked to rate their perception of the patients’ social position and involvement in medical decision-making. Social deprivation was assessed using the EPICES score in particular. The statistical analysis was mainly descriptive and completed by a structural equation model. Results A sample of 255 patients, 221 pairs of patient-physician and 235 pairs of patient-nurse were considered. One third of the patients (32.7%) were identified as socially deprived. They were significantly less satisfied with the information they received on their health status or their treatment; 56.7% of patients thought that they received sufficient explanations without having to ask. This proportion was significantly lower in socially deprived patients (42.3%) compared to not deprived patients (63.6%, p
... It would be important to organize shared courses for nurses and physicians already during their training so that they can learn about the content of the work of each profession. Shared training for physicians and nurses has been demonstrated to increase the understanding of professional roles and collaboration between these professional groups [29]. ...
... For instance, if the parturient has precise expectations she will probably need a larger amount of information on the ongoing process before accepting it (Blix-Lindstrom et al., 2004). Moreover, information must be consistent trough different members of the medical staff; otherwise they may generate anxiety (Moret et al., 2008). ...
In this autoethnographic study, I analyse my birthing event, in order to point out some relevant cultural aspects of the experience. I explore the role of expectations, childbirth place, medicalization and relationships with healthcare professionals and partner. My experience and the analysis of the context where childbirth takes place leads to the conclusion that hospital organization is central to women's experiences of giving birth, but the hospital culture is still too centred on the security that medical interventions guarantee, relegating people to a passive position. Health services should address personal agency, in order to guarantee more respectful childbirth care.
... In hospital, patients can be flooded with information from doctors, frequently beyond their capacity to assimilate and memorise it, 41 and, with shorter lengths of stay, ward staff are finding it harder to assess and meet the information needs of the patients, 42 further inhibited by the complexity of the modern healthcare team. 43 It has previously been suggested that greater responsibility for patient education should lie with primary care, 44 where the quiet surroundings, 45 managerial support, 46,47 and the allocation of undisturbed time 44 can facilitate improved communication. ...
Background:
Although there is considerable risk for patients from hospital-acquired thrombosis (HAT), current systems for reducing this risk appear inefficient and have focused predominantly on secondary care, leaving the role of primary care underexplored, despite the onset of HAT often occurring post-discharge.
Aim:
To gain an understanding of the perspectives of primary care clinicians on their contribution to the prevention of HAT. Their current role, perceptions of patient awareness, the barriers to better care, and suggestions for how these may be overcome were discussed.
Design and setting:
Qualitative study using semi-structured interviews in Oxfordshire and South Birmingham, England.
Method:
Semi-structured telephone interviews with clinicians working at practices of a variety of size, socioeconomic status, and geographical location.
Results:
A number of factors that influenced the management of HAT emerged, including patient characteristics, a lack of clarity of responsibility, limited communication and poor coordination, and the constraints of limited practice resources. Suggestions for improving the current system include a broader role for primary care supported by appropriate training and the requisite funding.
Conclusion:
The role of primary care remains limited, despite being ideally positioned to either raise patient awareness before admission or support patient adherence to the thromboprophylaxis regimen prescribed in hospital. This situation may begin to be addressed by more robust lines of communication between secondary and primary care and by providing more consistent training for primary care staff. In turn, this relies on the allocation of appropriate funds to allow practices to meet the increased demand on their time and resources.
... Comparably, physicians are reluctant to encourage patient participation because either they refuse to delegate power or control, or they are afraid to lose their identity (29,30,31), even though they may not be openly negative about the issue (29). Moret et al., (32) understood that nurses and physicians did not agree with regard to patient information matters, as nurses considered their role to be more vital than the physicians gave them credit for. However, the finding contrasts with that of Park's (33) study, in which nurses stated that information about medicine and treatment was not their responsibility. ...
The objective of the study was to evaluate the position of patient education measuring knowledge, attitude, and practice (KAP) among health care workers (HCWs). It is also aimed to emphasize the need for a real position for patient education. This survey was performed among a group of HCWs in Iran. The scores had an acceptable level. However, nurses, females and younger people received higher scores. The staff was already aware of patient education necessity and considered it as the duty of all medical team. Often HCWs cannot include patient education in their routine due to time shortage, lack of staff’s financial motivation, fatigue, and loads of work, etc. There is still need for a real training in the educational curriculum. Additionally, the various HCWs–related obstacles should be taken into account. © 2015 Tehran University of Medical Sciences. All rights reserved.
... Several studies confirmed that the affective response by patients was as important as the cognitive response to treatment: -Rather than being related to technical competence, satisfaction with care was related to communication, responsiveness, and reliability (Bowers et al., 1994) as well as having expectations met‖ (Leiter et al., 1998(Leiter et al., , p. 1611. Most patients desired and needed to communicate with nurses, doctors, and staff to gain as much information as possible (Moret, Rochedreux, Chevalier, Lombrail, & Gasquet, 2008;Taylor, Kennedy, Virtue, & McDonald, 2006). Roter and Hall (1993) conceptualized two functions of communication: ...
... In several studies, knowledge of teaching and learning was considered to be important, and a need for more education, training and skills to undertake patient teaching was emphasized [15] [16]. Although some studies [17] [18] show that nurses feel competent in their teaching role, others point to lack of training and lack of confidence as contributing factors in nurses' reluctance to conduct patient education [15] [16]. Another aspect of competence is the significance of having factual knowledge, which means knowing what to teach [16]. ...
Patient education is the process of influencing patient behaviour and producing the changes in knowledge, attitudes and skills necessary to maintain or improve health. Health education may be general preventive, health promotion or diseases specific education. With an education system in place, patients will be satisfied with care, patients will be healthier, and will seek medical services less frequently. There is little or no documentation on the practice of patient education at the University College Hospital, Ibadan. The aim of this descriptive study was to explore factors influencing the practice of patient education among nurses at the University College Hospital, Ibadan. Stratified and simple random sampling techniques were used in selecting 200 nurses at the University College Hospital Ibadan. A self-designed questionnaire was used to collect data. Statistical package for social sciences version 15 (SPSS 15) was used in analysing data. The study revealed that the knowledge and practice of patient education among the nurses in University College Hospital was high and the knowledge was found to be significantly associated with its practice (X2 = 7.89, p = 0.017). The working experience of nurses does not determine whether they practice patient education or not. Almost all the respondents (70% - 90%) in this study affirmed that the nurses’ experiences, cultural barriers, work place culture, lack of time, heavy workload, insufficient staffing, and the complexity of patients’ condition were important factors that influenced the practice of patient education. In conclusion, nurses at the University College Hospital have good knowledge and positive attitude towards patient education but could not practice effectively. A more critical approach in addressing heavy workload, insufficient staffing, among others is needed to improve patient education. Further studies should be carried out on developing nurses’ roles as patient educators.
... Patient satisfaction is referred as the judgement made by a recipient of care as to whether their expectations for care have been met or not (Palmer, Donabedian, & Pover, 1991). Patient satisfaction with medical care is a multidimensional concept, with a dimension that corresponds to the major characteristics of providers and services (Ware, Snyder, Wright, & Davies, 1983;Donahue, Piazza, Griffin, Dykes, & Fitzpatrick, 2008;More, Rochedreux, Chevalier, Lombrail, & Gasquet, 2008;Abdul Majeed, Habib, & Rafiqul, 2011). Within the health care industry, patient satisfaction can be considered as an important component and measure of the quality of care (Salisbury et al., 2005). ...
This study attempts to examine the mediation effect of satisfaction on service quality perception and intentions behavior of private hospital outpatients in Malaysia. 300 hospital outpatients were selected as the sample size. Regression analysis was run to test the hypotheses. Based on the 273 completed data, the results provide support for the association between perceived service quality dimensions (tangibles, assurance, and empathy) and behavioral intentions. The results also confirm that service quality perception is an antecedent of intentions. In addition, tangibility, reliability and assurance are important predictors of satisfaction, and satisfaction has a strong positive relationship with intentions. In short, service quality drives satisfaction which in turn drives behavioral intentions. The finding also indicates that satisfaction partially mediates the relationship between perceived service quality and behavioral intentions. As a result, the strength of the perceived service quality-behavioral intentions relationship becomes weaker when satisfaction is considered. Theoretical and managerial implications of the findings are also discussed.
... Patient satisfaction seemed to be greater where professional roles were clear-cut. 15 Another survey asking nurses and physicians about 13 elements of discharge education found in the literature reported that ambiguous responsibility for providing discharge education and poor communication between nurses and physicians offered an opportunity for improvement. 16 We found that though the overall perception was that the pharmacist should have the lead role, senior doctors actually opted for senior doctors to have this role, and pharmacists opted for pharmacists. ...
Objectives Studies have shown that on discharge from hospital, patients sometimes lack vital knowledge about their medicines. There is little research into how health professionals view the provision of information on medication side effects. The objective of this study was to elicit the views of hospital clinical staff on when, how and by whom information on medication side effects should be provided to inpatients.
Method An electronically delivered questionnaire emailed to clinical staff in a National Health Service hospital Trust in England. Participants were asked 10 questions. The main outcome measure was staff perceptions on the provision of information to patients on medication side effects.
Results The electronic survey was completed by 275 members of the clinical staff. More staff would prefer to give information when medicines are prescribed (58.8% think this is the best time) than currently do so (40.4% usually give information at this time). Time to talk to patients was perceived as the main barrier to providing information by 91.4% staff. Some staff groups identified insufficient knowledge of side effects as a barrier—38.8% nurses and 54.2% Foundation Year 1/Foundation Year 2 doctors. Pharmacists were seen as having the primary responsibility for providing verbal information about side effect by 59.9% of staff.
Conclusions Hospital staff recognise the importance of providing information about medicine side effects to patients, but struggle to embed this into routine practice. Some staff lack confidence in explaining side effects information to patients. There may be issues of staff training or beliefs and attitudes about perceived hierarchical structures or professional recognition among hospital staff.
... Furthermore, Crowe et al. (2002) pointed out that the interpersonal relationships between the patients and health care provider is the most important determinant of customer satisfaction (Gill and White, 2009). Similarly, the quality of the relationship between patients and doctors has a considerable impact on the patient satisfaction measure (Alhashem et al., 2011;Mercer et al., 2008;Moret et al., 2008). In this context, patient satisfaction is defined as the judgment made by patients on their expectations for care services that have been met or not in respect of both technical and interpersonal care (Campbell et al., 2000;Esch et al., 2008). ...
Purpose
The purpose of this study is to investigate hospital service quality and its effect on patient satisfaction and behavioural intention.
Design/methodology/approach
A convenience sampling technique was used in this study. A total of 350 questionnaires were distributed and 216 were returned (61.7 per cent response rate).
Findings
The results confirm that the five dimensions – admission, medical service, overall service, discharge and social responsibility – are a distinct construct for hospital service quality. Each dimension has a significant relationship with hospital service quality. The findings of this study indicate that the establishment of higher levels of hospital service quality will lead customers to have a high level of satisfaction and behavioural intention.
Research limitations/implications
This research examined the concept of hospital service quality, patient satisfaction and behavioural intention from the perspective of patients. However, this study did not explore the perspective of service providers. This is a limitation in as much as it only considers the patients' view, which might be different from the providers' view.
Practical implications
The results indicate that managers should use the perceived service quality and customer satisfaction as mechanisms for exit strategy that will increase loyalty among the present customers.
Originality/value
This study will enable hospitals to have a better understanding of the effects of service quality, which will lead to patient satisfaction and behavioural intention in order to build long‐term relationships with their patients.
... Providing patients with the required information is considered as an integral part of the nurses' mission [6]. On the other hand, the organizations governing nurses in practice have identified teaching as an essential responsibility of all registered nurses in caring for both well and ill clients. ...
... Casey underlines that physicians and nurses train separately, keep separate patient records, report to different hierarchies, read different journals, and use different jargon [21]. Moreover, a study carried out by our team showed that nurses do not know what the patient has been told, that this information is not recorded in the patient's file, and that as a result it is difficult for them to adapt what they say to patients, which in turn has an impact on the quality and coherence of the information actually delivered [22]. However, information provided to patients has become a central part of care provision. ...
Interprofessional collaboration is essential in creating a safer patient environment. It includes the need to develop communication and coordination between professionals, implying a better sharing of medical information. Several questionnaires exist in the literature, but none of them have been developed in the French context. The objective was to develop and test the psychometric properties of the communication and sharing information (CSI) scale which assesses specifically interprofessional communication, especially the sharing of medical information and the effectiveness of communication between members of the team.
The questionnaire construction process used a literature review and involved a panel of voluntary professionals. A list of 32 items explored the quality of shared information delivered to patients and the effectiveness of interprofessional communication. The study was conducted in 16 voluntary units in a University Hospital (France), which included medical, surgical, obstetrics, intensive care, pediatrics, oncology and rehabilitation care. The scale-development process comprised an exploratory principal component analysis, Cronbach's alpha-coefficients and structural equation modeling (SEM).
From these 16 units, a total of 503 health professionals took part in the study. Among them, 23.9% were physicians (n = 120), 43.9% nurses (n = 221) and 32.2% nurse assistants (n = 162).The validated questionnaire comprised 13 items and 3 dimensions relative to "the sharing of medical information" (5 items), "communication between physicians" (4 items) and "communication between nurses and nurse assistants" (4 items). The 3 dimensions accounted for 63.7% of the variance of the final questionnaire. Their respective Cronbach's alpha coefficients were 0.80, 0.87 and 0.81. SEM confirmed the existence of the 3 latent dimensions but the best characteristics were obtained with a hierarchical model including the three latent factors and a global "communication between healthcare professionals" latent factor, bringing the 8 items linked to communication together. All the structural coefficients were highly significant (P < 0.001).
This self-perception CSI scale assessing several facets of interprofessional communication is the first one developed in the French context. The development study exhibited excellent psychometric properties. Further psychometric analysis is needed to establish test-retest reliability, sensibility to change and concurrent validity.
... In France, alongside the annual national survey in place since 2011, the patient satisfaction questionnaire at discharge is used extensively, providing hospitals with close, ongoing follow-up of the satisfaction of their patients based on a few questions. Among the different components of patient satisfaction, two major dimensions are generally seen as conditioning the quality of the patient–caregiver interaction – the medical information delivered by caregivers and the quality of relations with them (Ware & Berwick 1990, Moret et al. 2008). A large volume of research has documented the determinants of patient satisfaction (Crow et al. 2002). ...
To explore the influence of staff absenteeism on patient satisfaction using the indicators available in management reports.
Among factors explaining patient satisfaction, human resource indicators have been studied widely in terms of burnout or job satisfaction, but there have not been many studies related to absenteeism indicators.
A multilevel analysis was conducted using two routinely compiled databases from 2010 in the clinical departments of a university hospital (France). The staff database monitored absenteeism for short-term medical reasons (5 days or less), non-medical reasons and absences starting at the weekend. The patient satisfaction database was established at the time of discharge.
Patient satisfaction related to relationships with staff was significantly and negatively correlated with nurse absenteeism for non-medical reasons (P < 0.05) and with nurse absenteeism starting at weekends (P < 0.05). Patient satisfaction related to the hospital environment was significantly and negatively correlated with nurse assistant absenteeism for short-term medical reasons (P < 0.05).
Our findings seem to indicate that patient satisfaction is linked to staff absenteeism and should lead to a better understanding of the impact of human resources on patient satisfaction.
To enhance patient satisfaction, managers need to find a way to reduce staff absenteeism, in order to avoid burnout and to improve the atmosphere in the workplace.
Purpose
The purpose of this study is to determine the interactions between factors such as organizational learning, feedback about errors, punitive response to errors and communication quality in hospitals in the Kingdom of Saudi Arabia and Colombia when adopting a culture of quality and safety (CQS) in patient care.
Design/methodology/approach
Based on a literature review, a self-administered questionnaire was developed and used to collect data from 417 Saudi respondents affiliated with hospitals and 483 Colombian respondents at the beginning of the pandemic. Structural equation modeling is used in this study to test the hypothesized relationships.
Findings
The results show a solid and significant predictive relationship between feedback about errors and the CQS in both countries (Colombia: b = 0.55, p < 0.001; KSA: b = 0.44, p < 0.001), but a very low and insignificant predictive relationship between no punitive response to errors and CQS (Colombia: b = –0.02, p > 0.05; KSA: b = 0.05, p > 0.05).
Practical implications
This study demonstrates the importance of organizational learning in fostering a CQS in the health-care sector in the Kingdom of Saudi Arabia and Colombia. Recent unprecedented policy actions motivated by the COVID-19 pandemic, such as social distancing, lockdowns and safety practices enforcement, have further highlighted this concern. Moreover, attention to the dimensions addressed in this study is required for accreditation purposes in organizations seeking to promote a CQS. Overall, this research highlights the vital role of safety and quality practices among health-care organizations, which has significant policy implications, especially in the current period of high uncertainty.
Originality/value
This paper contributes to the theory and practice in the health-care sector by extending the current knowledge of the impact of the quality of communications, non-punitive response to errors and feedback about errors in organizational learning and safety culture, and by presenting a novel, quantitative methodology seldom used for these topics.
Résumé
Introduction
Plus des deux-tiers des personnes en fin de vie décèdent à l’hôpital. Les soignants en première ligne dans la relation de soin, sont donc exposés à des situations particulièrement difficiles sur le plan émotionnel et dès lors peuvent développer des symptômes, notamment le syndrome de burn-out. Cette recherche s’intéresse donc au retentissement de la prise en charge des personnes en fin de vie en soins palliatifs par le biais d’une étude du burnout et du vécu des soignants.
Méthode
Nous avons procédé à une étude transversale auprès de 149 internes exerçant dans des hôpitaux publics de l’ouest. Ils ont rempli un dossier comportant l’échelle de Burnout de Maslach et des questions sur le vécu des soins palliatifs. Les données ont été traitées avec Statview© et par analyse de contenu.
Résultats
Les résultats ont fait apparaître des niveaux de burnout faibles. Les relations stressantes avec les patients augmentaient le désinvestissement, les problèmes institutionnels, le burnout et enfin les difficultés dans la distinction vie professionnelle/personnelle la détresse émotionnelle. Sur le plan subjectif, les internes ont rapporté des difficultés et des questionnements relatifs à la morbidité et l’éthique des situations rencontrées.
Discussion conclusion
Ces résultats nous aideront à mieux conceptualiser la souffrance des internes en soins palliatifs qui ne s’exprime pas dans notre échantillon par un burnout. Nous discutons les implications de cette recherche et proposons des préconisations pour améliorer les soins et prendre en charge les internes.
Introduction: In Indonesia the implementation of the nursing case manager in the hospital has not been very clear and how the implementation. The role of case managers include utility assessment, patient planning, facilitation and advocacy, service coordination, process evaluation, post-discharge follow-up. One indication of the role of the case manager in the inpatient ward is the long elapsed hospital day (ALOS) and the patient complains. Methods: The literature search is performed in several major databases such as proquest, sciencedirect, doaj, sagepub, medline, and google scholar with the time limits used are January 2008 to December 2018. Results: A total of fifteen studies raised in this study, all of which have almost the same objectives of how to implement case manager in increasing patient satisfaction in each population. From fifteen randomly selected respondents chose respondents. Conclusion: Significantly with patient satisfaction, so it can be concluded that patient satisfaction actually refers to appearance or form of service, that more perfect appearance of service, hence more perfect also quality or quality.
Background In order to achieve patient adherence, individuals require different levels of information. Basic and adequate information must be provided by different health care providers to patients. Objective To assess the information level of patients with asthma and chronic obstructive pulmonary disease (COPD) and to determine the source of their information regarding the medicine they use in addition to their satisfaction, inhalation usage techniques and perception of the information providing role of health care professionals. Setting Respiratory disease clinics in Nicosia and Famagusta state hospitals and community pharmacies in North Cyprus. Method A cross-sectional multicentered observational study was carried out in respiratory disease clinics and community pharmacies. Patients’ knowledge and healthcare providers’ perceptions of their roles were evaluated using “The satisfaction with information about medicines scale”. Evaluation of patient’s inhalation techniques was performed using a validated checklist. Main outcome measure (a) Patients’ knowledge of their medication and satisfaction with the information provided by health care professionals, (b) the prevalence of critical inhalation mistakes, (c) health care professionals' perceptions of their patient counseling practice. Results A total of 110 patients were evaluated, and 6 physicians and 76 pharmacists were recruited for the interview. The health care professionals reported that they talk about the action and the use of medicines with the patients. The standardized average patients’ satisfaction score for action and use was 0.35 (± 0.21), whereas for potential side effects, it was 0.26 (± 0.15). Even though 92% of patients believed that they use their inhaler properly, 75% of the patients made at least one critical mistake while using the inhalation demo, which would likely affect the delivery of the medicine to the lungs. Conclusion In spite of health care professionals feeling comfortable with their counseling practices, the majority of patients reported dissatisfaction with the information they provided about medicine, and three out of four patients were making critical mistakes in the use of inhalers. More effort is warranted by health care professionals on patient education to limit critical mistakes.
Providing information related to medication has many benefits for patients. However, patients’ conflicting perceptions about medical information provided by physicians and pharmacists may be associated with their psychological distress regarding treatment and medication. This study investigated associations between patients’ perceptions of agreement between physicians and pharmacists about medical information and improvements in their psychological distress. It also clarified the specific relationships of their perceptions with psychological distress. A cross-sectional survey was conducted in Japanese community pharmacy settings. Pharmacists approached 1,500 patients visiting community pharmacies and provided them with questionnaire packages. Patients completed the questionnaires at home and returned them to the researchers by mail. Multivariate logistic regression analysis and signal detection analysis were conducted to examine associations of patients’ perceptions of information agreement with improvement in psychological distress. Measures of improvement in worry and anxiety about disease, improvement in worry and anxiety about medication, and improvement in depressive mood were used to assess alleviation of psychological distress. A total of 645 patients returned the questionnaires; 628 contributed to the data. Multivariate logistic regression analyses clarified that patients’ perceptions of agreement in information regarding need for medication, methods for adverse drug reaction reduction, adverse drug reaction symptoms, coping with forgetting to take medication, and advice for daily life were significantly associated with improvements in psychological distress. Furthermore, signal detection analysis showed that several combinations of patients’ perceptions of agreement between physicians and pharmacists about specific medical information were also significantly associated with improvement in psychological distress. Consistent information provision by physicians and pharmacists could contribute to decreased psychological distress in patients, and consequently to adherence to treatment and taking medication.
The way patients are informed of an initial diagnosis of cancer in France has improved thanks to the introduction of a procedure referred to as the “Diagnostic Disclosure Procedure,” which is part of the first national Plan Cancer. This procedure requires the disclosure of a cancer diagnosis to be conducted in accordance with evidence-based recommendations of good communication practices (longer period spent with the oncologist, presence of a specialized nurse, consideration of psychosocial needs, traceability of information exchanged between the parties to ensure improved care coordination). Although three surveys conducted to assess satisfaction with the diagnostic procedure have revealed high levels of satisfaction, they indicate that there are still areas for improvement. These relate primarily to the fact that medical aspects are still presented in a way that is too technical and that there are no information documents relating to the disclosed diagnosis. These observations emphasize the need to pursue and further develop the initiatives present in France, although as yet on an insufficiently widespread basis, designed to assist communication through the use of psychosocial assessment tools within the context of clinical practice. They also indicate that it is necessary to promote training in doctor–patient communication and provide systematic access to high-quality information. Furthermore, the existence of patients at risk due to their age, socio-economic status, or the presence of physical or psychosocial comorbidities is as yet inadequately acknowledged in France. These groups deserve special attention due to the fact that they frequently have greater needs when diagnosed and treated for cancer.
Background and purpose: Nursing is a profession that establishes various cultural and social communications in the context of work environment. The purpose of this study was to determine the description and perception of the nurses working in educational hospitals about the professional communication experiences. Materials and methods: This study is a qualitative research using phenomenology method. Thirteen semi-structured interviews were carried out with 11 female and 2 male nurses. They described their experiences related to professional communication. The interviews were recorded and transcribed and the data were then analyzed using the Colizzii analysis method. Results: Seven themes emerged from the data showing the nurses perception and description of the communication with patients, colleagues, nursing supervisors and physicians. The following themes showed the experienced patterns of communication by the nurses: being special, altruism, psychosocial support, updated knowledge and skills for interactions management, reaction to actions related to different factors, complement of patient-physician communication deficiency, and professional identity and socialization basis of communication. Conclusion: The findings revealed a clear image of participants' experiences of communication in their profession. Recognition of nurses, description and perception of communication can present valuable data for professional planning and decreasing or eliminating the communication problems. Also improving the professional communication can guarantee the quality of professional services to the patients.
Background: After a major cardiovascular event, patients experience many problems regarding the outcome of the disease or rehabilitation including concern about return in their previous life. Recovering from a cardiac event is a complex procedure that presents psychological and physical needs that continue after discharge from hospital. The purpose of this review was to explore the role of nursing education after a cardiac event or procedure. Material and Methods: Studies published in English between 2002 and 2011 were selected through a computer-assisted literature search (i.e., Pubmed http://igm.nlm.nih.gov, and Scopus www.scopus.com). The computer searches used combinations of key words relating to the role of nursing (i.e., nursing support, nursing training, nursing education, coronary artery disease) and cardiac rehabilitation. Results: Many studies have highlighted the value of nursing support in cardiac rehabilitation programs. In particular, there is an amount of evidence that a nurse- led educational program is closely associated with reduce rate of complications, of anxiety following cardiac events and readmissions to hospital. Moreover, the therapeutic lifestyle-change intervention into a nursing program effectively modifies cardiac risk factors and may improve prognosis. Conclusion: The benefits of nursing support in cardiac rehabilitation patients can improve health outcomes and reduce the risk of a new cardiac event. It is of most importance for nurses to meet the rehabilitative care needs of patients through education, support, supervision and reinforcement.
Conditions for nurses’ daily patient education work are unclear and require clarification. The aim was to develop and validate the Nurses’ Patient Education Questionnaire, a questionnaire that assesses nurses’ perceptions of appropriate conditions for patient education work: what nurses say they actually do and what they think about what they do. The questionnaire was developed from a literature review, resulting in the development of five domains. This was followed by ‘cognitive interviewing’ with 14 nurses and dialogue with 5 pedagogical experts. The five domains were identified as significant for assessing nurses’ beliefs and knowledge; education environment; health care organisation; interdisciplinary cooperation and collegial teamwork; and patient education activities. A content validity index was used for agreement of relevance and consensus of items by nurses (n = 10). The total number of items in the final questionnaire is 60, consisting of demographic items, what nurses report they do and perceptions about patient education in daily work. The questionnaire can be used by managers and nurses to identify possibilities and barriers to patient education in different care contexts.
Health communication is a process of persuading good health by disseminating messages through communication channels that are aimed to improve patients' confidence and promote optimistic behaviour. Traditional communication tools lacked a direct communication approach for effective dissemination of health messages to the patients. New Information and Communication Technologies (ICTs) have the potential to break that barrier but are scantily used in health communication as examined by the authors, qualitatively. There is an evolving need for better utilization of ICT resources which are direct, cost effective, time-saving, and highly persuasive in pursuit of quality healthcare delivery. Therefore this research proposes a ten-layer ICT model converging advanced Mobile and Internet interventions, to disseminate health messages for patients suffering from fatal diseases. Using breast cancer as an instance, a communication strategy is exemplified using the ten-layer model. This model benefits healthcare professionals and patients with messages or information that will be timely, instantaneously, decidedly reachable and highly reliable for obtaining positive patient outcomes.
The aim of this study is to describe the attitudes of Iranian nurses and students on barriers and facilitators to patient education. In this descriptive quantitative study, 103 nurses and 84 nursing students in two teaching hospitals in an urban area of Iran responded to a questionnaire investigating their attitudes on patient education. Results showed that all nurses and the majority (87.3%) of the students mentioned that they performed patient education. Moreover, 95% and 63.3% of the nurses and students respectively accepted that patient education was one of their roles. The nurses stated that heavy workload, inadequate time and lack of educational facilities were main barriers to patient education. The students believed that lack of knowledge, lack of communication skills and heavy workload were main barriers to patient education from their perspectives. While Iranian nurses and nursing students had positive attitudes towards patient education, it could not guarantee the implementation of patient education. Therefore, the clarification of patient education activities and development of a patient education team with the support of healthcare settings' administrators can facilitate the process of patient education in the Iranian healthcare settings.
Previous research on the relationship between physician behavior and patient satisfaction has not always used standardized terminology and instruments to measure physician behavior. The Davis Observation Code (DOC) provides a reliable and valid means of analyzing clinically relevant units of physician behavior. The units of behavior can then be related to patient satisfaction.
One hundred new patients randomly assigned to receive care from primary care residents at a university medical center outpatient facility were evaluated. Before seeing their physicians, patients completed a previsit questionnaire to determine their general level of satisfaction with health care. During the visit, the encounter was videotaped and physician behavior characterized using DOC. After the appointment, patients completed a visit-specific satisfaction questionnaire. Multiple regression analysis was used to model the visit-specific satisfaction variables in terms of DOC measurements.
Total visit-specific satisfaction was positively related to previsit satisfaction (P < or = .05) and to time spent on health education (P < or = .001), physical examination (P < or = .05), and discussion of treatment effects (P < or = .01). There was a negative relationship with time spent on history taking (P < or = .01). Slightly more than 25% of the variability in satisfaction was explained by these five variables (R2 = .26). The general, humaneness, and quality/competence subscales of visit-specific satisfaction were also positively related to health education, physical examination, and treatment effects and negatively related to history taking.
Patients are most satisfied with medical visits in which they talk about their specific therapeutic interventions, are examined, and receive health education. Extended general discussion of medical history is negatively related to satisfaction.
To use audiotape analysis to describe communication patterns in primary care, to relate these to ideal relationship types as described in the literature, and to explore the patterns' relationships with physician and patient characteristics and satisfaction.
Description of routine communication in primary care based on audiotape analysis and patient and physician exit questionnaires.
A total of 11 ambulatory clinics and private practices.
The participants were 127 physicians and 537 patients coping with ongoing problems related to disease.
Roter Interactional Analysis System (RIAS) and patient and physician exit satisfaction questionnaires.
Cluster analysis revealed 5 distinct communication patterns: (1) "narrowly biomedical," characterized by closed-ended medical questions and biomedical talk occurring in 32% of visits; (2) "expanded biomedical," like the restricted pattern but with moderate levels of psychosocial discussion occurring in 33% of the visits; (3) "biopsychosocial," reflecting a balance of psychosocial and biomedical topics (20% of the visits); (4) "psychosocial," characterized by psychosocial exchange (8% of visits); and (5) "consumerist," characterized primarily by patient questions and physician information giving (8% of visits). Biomedically focused visits were used more often with more sick, older, and lower income patients by younger, male physicians. Physician satisfaction was lowest in the narrowly biomedical pattern and highest in the consumerist pattern, while patient satisfaction was highest in the psychosocial pattern.
Primary care communication patterns range from narrowly biomedical to consumerist patterns and parallel the ideal forms of patient-physician relationships described in the literature.
The objective of this study was to determine if there is an association between meeting patients' information needs and their overall satisfaction with care and their general health status outcomes.
This non-experimental study used data from hospital medical records as well as patient-completed surveys conducted two and eight weeks post discharge. The setting involved three community hospitals in the southeastern section of the US that provided care to a series of 167 acute myocardial infarction (Acute MI) patients.
The independent variable was an index measuring how well patients' information needs were met. The dependent variables were patient satisfaction (ratings of satisfaction with care process, global satisfaction, and health benefit) and general health status outcomes (physical function, psychosocial function and quality of life). Covariates used as control variables to hold patient characteristics constant, included demographics (age, gender) and clinical measures of acute MI severity, comorbidity, angina (at eight weeks), and dyspnea (at eight weeks).
Univariate analyses were employed to: (1) describe patients' characteristics; (2) determine the relative importance of meeting different types of information needs; and (3) identify information need areas most likely not to be met. Multivariate linear regression and logistic regression was used to evaluate the association between patients' ratings of meeting information needs with satisfaction and health outcomes, respectively, after controlling for covariates.
The multivariate regression results show that meeting information needs are positively and significantly associated with both patient satisfaction measures (i.e., Ratings of Care Processes, p < 0.01; Global Satisfaction, p < 0.05, Perceived Health Benefit, p < 0.01) and one general health status measure (i.e. Quality of Life, p < 0.01).
The results suggest that providers of care should ensure that they meet the information needs of patients with specific conditions because patients' perceptions of both quality of care and quality of life are associated with the clinicians' ability to transfer key information to their patients.
To develop a reliable and valid measure of patient opinions on quality of hospital care.
Issues of importance to patients and possible scale items were generated by literature review and non-structured interviews of patients, former patients, health care providers and researchers. Semi-structured interviews with inpatients and pilot studies were conducted to modify or remove ambiguous questions and reduce skewed responses. A study was then made to select from these questions relevant items and variables correlated to patient evaluation of quality of care. A principal-components analysis was performed to select items and assess construct validity. Cronbach's alpha coefficients were calculated to estimate the reliability of the scale. Time reliability and concurrent validity were also considered.
An 800-bed French short-stay teaching hospital in Paris.
Five-hundred and thirty-four consecutive patients hospitalized in eight medical and surgical wards.
A 26-item scale was developed. Component analysis indicated two subscales: 'medical information' and 'relationship with staff and daily routine'. Levels of reliability were satisfactory: Cronbach's alpha coefficient exceeded 0.87 for overall scale and subscales. Concurrent validity and time reliability were also satisfactory. Multivariate analysis showed that, taking into account patients and hospitalization characteristics linked to scores (age, health status, number of hospitalizations, comorbidity, time since diagnosis, admission pattern, private patient and difficulties reported by staff), these scores differed among departments.
A reliable, valid measure of inpatients' opinions on quality of care has been developed in a French hospital and variables that have to be taken into account to compare hospital departments have been selected. Items selected in the scale emphasized the importance that patients give to receiving medical information.
The aim of this systematic review of the Cochrane Collaboration was to assess the impact of interventions designed to change nurse-doctor collaboration on collaboration itself, on patient satisfaction, and on the effectiveness and efficiency of the health care provided. There are no good trials on interventions to improve collaboration between doctors and nurses. There are numerous strategies suggested to improve inter-disciplinary collaboration between doctors and nurses, such as joint workshops, meetings, development of team systems and strategies, and training in collaboration. However, no studies of these interventions that met the reviewers' criteria could be found. More research is needed to determine any impact of these strategies on interprofessional collaboration, and on the outcomes for patients.
Although current depression treatment guidelines recommend continuing antidepressant therapy for at least 4 to 9 months, many patients discontinue treatment prematurely, within 3 months.
To investigate the relationship between patient-physician communication and the continuation of treatment with antidepressants and to explore the demographics, adverse effects, therapeutic response, and frequency of follow-up visits.
A total of 401 telephone interviews of depressed patients being treated with selective serotonin reuptake inhibitor (SSRI) therapy between December 15, 1999, and May 31, 2000, were conducted and 137 prescribing physicians completed written surveys from Northern California Kaiser Permanente health maintenance organization outpatient clinics.
Patient-physician communication about therapy duration and about adverse effects; therapy discontinuation or medication switching within 3 months after start of SSRI therapy.
Ninety-nine physicians (72%) reported that they usually ask patients to continue using antidepressants for at least 6 months, but 137 patients (34%) reported that their physicians asked them to continue using antidepressants for this duration and 228 (56%) reported receiving no instructions. Patients who said they were told to take their medication for less than 6 months were 3 times more likely to discontinue therapy (odds ratio [OR], 3.12; 95% confidence interval [CI], 1.21-8.07) compared with patients who said they were told to continue therapy longer. Patients who discussed adverse effects with their physicians were less likely to discontinue therapy than patients who did not discuss them (OR, 0.49; 95% CI, 0.25-0.95). Patients who reported discussing adverse effects with their physicians were more likely to switch medications (OR, 5.60; 95% CI, 2.31-13.60). Fewer than 3 follow-up visits for depression, adverse effects, and lack of therapeutic response to medication were also associated with patients' discontinuing therapy.
Discrepancies exist between instructions that physicians report they communicate to patients and what patients remember being told. Explicit instructions about expected duration of therapy and discussions about medication adverse effects throughout treatment may reduce discontinuation of SSRI use. Our finding that patients with 3 or more follow-up visits were more likely to continue using the initially prescribed antidepressant medication suggests that frequent patient-physician contact may increase the probability that patients will continue therapy.
Although physicians' communication skills have been found to be related to clinical outcomes and patient satisfaction, teaching of communication skills has not been fully integrated into many medical school curricula or adequately evaluated with large-scale controlled trials.
To determine whether communications training for medical students improves specific competencies known to affect outcomes of care.
A communications curriculum instituted in 2000-2001 at 3 US medical schools was evaluated with objective structured clinical examinations (OSCEs). The same OSCEs were administered to a comparison cohort of students in the year before the intervention.
One hundred thirty-eight randomly selected medical students (38% of eligible students) in the comparison cohort, tested at the beginning and end of their third year (1999-2000), and 155 students in the intervention cohort (42% of eligible students), tested at the beginning and end of their third year (2000-2001).
Comprehensive communications curricula were developed at each school using an established educational model for teaching and practicing core communication skills and engaging students in self-reflection on their performance. Communications teaching was integrated with clinical material during the third year, required clerkships, and was supported by formal faculty development.
Standardized patients assessed student performance in OSCEs on 21 skills related to 5 key patient care tasks: relationship development and maintenance, patient assessment, education and counseling, negotiation and shared decision making, and organization and time management. Scores were calculated as percentage of maximum possible performance.
Adjusting for baseline differences, students exposed to the intervention significantly outperformed those in the comparison cohort on the overall OSCE (65.4% vs 60.4%; 5.1% difference; 95% confidence interval [CI], 3.9%-6.3%; P<.001), relationship development and maintenance (5.3% difference; 95% CI, 3.8%-6.7%; P<.001), organization and time management (1.8% difference; 95% CI, 1.0%-2.7%; P<.001), and subsets of cases addressing patient assessment (6.7% difference; 95% CI, 5.9%-7.8%; P<.001) and negotiation and shared decision making (5.7% difference; 95% CI, 4.5%-6.9%; P<.001). Similar effects were found at each of the 3 schools, though they differed in magnitude.
Communications curricula using an established educational model significantly improved third-year students' overall communications competence as well as their skills in relationship building, organization and time management, patient assessment, and negotiation and shared decision making-tasks that are important to positive patient outcomes. Improvements were observed at each of the 3 schools despite adaptation of the intervention to the local curriculum and culture.
Communication is an important component of patient care. Traditionally, communication in medical school curricula was incorporated informally as part of rounds and faculty feedback, but without a specific or intense focus on skills of communicating per se. The reliability and consistency of this teaching method left gaps, which are currently getting increased attention from medical schools and accreditation organizations. There is also increased interest in researching patient-doctor communication and recognizing the need to teach and measure this specific clinical skill. In 1999, the Accreditation of Council for Graduate Medical Education implemented a requirement for accreditation for residency programs that focuses on "interpersonal and communications skills that result in effective information exchange and teaming with patients, their families, and other health professionals." The National Board of Medical Examiners, Federation of State Medical Boards. and the Educational Commission for Foreign Medical Graduates have proposed an examination between the. third and fourth year of medical school that "requires students to demonstrate they can gather information from patients, perform a physical examination, and communicate their findings to patients and colleagues" using standardized patients. One's efficiency and effectiveness in communication can be improved through training, but it is unlikely that any future advances will negate the need and value of compassionate and empathetic two-way communication between clinician and patient. The published literature also expresses belief in the essential role of communication. "It has long been recognized that difficulties in the effective delivery of health care can arise from problems in communication between patient and provider rather than from any failing in the technical aspects of medical care. Improvements in provider-patient communication can have beneficial effects on health outcomes". A systematic review of randomized clinical trials and analytic studies of physician-patient communication confirmed a positive influence of quality communication on health outcomes. Continuing research in this arena is important. For a successful and humanistic encounter at an office visit, one needs to be sure that the patient's key concerns have been directly and specifically solicited and addressed. To be effective, the clinician must gain an understanding of the patient's perspective on his or her illness. Patient concerns can be wide ranging, including fear of death, mutilation, disability; ominous attribution to pain symptoms; distrust of the medical profession; concern about loss of wholeness, role, status, or independence; denial of reality of medical problems; grief; fear of leaving home; and other uniquely personal issues. Patient values, cultures, and preferences need to be explored. Gender is another element that needs to be taken into consideration. Ensuring key issues are verbalized openly is fundamental to effective patient-doctor communication. The clinician should be careful not to be judgmental or scolding because this may rapidly close down communication. Sometimes the patient gains therapeutic benefit just from venting concerns in a safe environment with a caring clinician. Appropriate reassurance or pragmatic suggestions to help with problem solving and setting up a structured plan of action may be an important part of the patient care that is required. Counseling around unhealthy or risky behaviors is an important communication skill that should be part of health care visits. Understanding the psychology of behavioral change and establishing a systematic framework for such interventions, which includes the five As of patient counseling (assess, advise, agree, assist, and arrange) are steps toward ensuring effective patient-doctor communication. Historically in medicine, there was a paternalistic approach to deciding what should be done for a patient: the physician knew best and the patient accepted the recommendation without question. This era is ending, being replaced with consumerism and the movement toward shared decision-making. Patients are advising each other to "educate yourself and ask questions". Patient satisfaction with their care, rests heavily on how successfully this transition is accomplished. Ready access to quality information and thoughtful patient-doctor discussions is at the fulcrum of this revolution.
To compare the views of healthcare professionals and patients regarding compliance with standards of care concerning patient information.
Self-rated questionnaire survey.
Nine wards in short stay French hospitals.
939 patients and 359 healthcare professionals (physicians, nurses, assistants and other professionals).
Patients' and healthcare professionals' views of compliance with 20 standards of patient care described in the French accreditation manual. Comparison of the rank order of the standards within the two samples.
The response rate was 61.5% in the patient group and 85.8% in the healthcare professionals. The rank orders for the 20 items were similar in both groups (Spearman rank order correlation 0.6, p = 0.004). The two items ranked highest by healthcare professionals ("consent request for a surgical procedure" and "the doctors ask the visitors to leave the room before examining a patient") were also the two ranked highest by the patients. Three items were ranked low by both groups: "consent request for students to be present", "health education given to patients", and "possibility to express satisfaction during discharge". Patients were more satisfied with their pain management than were healthcare providers. Professionals were more satisfied with the social services than the patients.
There are both similarities and differences between patients' and healthcare professionals' views of care. Accurate assessments of quality performed during the accreditation procedure require that both patients' and professionals' views be taken into account.
To measure and compare critical care physicians' and nurses' attitudes about teamwork.
Cross-sectional surveys.
Eight nonsurgical intensive care units in two teaching and four nonteaching hospitals in the Houston, TX, metropolitan area.
Physicians and nurses who worked in the intensive care units.
Three hundred twenty subjects (90 physicians and 230 nurses) responded to the survey. The response rate was 58% (40% for physicians and 71% for nurses). Only 33% of nurses rated the quality of collaboration and communication with the physicians as high or very high. In contrast, 73% of physicians rated collaboration and communication with nurses as high or very high. By using factor analysis, we developed a seven-item teamwork scale. Multivariate analysis of variance of the items yielded an omnibus ( [7, 163] = 8.37; p <.001), indicating that physicians and nurses perceive their teamwork climate differently. Analysis of individual items revealed that relative to physicians, nurses reported that it is difficult to speak up, disagreements are not appropriately resolved, more input into decision making is needed, and nurse input is not well received.
Critical care physicians and nurses have discrepant attitudes about the teamwork they experience with each other. As evidenced by individual item content, this discrepancy includes suboptimal conflict resolution and interpersonal communication skills. These findings may be the result of the differences in status/authority, responsibilities, gender, training, and nursing and physician cultures.
No studies have systematically asked larger groups of health professionals about their own experience as patients. This study estimated the level of satisfaction with hospital care among health professionals based on experience from their own hospital admission or that of a close family member.
A cross-sectional questionnaire study of 1995 doctors (41% women) and 1472 nurses (98% women) drawn randomly from union registers. Response rate: 70%.
Twenty-seven percent had themselves been hospitalized within the preceding five years, and 31% had followed a hospital stay for a close relative during the preceding two years. At least 85% were satisfied with these conditions: information from the hospital, nursing staff, and doctors before admission; quality of the sickroom; level of smoke exposure; quality of breakfast, lunch, and beverages; nursing staff's and doctors' communication with the patient, and; doctors' treatment and diagnostics. Dissatisfaction above 15% was seen for several other factors associated with facilities, care, and treatment. One severe observation was related to the degree of treatment complications, reported by 23% of the patients. When reporting on behalf of an admitted relative a tendency was found to be slightly more critical. Generally, the results of this study are in agreement with previous Danish studies on patient satisfaction.
The results of the present study indicate room for improvement in several respects in Danish hospital care: Better physical facilities, improved patient information, and a continuous quality surveillance to prevent treatment errors.
Context Although current depression treatment guidelines recommend continuing
antidepressant therapy for at least 4 to 9 months, many patients discontinue
treatment prematurely, within 3 months.Objectives To investigate the relationship between patient-physician communication
and the continuation of treatment with antidepressants and to explore the
demographics, adverse effects, therapeutic response, and frequency of follow-up
visits.Design, Setting, and Patients A total of 401 telephone interviews of depressed patients being treated
with selective serotonin reuptake inhibitor (SSRI) therapy between December
15, 1999, and May 31, 2000, were conducted and 137 prescribing physicians
completed written surveys from Northern California Kaiser Permanente health
maintenance organization outpatient clinics.Main Outcome Measures Patient-physician communication about therapy duration and about adverse
effects; therapy discontinuation or medication switching within 3 months after
start of SSRI therapy.Results Ninety-nine physicians (72%) reported that they usually ask patients
to continue using antidepressants for at least 6 months, but 137 patients
(34%) reported that their physicians asked them to continue using antidepressants
for this duration and 228 (56%) reported receiving no instructions. Patients
who said they were told to take their medication for less than 6 months were
3 times more likely to discontinue therapy (odds ratio [OR], 3.12; 95% confidence
interval [CI], 1.21-8.07) compared with patients who said they were told to
continue therapy longer. Patients who discussed adverse effects with their
physicians were less likely to discontinue therapy than patients who did not
discuss them (OR, 0.49; 95% CI, 0.25-0.95). Patients who reported discussing
adverse effects with their physicians were more likely to switch medications
(OR, 5.60; 95% CI, 2.31-13.60). Fewer than 3 follow-up visits for depression,
adverse effects, and lack of therapeutic response to medication were also
associated with patients' discontinuing therapy.Conclusions Discrepancies exist between instructions that physicians report they
communicate to patients and what patients remember being told. Explicit instructions
about expected duration of therapy and discussions about medication adverse
effects throughout treatment may reduce discontinuation of SSRI use. Our finding
that patients with 3 or more follow-up visits were more likely to continue
using the initially prescribed antidepressant medication suggests that frequent
patient-physician contact may increase the probability that patients will
continue therapy.
Objectives
To compare the views of healthcare professionals and patients regarding compliance with standards of care concerning patient information.
Design
Self-rated questionnaire survey.
Setting
Nine wards in short stay French hospitals.
Participants
939 patients and 359 healthcare professionals (physicians, nurses, assistants and other professionals).
Main outcome measure
Patients’ and healthcare professionals’ views of compliance with 20 standards of patient care described in the French accreditation manual. Comparison of the rank order of the standards within the two samples.
Results
The response rate was 61.5% in the patient group and 85.8% in the healthcare professionals. The rank orders for the 20 items were similar in both groups (Spearman rank order correlation 0.6, p = 0.004). The two items ranked highest by healthcare professionals (“consent request for a surgical procedure” and “the doctors ask the visitors to leave the room before examining a patient”) were also the two ranked highest by the patients. Three items were ranked low by both groups: “consent request for students to be present”, “health education given to patients”, and “possibility to express satisfaction during discharge”. Patients were more satisfied with their pain management than were healthcare providers. Professionals were more satisfied with the social services than the patients.
Conclusion
There are both similarities and differences between patients’ and healthcare professionals’ views of care. Accurate assessments of quality performed during the accreditation procedure require that both patients’ and professionals’ views be taken into account.
• This paper describes the participation of critical care nurses in ward rounds, and explores the power relations associated with the ways in which nurses interact with doctors during this oral forum of communication.
• The study comprised a critical ethnographic study of six registered nurses working in a critical care unit.
• Data collection methods involved professional journalling, participant observation, and individual and focus group interviews with the six participating nurses.
• Findings demonstrated that doctors used nurses to supplement information and provide extra detail about patient assessment during ward rounds. Nurses experienced enormous barriers to participating in decision-making activities during ward round discussions.
• By challenging the different points of view that doctors and nurses might hold about the ward round process, the opportunity exists for enhanced participation by nurses.
A 21-item check-list is presented that evaluates the quality of the medical interview, focusing on politeness, respect, and communication. Twenty-eight interviews conducted by family medicine residents were videotaped. Using the check-list, four teachers as well as the resident evaluated each interview. Reliability and content validity were demonstrated. This list is easy to use and may enhance the learning of interviewing skills by giving objective feedback to the resident.
After pain management, poor communication with health professionals creates the most distress for families of patients with cancer. Difficulties communicating with families also have been identified as potentially stressful for nurses. This is particularly the case for nurses working in acute care settings. However, little research has been undertaken to examine the specific problems and challenges confronting nurses who endeavor to communicate with families of patients with cancer in a hospital setting. The purpose of this study was to describe nurses' perceptions of communication issues, potential barriers, and strategies associated with nurse-family interactions in an acute cancer hospital setting. Focus groups were conducted with nurses from two cancer wards at an Australia hospital. Four distinct themes emerged. First, all nurses described communication difficulties they encountered when interacting with families. Second, team factors appeared to be a central determinant of the quality of nurse-family communication. Third, nurses described difficulties associated with the delivery of bad news and treatment plans that are not clearly defined for the patient. Finally, the effects of poor communication on nurses were notably and vividly described. in this report, recommendations for clinical practice and subsequent research are offered.
Doctors and patients alike are saddened and angered by the distance that increasingly interferes with their interactions. Two complementary strategies may enhance the human quality of clinical care and improve outcomes. First, the doctor and patient can undertake a systematic "patient's review" that addresses seven dimensions of care: 1) respect for patient's values, preferences, and expressed needs; 2) communication and education; 3) coordination and integration of care; 4) physical comfort; 5) emotional support and alleviation of fears and anxieties; 6) involvement of family and friends; and 7) continuity and transition. Incorporating the "review" into the clinical encounter encourages both patient and doctor to confront individual preferences and values and offers patients an explicit framework for participating actively in their care. Second, using survey instruments designed to solicit focused reports from patients that address each dimension of care, doctors can gather aggregate feedback about their practices. Such reports move beyond anecdote and can serve as screening tests that uncover areas in doctors' practices that merit improvement. In addition, patients can join doctors in developing solutions to problems uncovered by patients' reports.
Communication difficulties between hospital doctors and nurses are well documented. A survey undertaken jointly by medical and nursing administration at Sir Charles Gairdner Hospital in Perth, Western Australia, verified difficulties in doctor-nurse communication as perceived by doctors and nurses, as well as by ward clerks as impartial observers. Questionnaire responses revealed some impediments in the flow of communication. Both nurses and doctors perceived less frequency of difficulties in communicating with members of their own professional group than with members of the other group. Nurses with university preparation and other special clinical qualifications perceived significantly fewer communication problems with doctors than nurses with less education. Interns perceived greater frequency in difficulty communicating with nurses than did more highly qualified doctors, and female doctors who were not interns claimed fewer problems than their male counterparts. Moreover, more highly qualified male doctors who had a previous occupation acknowledged fewer doctor-nurse communication problems.
This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals.
Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions.
The study involved cross-sectional examination of the named relationships.
Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care.
A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation.
What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard.
In a study to identify and describe nurses' use of comforting strategies, techniques of qualitative ethology were used to analyse videotaped recordings of nurse-patient interactions on an active cancer treatment ward. Comforting strategies nurses were observed to use included gentle humour, physical comfort measures, emotionally supportive statements, and comforting and connecting touch. In addition they increased physical proximity, provided patients with information, supported patients' active participation in decisions regarding their care, and offered opportunities for patients to engage in social exchange. These strategies appeared to play a major role in helping cancer patients endure the discomforts associated with their illness and/or treatment. Various combinations of comforting strategies were used in four different contexts, including: helping patients put experiences into perspective; helping them stay in control; providing opportunities to function as normally as possible; and providing emotional support. The findings of this study support conceptualizations of comforting that extend beyond measures related to symptom control and indicate that comforting strategies used by cancer nurses comprise a significant part of their work.
To compare patients' and physicians' opinions on the importance of discrete elements of health care as determinants of the quality of outpatient care.
Analysis of results of a mailed survey.
Community-based internal medicine practices.
74 general internists and 814 patients randomly selected from the practices of these internists.
125 elements of care that covered nine domains were identified: physician clinical skill, physician interpersonal skill, support staff, office environment, provision of information, patient involvement, nonfinancial access, finances, and coordination of care. Participants rated each element on its importance to high-quality care on a 4-point scale: 1 = not important; 2 = of medium importance; 3 = of high importance; and 4 = essential. Patients' and physicians' ratings were compared for individual elements of care and for elements aggregated into domains.
Survey response rates were 93% for physicians and 60% for patients. In an element-by-element comparison of ratings, ratings by the two groups differed substantially for 58% of the attributes. The most striking difference was seen in the domain of provision of information (median ratings, 3.56 for patients and 2.85 for physicians; P < 0.001). Ratings by the two groups also differed in the domains of clinical skill (3.75 for patients and 3.35 for physicians; P < 0.001), nonfinancial access (3.00 for patients and 2.87 for physicians; P < 0.001), and finances (3.00 for patients and 2.80 for physicians; P = 0.006). When relative rankings of the domains were compared, both groups agreed that clinical skill is most important; however, patients ranked provision of information second in importance whereas physicians ranked it sixth.
Patients and physicians agreed that the most crucial element of outpatient care is clinical skill, but they disagreed about the relative importance of other aspects of care, particularly effective communication of health-related information. These differences in perception may influence the quality of interactions between physicians and patients.
The social environment in which hospitals in the Netherlands have to function nowadays is greatly changing. Over the last 10 years the policy of the Dutch government has become less directive, market mechanisms are gaining weight and the demand for services by patients is changing. As a result of these changes hospitals formulate their strategic goals in terms of improvement of quality of care and efficacy. A basic assumption in this article is that quality of care is to be gained by collaborative practice between physicians and nurses. A necessary condition for this is that there is a correspondence in role concepts and expectancies of physicians and nurses in hospitals. The object of this research is to describe the role concepts and role expectations of nurses, physicians and patients in two Dutch hospitals. In general, the research revealed considerable differences between role behaviour and role concepts among nurses. In the long run these differences may not be favourable for good understanding between them and physicians, or for their own job satisfaction. This may also have negative consequences for collaboration between nurses and physicians and, finally, for the quality of care and cure within the ward. There is a need for discussion of the role concepts of nurses in relation to their actual regular tasks in order to resolve this. A second discrepancy exists between the role behaviour of physicians and the expectations of nurses about this behaviour. This may also lead to a lower job satisfaction for nurses. Taking into account the fact that patients are satisfied with the way physicians and nurses pay attention to most aspects of care and cure, a discussion between physicians and nurses could be recommended. The aim is revising either the role behaviour of physicians, especially as regards their attention to the psycho-social needs of patients, or the expectations of nurses, or both.
This study examined the relationships of nurse burnout, intention to quit, and meaningfulness of work as assessed on a staff survey with patient satisfaction with nursing care, physician care, information provided and coordination of care, and outcomes of the hospital stay assessed post-discharge. Sixteen inpatient units from two hospital sites formed the data base and included 605 patients and 711 nurses. Patients' perceptions of the quality of each of the four care dimensions corresponded to the relationships nurses had with their work. Patients on units where nurses found their work meaningful were more satisfied with all aspects of their hospital stay. Patients who stayed on units where nursing staff felt more exhausted or more frequently expressed the intention to quit were less satisfied with the various components of their care. Although nurse cynicism was reflected in lower patient satisfaction with interactions with nursing staff, the correlations between cynicism and other aspects of care fell below statistical significance. No significant correlations were found between nurse professional efficacy and any of the patient satisfaction components measured. The implications of the relationship between patient satisfaction and nurses' perception of their work is discussed.
Effective communication between nurses and physicians is central to the clinical care of nursing home residents. Anecdotal evidence suggests that communication between the groups is unsatisfactory, but no empirical data exist with which to validate assumptions. The purpose of this pilot study was to compare perceptions of potential communication barriers among nurses and physicians in four California nursing homes.
Registered nurses (n = 59), and physicians (n = 47) involved in the direct clinical care of nursing home residents completed a 12-item questionnaire designed to elicit perceptions about potential communication barriers. Five specific categories of barriers were identified. These included nurse competence, time burden of calls, necessity of calls, professional respect, and language comprehension. Responses were compared using t test analysis.
Significant differences in perceived communication barriers were identified. Physicians, but not nurses, perceive nursing competence to be a significant barrier. Nurses perceive physicians to be unpleasant. Both physicians and nurses perceive that physicians do not value nurses' opinions. Neither group perceived language expression, language comprehension, or time burden of phone calls to be barriers to communication.
Issues related to the perceived competency of nurses by physicians is consistent with existing data from other clinical settings. Differences in awareness about scope of practice and regulatory requirements between the groups may offer a partial explanation for the discordant perceptions. Perceptions by nurses (but not physicians) of unpleasantness and/or disrespect during telephone encounters may reflect the broader ongoing differences in professional culture, social status, and gender inequality between the two groups. Further clarification of the causes of barriers to effective communication is essential in order to plan appropriate interventions.
To investigate the association of collaboration between intensive care unit (ICU) physicians and nurses and patient outcome.
Prospective, descriptive, correlational study using self-report instruments.
A community teaching hospital medical ICU, a university teaching hospital surgical ICU, and a community non-teaching hospital mixed ICU, all in upstate New York.
Ninety-seven attending physicians, 63 resident physicians, and 162 staff nurses.
When patients were ready for transfer from the ICU to an area of less intensive care, questionnaires were used to assess care providers' reports of collaboration in making the transfer decision. After controlling for severity of illness, the association between interprofessional collaboration and patient outcome was assessed. Unit-level organizational collaboration and patient outcomes were ranked.
Healthcare providers' reported levels of collaboration, patient severity of illness and individual risk, patient outcomes of death or readmission to the ICU, unit-level collaboration, and unit patient risk of negative outcome.
Medical ICU nurses' reports of collaboration were associated positively with patient outcomes. No other associations between individual reports of collaboration and patient outcome were found. There was a perfect rank order correlation between unit-level organizational collaboration and patient outcomes across the three units.
The study offered some support for the importance of physician-nurse collaboration in ICU care delivery, a variable susceptible to intervention and further study.
The objective was to assess primary care physicians' awareness of their patients' rated emotions, satisfaction, and opinion of the quality of their communication.
Diabetic patients (n = 261) and their primary care physicians (n = 44) each filled in a questionnaire following a routine medical visit. Patients were asked about the quality of communication with their physician, their satisfaction, and their experience of six emotions. Physicians were asked to estimate the patients' views on each of these questions. Physicians' awareness was measured by (1) correlating the physician and patient ratings, and (2) comparing mean ratings between physicians and patients.
Correlations between patients' and physicians' views of patients' emotions and satisfaction were weak to moderate in magnitude; for patients' opinion of communication quality, there was no correlation. All ratings showed a substantial discrepancy between physicians and patients, such that physicians thought patients' responses were more negative than they actually were.
Although the causes of physicians' weak awareness of their patients' responses are not known, the results suggest that the patients' affective responses may be an especially neglected aspect of communication in the medical visit.
This paper describes the participation of critical care nurses in ward rounds, and explores the power relations associated with the ways in which nurses interact with doctors during this oral forum of communication. The study comprised a critical ethnographic study of six registered nurses working in a critical care unit. Data collection methods involved professional journalling, participant observation, and individual and focus group interviews with the six participating nurses. Findings demonstrated that doctors used nurses to supplement information and provide extra detail about patient assessment during ward rounds. Nurses experienced enormous barriers to participating in decision-making activities during ward round discussions. By challenging the different points of view that doctors and nurses might hold about the ward round process, the opportunity exists for enhanced participation by nurses.
Health professionals play an important role in meeting the information and support needs of individuals following a diagnosis of cancer. The aim of this study was to evaluate the acceptability and impact of a hospital-based cancer support nurse (CSN) service. A total of 98 patients completed a structured telephone interview after discharge concerning their use, perceptions and satisfaction with the service. The majority of patients perceived service delivery to be appropriate and reported that they had gained both information and support. The service also had a positive impact on behavioural, cognitive and affective outcomes. Overall satisfaction with the service was very high. Results indicate that a hospital-based cancer support nurse service provides a promising model for meeting the early information and support needs of patients, thereby promoting continuity of care.
This study compared surgical patients' (n = 874) and perioperative nurses' (n = 143) perceptions of the quality of perioperative nursing care. The data were collected with a structured questionnaire in five hospital operating departments in Finland. The questionnaire items were divided into five main categories (staff characteristics, nursing activities, preconditions, progress of nursing process and environment); some of these categories were further divided into subcategories. Overall, patients tended to give significantly higher (P <.001) ratings than nurses, but for some items the patients had more critical perceptions. The results provide important clues for improving the quality of patient care so that staff activities better serve the needs of patients.