Using Servqualto Identify Gaps in Quality Care for Patients with Cystic Fibrosis: A Hospital-Based Quality Improvement Project

Background: Cystic Fibrosis (CF) Care Centers were established to centralize and integrate the knowledge and skills of pulmonary medicine, nutrition, gastroenterology, nursing, respiratory therapy, social work, and genetics to efficiently provide care for people living with CF. The high quality, specialized care that is given at CF Care Centers has led to the improved length and quality of life for people living with CF. Aim: The aim of this quality improvement project was to identify any gaps in providing effective, high quality care to patients with CF to reduce the variability in nursing practices and improve their quality of care. Methods: The site of this quality improvement project was a nationally accredited CF Care Center that serves both pediatric and adult patients with CF. Using the Chronic Care Model as the theoretical framework, a quantitative SERVQUAL survey was developed. The SERVQUAL survey is a tool that identifies gaps in quality of care. The tool was used to identify nurses’ expectations and perceptions of the quality of care given to patients with CF. Results: Forty-seven out of 60 (78.3%) nurses completed the SERVQUAL survey. The results of the gap analysis showed that each dimension of the survey had a negative gap score, which indicates a gap in quality of care. The unweighted gap score (UGS) of the tangibility dimension was -0.92 with a weighted gap score (WGS) of -13.40. The UGS of the reliability dimension was -0.53 with a -9.47 WGS. The responsiveness dimension’s UGS was -0.65 and had a -11.76 WGS. The assurance dimension’s UGS was a -0.72 with a -21.07 WGS. The UGS for the empathy dimension was a -0.45 with a WGS of -9.09. Conclusion and Implications for CNL Practice: The results of the gap analysis indicate that to improve nurses’ perceptions of CF quality of care and care delivery education should focus on the assurance, tangibility, and responsiveness dimensions, with less focus on reliability and empathy components. A summary of the gap analysis results, interpretations of the findings, and the role of the CNL in developing an educational module to improve quality of care are discussed

Customers satisfaction in pediatric inpatient services: A multiple criteria satisfaction analysis

Objective: To assess customer satisfaction determinants in a public pediatric inpatient service and propose some strategies to enhance the consumer and customer experience. Methods: We applied a Multiple Criteria Customer Satisfaction Analysis to estimate the value functions associated with each satisfaction (sub)criterion and determine the corresponding weights. We characterized satisfaction criteria (according to the Kano’s model), estimated the customers’ demanding nature and the potential improvements, and proposed strategic priorities and opportunities to enhance customer satisfaction. Main findings: Strategies for satisfaction enhancement do not depend solely on the criteria with the lowest satisfaction levels and the estimated weights, each criterion’s nature, the customers’ demanding nature, and the technical margin for improvements. Conclusions: Areas deserving attention include clinical staff’s communication skills, the non-clinical professionals’ efficiency, availability, and kindness; food quality; visits’ scheduling and quantity; and facilities’ comfort.info:eu-repo/semantics/publishedVersio

First-Aid Kit for College Mental Health

In the United States, people are experiencing mental illnesses at an incredibly high rate, especially the college population. With more students being clinically diagnosed with depression and anxiety disorders, and with suicide being the second leading cause of death among college students, it is imperative that colleges take action to combat these diseases. This article addresses why implementing Mental Health First Aid programs in college orientations nationwide is critical and how it would help reduce the United States’ mental health crisis

Service Quality: Revisiting the Two Factors Theory

Present paper is based on the findings of the ongoing Ajmer Experiments. Ajmer Experiments are quasiexperiments that inquire into the consumer evaluation of service quality. The paper presents the two factors’ theory of the author. The paper suggests that a more detailed approach is required wherein each factor needs to be considered independently and not as an aggregate dimension. The paper reports evidence to support two - factor theory for services that was dis carded by earlier researchers. The paper argues to differentiate between the factors and the outcome of performance along these factors. The study describes the two factors as ‘vantage factors’ and ‘qualifying factors’. Marketers need to be selective in that certain factors behave as vantage factors while others as qualifying factors. The two are different in nature and require a differential treatment. The paper also analyses the nature and behavior of these two types of factors. Managerial implications of these factors are also dealt with in this paper

Final report: refugee oral health sector capacity building project

This report develops new resources that support the Victorian public oral health sector\u27s clients of refugee and asylum seeker backgrounds.Summary: The first key outcome of the project was the development of new resources that support the Victorian public oral health sector. A Model of Care, two Factsheets on identifying and working with clients of refugee and asylum seeker background, and a central resource repository were developed by the Project Worker with assistance from the Project Advisory Group. The Model of Care and the complementary Factsheets were designed to support services to implement Priority Access and Fee Exemption policies. Further, the proposed Model of Care places a focus on oral health education which assists to minimise late-stage and costly interventions, consistent with developments in relation to Minimal Intervention Dentistry (MID). The Model of Care encourages dental staff to observe and assess clients for clinical and social risks that may impact on the client’s oral health care and/or client ability to renegotiate complex appointment systems for follow up care; and, based on this assessment, to set up recall for clients who show high oral health risk (including any identified clinical and social risks). The Model of Care also aims to provide services with guidance to assist in ascertaining when those of refugee background can be assessed as no longer requiring Priority Access. The Model of Care has been positively received by practitioners and services, however needs to be incorporated into policy and guidelines in order to support its implementation.In addition to the Model of Care and Factsheets, a collection of refugee oral health literature and resources have been collated into a repository on the Victorian Refugee Health Network website www.refugeehealthnetwork.org.au. The project identified a need for additional pictorial, translated and interactive web-based oral health information to be developed, especially on the topic of health education for people of refugee backgrounds. Oral hygiene maintenance, how to navigate the oral health care system, and what to expect before and after a dental treatment are suggested themes.Another key output was the development, trialling and evaluation of the Refuge Oral Health Targeted Education Program (TEP) – a professional development curriculum for oral health service staff. Evaluation of the TEP showed that staff who participated in the program demonstrated an increase in (a) knowledge, (b) confidence and (c) understanding of practice in working with clients of refugee and asylum seeker backgrounds.There is a high demand for oral health training and evidence from this project shows that the TEP is not only informative, but also effective in changing perception and practice in oral health service delivery. The TEP should be implemented across Victoria in services responding to high numbers of refugee and asylum seeker clients. While there is a need to make the TEP widely available, this also has resource implications and it is suggested that these could be partially addressed by making some of the learning modules available online.The project also identified the need for regional or statewide forum(s) to promote the findings of the project and promote good practice across services. It will be important to continue to develop opportunities for dental professionals, researchers, government and refugee related services to come together to share clinical expertise, emerging issues, clinical presentations, case studies and service developments, specific to working with clients or refugee and asylum seeker background.A lack of formalised pathways between dental, intake, Refugee Health Nurses and settlement services was highlighted during the TEP as an area for further development, and for consideration in other services.Finally, this project highlighted significant gaps in Australian research in relation to the following areas: the oral health status of new and recently arrived refugee background populations (noting changing demographics now and in the future); evidence regarding approaches to providing better access, appropriate clinical care and addressing oral health literacy for refugee background population (including oral health promotion and education); and in new and emerging approaches such as Minimal Intervention Dentistry (MID). The recommendations below provide next steps in implementation in the areas of policy, referral pathways, professional and organisation development, resources and research.Authored by: Thuy Nguyen, Sue Casey, May Maloney & Stephanie Rich on behalf of the Project Advisory Grou

Clinician and Patient Experiences of Managing and Living with Oral and Dental Manifestations of Scleroderma: A Scoping Review

Oral and dental manifestations of scleroderma are extremely common, yet they are often overlooked within rheumatology and poorly understood within dentistry. Previous research has indicated the need to understand the oral and dental experiences of people living with scleroderma and those involved in their care. This scoping review aims, for the first time, to comprehensively map what is known regarding the identification and management of oral and dental manifestations of scleroderma, how these are experienced by people living with scleroderma, and to explore key characteristics of barriers and enablers to good oral and dental care in scleroderma. A scoping review was conducted using six databases (Embase, PubMed, PsychINFO, ASSIA, Scopus, and SSCI), according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses – extension for Scoping Review. Grey literature were also included. Studies were eligible for inclusion if the full text and abstract were available in English, published between 2002 and 2022, and focused on the concept of oral and dental care in adults with scleroderma, either relating to identification and management, enablers and barriers to best practice, or patient experiences and wellbeing. Qualitative research which seeks to understand patients’ lived experiences was a notable gap in the literature. Similarly, there was a significant lack of focus on the oral and dental manifestations of scleroderma in rheumatology. Three key features were identified which would facilitate best practice in research and clinical contexts: the necessity of multidisciplinary care; the necessity of centralising patient experience; and the necessity of mitigating barriers to dental care. We conclude that increased awareness of scleroderma within dentistry, and streamlining referral procedures between the disciplines of dentistry and rheumatology, to enable the early identification and management of scleroderma, are crucial

‘Male circumcision’ and ‘female genital mutilation’: Why parents choose the procedures and the case for gender bias in medical nomenclature

Cutting of boys’ and girls’ genitalia is a debated human rights topic. Here, the first aim was to summarise why parents choose to have these procedures performed on their children. Results from 22 survey studies on ‘male circumcision’ and 27 studies on ‘female genital mutilation’ revealed that non-medical reasons, such as tradition, are prominent in the decisions for both procedures. The second aim was to describe researchers’ use of medical words (i.e. ‘circumcision’) and non-medical words (i.e. ‘cutting’, ‘mutilation’) when referring to these procedures. Relevant phrases were searched in titles and abstracts of articles indexed in PubMed. Total article count was similar for male (1721 articles) and female (1906 articles) procedures. However, for female procedures, ‘genital mutilation’ was used most frequently (61.7% of articles), whereas for males, ‘circumcision’ was used almost exclusively (99.4%). Because both procedures involve significant alteration of genitalia, and social/culture reasons are prominent in parents’ decisions for both, the results suggest a gender bias in medical ethics applied to bodily integrity, which manifests itself in nomenclature that expresses negative value judgement toward the female procedure (‘mutilation’) but not the male procedure (‘circumcision’). The results add to emerging evidence of a ‘male empathy gap’ in public health

Explaining public support for counterproductive homeless policy: the role of disgust

Federal, state, and city governments spend substantial funds on programs intended to aid homeless people, and such programs attract widespread public support. In recent years, however, state and local governments have increasingly enacted policies, such as bans on panhandling and sleeping in public, that are counterproductive to alleviating homelessness. Yet these policies also garner substantial support from the public. Given that programs aiding the homeless are so popular, why are these counterproductive policies also popular? We argue that disgust plays a key role in the resolution of this puzzle. While disgust does not decrease support for aid policies or even generate negative affect towards homeless people, it motivates the desire for physical distance, leading to support for policies that exclude homeless people from public life. We test this argument using survey data, including a national sample with an embedded experiment. Consistent with these expectations, our findings indicate that those respondents who are dispositionally sensitive to disgust are more likely to support exclusionary policies, such as banning panhandling, but no less likely to support policies intended to aid homeless people. Furthermore, media depictions of the homeless that include disease cues activate disgust, increasing its impact on support for banning panhandling. These results help explain the popularity of exclusionary homelessness policies and challenge common perspectives on the role of group attitudes in public life.Accepted manuscrip

Empathic engineering: helping deliver dignity through design.

Dignity is a key value within healthcare. Technology is also recognized as being a fundamental part of healthcare delivery, but also a potential cause of dehumanization of the patient. Therefore, understanding how medical devices can be designed to help deliver dignity is important. This paper explores the role of empathy tools as a way of engendering empathy in engineers and designers to enable them to design for dignity. A framework is proposed that makes the link between empathy tools and outcomes of feelings of dignity. It represents a broad systems view that provides a structure for reviewing the evidence for the efficacy of empathy tools and also how dignity can be systematically understood for particular medical devices.This paper was authored through funding from the EPSRC-NIHR HTC Partnership Award: Promoting Real Independence through Design Expertise (ref: EP/M000273/1) and NIHR Collaboration for Leadership in Applied Health Research and Care East of England (CLAHRC EoE) at the Cambridge and Peterborough NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.This is the final version of the article. It first appeared from Taylor & Francis via http://dx.doi.org/10.3109/03091902.2015.108809