Patient-based mobile alerting systems- requirements and expectations

Patients with chronic conditions are not well supported by technical systems in managing their conditions. However, such systems could help patients to self-reliantly comply with their treatment. This help could be rendered in the form of alerting patients about condition-relevant issues, transmitting relevant parameters to healthcare providers and analysing these parameters according to guidelines specified by both patients and healthcare staff. If necessary, this analysis of condition parameters triggers the alerting of patients and healthcare providers about actions to be taken. In this paper, we present the results of a survey we have undertaken to verify and extend requirements we have identified for the design of a Mobile Alerting System for patients with chronic conditions. First of all, the results show that a Mobile Alerting System is desired by patients. Moreover, due to the inter- and intra-user variance of patients and healthcare staff, the system has to work in a context-aware manner and allow for personalised parameters in order to be adaptable to every user’s needs

A Grounded Theory Study to Understand Nurse and Resident Physician Communication Dynamics

Communication between nurses and physicians frequently occurs in the delivery of care to patients in the acute healthcare setting. In an environment where a person's life and well-being depends upon accurate communication, it becomes an essential component of care delivery and care coordination among health professionals. Investigations of how physician-nurse relationships contribute to the physician's value of nursing and nursing communication do not exist. The purpose of this study is to uncover how nurses and resident physicians relate as members of the healthcare team and how nursing communication is valued. This study followed Constructivist Grounded Theory to develop a substantive theory that explains how relationships influence nurse and resident physician communication. Interviews were conducted with 15 internal medicine resident physicians at an academic medical center in a southeastern state. The overarching theme for this study was getting things done, which was comprised of three theoretical categories: shifting communication, accessing nurse's knowledge, and determining the team. The relationship between these theoretical categories create a context for understanding how communication between nurses and resident physicians influences teamwork and health care delivery. For resident physicians in this study the relationship with nurses is built on a basic foundation of getting work done. Nurses are not perceived as having discipline specific knowledge that contributes to patient care planning. Rounding patterns illustrate how the nurse is prevented from contributing unique knowledge to the plan of care for patients. The patriarchy that has traditionally influenced the relationship between nurses and resident physician continues to exist today. Further, resident physicians are unaware of the scope of nursing practice and see the nurse as a source for data and executor of prescribed orders. The findings from this study will inform how interprofessional education and practice must focus on relationships that are built on acknowledging the uniqueness of each individual on the patient care team

Prescribing in teaching hospitals:exploring social and cultural influences on practices and prescriber training

Medicines are a fundamental healthcare intervention, but the benefits they provide depend entirely on the way in which they are used. This begins with prescribing, a complex task with substantial risks. Systematic evaluation of biomedical factors may be viewed as an essential component of this task, but prescribers also integrate an array of individual, social, cultural, environmental and commercial factors into their prescribing decisions. Furthermore, social and cultural characteristics of the prescriber’s workplace may influence how well prescribing decisions are carried out. Whilst numerous research efforts have helped to construct an in-depth understanding of non-biomedical influences on GP’s prescribing patterns, the characteristics of corresponding sorts of influences in teaching hospitals have not been well determined. In hospitals, supervised medical trainees, registrars and consultants prescribe within the framework of medicines management systems involving nurses, pharmacists and patients. Currently, little is known about whether each of these groups has distinct beliefs, attitudes and values that may affect either prescribing behaviour or how prescribing skills of medical trainees are acquired. The aim of this study was to explore the social and cultural dynamics of prescribing and prescriber training in teaching hospitals. To do this, established qualitative methods were employed. Junior doctors, registrars, consultants, nurses, and pharmacists from two metropolitan teaching hospitals were sampled purposively and invited to participate in semi-structured interviews. A brief questionnaire was used to collect demographic and contextual information. In the interviews, participants were asked about their attitudes towards prescribing, their perceptions of roles and responsibilities, how they communicated prescribing decisions, their perceptions of influences on prescribing, and their perceptions of factors contributing to prescribing errors. Participants were also asked for their opinions on various aspects of new prescriber training. Sampling proceeded until redundancy of themes was established. A pilot study was conducted with one participant from each professional group to optimise the interview schedule, and then using this tool, a further 38 participants were interviewed. In total, eight consultants, eight registrars, nine junior doctors, eleven pharmacists, and seven nurses participated. Using reiterative content analysis of a third of all transcripts, a coding scheme was developed, which was used to label and categorise the remaining transcripts. Categories were further developed and refined. The resultant core themes were cross indexed against the five different health professional types using thematic charts to explore patterns. The main lines of enquiry for this research were mapped, the properties of these categories and interrelationships explored in detail, and a model of the prescribing process was developed. Prescribing at the teaching hospitals was a complex process consisting of multiple steps undertaken by several different health professionals of varying levels of experience from three different health care disciplines. Because of the intricate separation of responsibilities, the operation of the process was highly reliant on the behaviours of each player and their relationships with each other. Key prescribing decisions associated with patient admissions were made, almost exclusively, by medical teams. Prescribing was therefore chiefly characterised by factors influencing the behaviours of the doctors. Their behaviours were influenced by factors relating to their individual characteristics (eg, knowledge, skills, experience); but also by a web of socio-cultural determinants inherent to the environment in which they worked. These factors were related to: the organisational structure of the prescribing process; the knowledge characteristics of the doctors; the communication patterns they used; the underlying assumptions they made about prescribing; and the work environment

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

January 2007

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