Exploring Sentiment and Care Management of Hospitalized Patients During the First Wave of the COVID-19 Pandemic Using Electronic Nursing Health Records: Descriptive Study.

Background: The COVID-19 pandemic has changed the usual working of many hospitalization units (or wards). Few studies have used electronic nursing clinical notes (ENCN) and their unstructured text to identify alterations in patients' feelings and therapeutic procedures of interest. Objective: This study aimed to analyze positive or negative sentiments through inspection of the free text of the ENCN, compare sentiments of ENCN with or without hospitalized patients with COVID-19, carry out temporal analysis of the sentiments of the patients during the start of the first wave of the COVID-19 pandemic, and identify the topics in ENCN. Methods: This is a descriptive study with analysis of the text content of ENCN. All ENCNs between January and June 2020 at Guadarrama Hospital (Madrid, Spain) extracted from the CGM Selene Electronic Health Records System were included. Two groups of ENCNs were analyzed: one from hospitalized patients in post–intensive care units for COVID-19 and a second group from hospitalized patients without COVID-19. A sentiment analysis was performed on the lemmatized text, using the National Research Council of Canada, Affin, and Bing dictionaries. A polarity analysis of the sentences was performed using the Bing dictionary, SO Dictionaries V1.11, and Spa dictionary as amplifiers and decrementators. Machine learning techniques were applied to evaluate the presence of significant differences in the ENCN in groups of patients with and those without COVID-19. Finally, a structural analysis of thematic models was performed to study the abstract topics that occur in the ENCN, using Latent Dirichlet Allocation topic modeling. Results: A total of 37,564 electronic health records were analyzed. Sentiment analysis in ENCN showed that patients with subacute COVID-19 have a higher proportion of positive sentiments than those without COVID-19. Also, there are significant differences in polarity between both groups (Z=5.532, P0.8) and with significant P values between both groups. Through Structural Topic Modeling analysis, the final model containing 10 topics was selected. High correlations were noted among topics 2, 5, and 8 (pressure ulcer and pharmacotherapy treatment), topics 1, 4, 7, and 9 (incidences related to fever and well-being state, and baseline oxygen saturation) and topics 3 and 10 (blood glucose level and pain). Conclusions: The ENCN may help in the development and implementation of more effective programs, which allows patients with COVID-19 to adopt to their prepandemic lifestyle faster. Topic modeling could help identify specific clinical problems in patients and better target the care they receive.post-print353 K

The entropy of suffering : an inquiry into the consequences of the 4-Hour Rule for the patient-doctor relationship in Australian public hospitals

As a medical practitioner, predominantly working in Australian public hospitals, I have always been interested in the factors that shape and influence my and my colleagues’ performance in the practice of medicine. In 2011, the Australian Government instituted a range of reforms to the public health-care system, including some directed at improving access for patients to Emergency Departments, which had, over many years, become increasingly overwhelmed by the number and complexity of presentations. This included a target of four hours within which patients in Emergency Departments were to be discharged, admitted or transferred to alternative institutions. These reforms generated widespread strong emotional responses from medical and other health staff with whom I worked, and I was prompted to consider the origins of these powerful human reactions to the administrative intervention. Emergency Departments are often described, derisively, as chaotic working environments. However, this epithet may instead be describing something quite profound about the ontological nature of hospitals and Emergency Departments — that they are, indeed, non-linear dynamical physical systems in which phenomena of complexity exist. Other human-centred interactional and transactional systems have been successfully examined from a complexity perspective, including economics and human physiology. Framing inquiry into Emergency Departments, and the humans who encounter each other within them, from a complexity perspective might also then prove useful in defining and characterising the complex and manifold relationships and interactions between people, technology and systemic organising principles. This health services research evaluates the lived experience of four medical practitioners through the paradigm of phenomenological inquiry, as actors on a performance landscape of clinical encounters and as key sources of information about the structure and functions of that performance manifold. Inquiry into and analysis of these rich descriptive data yield strong inferences that non-linear dynamics are operating across scales — from the cellular to the organisational. The complexity perspective provides a unifying explanatory power for making sense of how energetic transactions and transformations between patients, health-care practitioners, technology and the hospital system unfold to result in the recovery from injury and trauma. Specifically, literature on interoception suggests that human biological systems are exquisitely sensitive to changes in dynamic steady-states that might indicate increased entropy. This inquiry suggests that suffering is a phenomenological experience of sudden increases in entropy. An explanatory model in complexity, using the Second Law of Thermodynamics in open systems, suggests that entropy — that is, suffering — can be understood as being transferred and expelled from patient to doctor. Framing in this explanatory model would suggest that the patient-doctor relationship is a powerful systemic attractor in a dynamic system. Elaborating this construct of energetic dynamics further suggests that insertion of system controllers, such as time-based targets, can have profound non-linear effects on the function of these dynamics and, hence, the outcomes of these patient-doctor encounters. The implications of this inquiry include a new and powerful reframing of the ontological characterisation of the practice of medicine in Emergency Departments in terms of nonlinear open thermodynamic functions operating at distance from equilibrium. It recommends a more thoughtful consideration of human experiences such as suffering and its relief. Giving priority and visibility to suffering within health-care, a recrudescence of times past when technology in medicine was limited, may elucidate ways of practising that improve patient experiences and health outcomes. Furthermore, the findings suggest that medical practitioners, health workers and administrators are called on to deeply consider embracing complex dynamics as problem framing references, and to engage with methodologies that build better theories about the nature of phenomena under investigation. Rather than seeking to diminish or extinguish the complexities of Emergency Departments, researchers and practitioners might acknowledge and engage with the next wave of complexity-informed health-care research to better understand how and why health-care relieves suffering and restores human function

The promise of open survey questions - The validation of text-based job satisfaction measures

Recent advances in computer-aided text analysis (CATA) have allowed organizational scientists to construct reliable and convenient measures from open texts. As yet, there is a lack of research into using CATA to analyze responses to open survey questions and constructing text-based measures of psychological constructs. In our study, we demonstrated the potential of CATA methods for the construction of text-based job satisfaction measures based on responses to a completely open and semi-open question. To do this, we employed three sentiment analysis techniques: Linguistic Inquiry and Word Count 2015, SentimentR and SentiStrength, and quantified the forms of measurement error they introduced: specific factor error, algorithm error and transient error. We conducted an initial test of the textbased measures' validity, assessing their convergence with closed-question job satisfaction measures. We adopted a time-lagged survey design (Nwave 1 = 996; Nwave 2 = 116) to test our hypotheses. In line with our hypotheses, we found that specific factor error is higher in the open question text-based measure than in the semi-open question text-based measure. As expected, algorithm error was substantial for both the open and semi-open question textbased measures. Transient error in the text-based measures was higher than expected, as it generally exceeded the transient error in the human-coded and the closed job satisfaction question measures. Our initial test of convergent and discriminant validity indicated that the semi-open question text-based measure is especially suitable for measuring job satisfaction. Our article ends with a discussion of limitations and an agenda for future research

The promise of open survey questions - The validation of text-based job satisfaction measures

Recent advances in computer-aided text analysis (CATA) have allowed organizational scientists to construct reliable and convenient measures from open texts. As yet, there is a lack of research into using CATA to analyze responses to open survey questions and constructing text-based measures of psychological constructs. In our study, we demonstrated the potential of CATA methods for the construction of text-based job satisfaction measures based on responses to a completely open and semi-open question. To do this, we employed three sentiment analysis techniques: Linguistic Inquiry and Word Count 2015, SentimentR and SentiStrength, and quantified the forms of measurement error they introduced: specific factor error, algorithm error and transient error. We conducted an initial test of the text-based measures’ validity, assessing their convergence with closed-question job satisfaction measures. We adopted a time-lagged survey design (Nwave 1 = 996; Nwave 2 = 116) to test our hypotheses. In line with our hypotheses, we found that specific factor error is higher in the open question text-based measure than in the semi-open question text-based measure. As expected, algorithm error was substantial for both the open and semi-open question text-based measures. Transient error in the text-based measures was higher than expected, as it generally exceeded the transient error in the human-coded and the closed job satisfaction question measures. Our initial test of convergent and discriminant validity indicated that the semi-open question text-based measure is especially suitable for measuring job satisfaction. Our article ends with a discussion of limitations and an agenda for future research

Communicating contentious issues in Canada: Analyzing media discourse of medical assistance in dying (MAID)

Examining the ways medical assistance in dying (MAID) discourse is presented in the media, this thesis analyzes the key themes, issues and contentions found throughout the topic in Canada’s two national papers, The Globe and Mail and the National Post. Through a mixed-methods approach of qualitative and quantitative means, this study examines the period in and around June 17, 2016 when MAID legislation came into effect up to July 1, 2019 using a thematic content analysis, framing analysis, and sentiment analysis approach. Collectively, these methods allowed for an in-depth analysis and breakdown of the ethical, moral, religious, and personal beliefs that contribute to key contentions around the topic of MAID, supplemented by five in-depth interviews among individuals with vested interest in the subject matter. Together, these methods aimed to explore the way contentious issues are presented in the media in the context of medical assistance in dying

Madness Narratives: Victorian Textual Responses to the Insanity Diagnosis

In Madness Narratives, I examine four understudied texts at the intersection of Victorian asylums, patients’ lack of voice, and resistance narratives. I argue that these texts all reject the silencing power of the insanity diagnosis as they represent patients, former patients, and asylum reformers creating counternarratives that call for recognition of the patients’ humanity and right to be heard. In my first chapter, “Narrating Insanity: Constructing the Madness Narrative in Charles Reade’s Hard Cash,” I assert that Reade’s 1863 novel proposes a nuanced understanding of the insanity diagnosis as a collaboratively-composed story that justifies the confinement of the patient. This story, which I call the madness narrative, is supported by the symbolic capital of the psychiatric establishment and operates under the authority of the asylum system. Reade’s novel suggests that the only way to resist the madness narrative is to create counternarratives supported by symbolic capital and offered outside the asylum system. In the second chapter, “Exposing the System: Richard Paternoster’s The Madhouse System as Early Exposé,” I claim that Paternoster’s 1841 publication features rhetorical techniques that allow him to reject assumptions about his objectivity, self-control, and sense of judgment, practices that would eventually become common in investigative journalism. Paternoster’s rhetorical approach foreshadows the rise of the undercover journalist later in the century and allows him to resist his confinement by rejecting his madness narrative and working to build an identity as an objective investigator. In “A Magazine of Their Own: Literary Periodicals of Victorian Asylums in Scotland,” the final chapter, I study two magazines, The New Moon (1844-1937) and The Gartnavel Gazette (1853-54), that were established by asylum patients. Created to benefit the patients and to support the reputations of the asylums, these periodicals align with moral management’s goal of providing patients with productive occupation. Patients use these creative spaces for identity reinforcement and reclamation. The opportunity for self-expression is occasionally problematic, for some of the contributions challenge the respectability of the sponsoring asylums, subverting the “civilizing” influence of moral management. In conclusion, Madness Narratives: Victorian Textual Responses to the Insanity Diagnosis reframes these texts within the context of the narrative nature of the insanity diagnosis and shows how the authors create counternarratives that reject or modify the implicit narratives about their sanity and humanity

Agency And Resistance Strategies Among Black Primary Care Patients

Research has identified marginalized and minority patients as displaying fewer participatory behaviors during the clinical interaction. Using a culture-centered framework, this study examines the process by which patients with a previous history of discrimination employed agency and resistance strategies in order to influence the outcome of their clinical interactions. This study conducted a secondary analysis of the video taped interactions of 25 black primary care patients in an urban low-income clinic. Using qualitative content analysis, I identified five emergent themes for patient agency: interrupting the physician, stating observations of care, expressing needs and desires, constructing identity, and agenda/goal management. Participants also used both active and passive forms of resistance tactics in an effort to influence the diagnosis and treatment plan, including questioning the diagnosis/treatment plan, proposing a new diagnosis/treatment plan, providing values and beliefs, questioning the physician’s competence and refusing to endorse the treatment plan. Results from this study indicate that black primary care patients with a history of previous discrimination displayed highly participatory behaviors during the clinical interaction, with displays of patient agency and, in some instances, patient resistance. Future research should examine the role of patient resistance as an attempt to negotiate within the interaction

Psychosocial Well-Being in Persons with Aphasia Participating in a Nursing Intervention after Stroke

This article can also be read here: http://www.hindawi.com/journals/nrp/2012/568242/The psychosocial adjustment process after stroke is complicated and protracted. The language is the most important tool for making sense of experiences and for human interplay, making persons with aphasia especially prone to psychosocial problems. Persons with aphasia are systematically excluded from research projects due to methodological challenges. This study explored how seven persons with aphasia experienced participating in a complex nursing intervention aimed at supporting the psychosocial adjustment process and promoting psychosocial well-being. The intervention was organized as an individual, dialogue-based collaboration process based upon ideas from “Guided self-determination.” The content addressed psychosocial issues as mood, social relationships, meaningful activities, identity, and body changes. Principles from “Supported conversation for adults with aphasia” were used to facilitate the conversations. The data were obtained by participant observation during the intervention, qualitative interviews 2 weeks, 6 months, and 12 months after the intervention and by standardized clinical instruments prior to the intervention and at 2 weeks and 12 months after the intervention. Assistance in narrating about themselves and their experiences with illness, psychological support and motivation to move on during the difficult adjustment process, and exchange of knowledge and information were experienced as beneficial and important by the participants in this study

Information Technology's Role in Global Healthcare Systems

Over the past few decades, modern information technology has made a significant impact on people’s daily lives worldwide. In the field of health care and prevention, there has been a progressing penetration of assistive health services such as personal health records, supporting apps for chronic diseases, or preventive cardiological monitoring. In 2020, the range of personal health services appeared to be almost unmanageable, accompanied by a multitude of different data formats and technical interfaces. The exchange of health-related data between different healthcare providers or platforms may therefore be difficult or even impossible. In addition, health professionals are increasingly confronted with medical data that were not acquired by themselves, but by an algorithmic “black box”. Even further, externally recorded data tend to be incompatible with the data models of classical healthcare information systems.From the individual’s perspective, digital services allow for the monitoring of their own health status. However, such services can also overwhelm their users, especially elderly people, with too many features or barely comprehensible information. It therefore seems highly relevant to examine whether such “always at hand” services exceed the digital literacy levels of average citizens.In this context, this reprint presents innovative, health-related applications or services emphasizing the role of user-centered information technology, with a special focus on one of the aforementioned aspects