O R I G I N A L P A P E R Cross-national diagnostic analysis of patient empowerment in England and Greece

Abstract Background: Different NHS patient empowerment policies have been adopted in England and Greece; the voluntary sector development and its influence also differ. Although various aspects of patient empowerment have been explored in England, the patient empowerment systems' application is under-researched. In Greece, the few relevant attempts looking at patients' experiences focus on patient satisfaction, with only one study exploring the public hospitals managers' perspectives on user involvement. However, patient empowerment questions may be similar in both countries. Aims and Objectives:The study aimed to explore and compare the general patient empowerment settings in the two countries, with main objectives to: a. identify and explore the relationships of national voluntary and governmental organisations, b. explore the cross-national challenges and facilitators, and make cross-national recommendations. Methodology:This is a cross-national comparative research study. A 'diagnostic analysis' approach, an assessment of potential and actual barriers and facilitators, including the context and potential change, was chosen. The methods used were:-a. a network analysis of national voluntary and governmental organisations; b. semi-structured interviews with key representatives of these, and c. documentary analysis. Results: The network analysis revealed the potential of English organisations to influence more people, with extensive memberships and stronger interrelationship between them than the Greek organisations. Different levels of awareness, knowledge and perceptions of application of the national patient empowerment policies, systems and mechanisms were identified; being generally good in England, limited in Greece. Variable general information provision, with good verbal information in England, and limited, written and verbal, information in Greece was also identified. Although the commonest cross-national perceived challenges were organisational, the Greek culture, professional systems and attitudes were also challenges in Greece. National relevant policies and professional attitudes in England, and integrated working in Greece were perceived facilitators. Changes in professional attitudes and cultures, information awareness / provision, and national drivers were common crossnational facilitators. Greek participants called for better function of patient empowerment systems within hospitals; while hearing the patients 'voice' and non-tokenism were highlighted in England. Conclusions: Notwithstanding its limitations, this analysis identified factors and complexities likely to influence patient empowerment change. The influence of the voluntary sector and well-developed policies in England was evident, while in Greece there was lack of knowledge and awareness. Nonetheless, it seems that the need for better non-tokenistic systems is cross-national

Health-related religious rituals of the Greek Orthodox Church : their uptake and meanings

AimTo examine the uptake of religious rituals of the Greek Orthodox Church by relatives of patients in critical condition in Greece and to explore their symbolic representations and spiritual meanings.BackgroundPatients and their relatives want to be treated with respect and be supported for their beliefs, practices, customs and rituals. However nurses may not be ready to meet the spiritual needs of relatives of patients, while the health-related religious beliefs, practices and rituals of the Greek Orthodox Christian denomination have not been explored.MethodThis study was part of a large study encompassing 19 interviews with 25 informants, relatives of patients in intensive care units of three large hospitals in Athens, Greece, between 2000 and 2005. In this paper data were derived from personal accounts of religious rituals given by six participants.ResultsRelatives used a series of religious rituals, namely blessed oil and holy water, use of relics of saints, holy icons, offering names for pleas and pilgrimage.ConclusionThrough the rituals, relatives experience a sense of connectedness with the divine and use the sacred powers to promote healing of their patients.Implications for nursing managementNurse managers should recognize, respect and facilitate the expression of spirituality through the practice of religious rituals by patients and their relatives.<br /

Cancer patients' information needs and information seeking behaviour : in depth interview study

Objectives: To explore why cancer patients do not want or seek information about their condition beyond that volunteered by their physicians at times during their illness. Design: Qualitative study based on in-depth interviews. Setting: Outpatient oncology clinics at a London cancer centre. Participants: 17 patients with cancer diagnosed in previous 6 months. Main outcome measures: Analysis of patients' narratives to identify key themes and categories. Results: While all patients wanted basic information on diagnosis and treatment, not all wanted further information at all stages of their illness. Three overarching attitudes to their management of cancer limited patients' desire for and subsequent efforts to obtain further information: faith, hope, and charity. Faith in their doctor's medical expertise precluded the need for patients to seek further information themselves. Hope was essential for patients to carry on with life as normal and could be maintained through silence and avoiding information, especially too detailed or "unsafe" information. Charity to fellow patients, especially those seen as more needy than themselves, was expressed in the recognition that scarce resources, including information and explanations, had to be shared and meant that limited information was accepted as inevitable. Conclusions: Cancer patients' attitudes to cancer and their strategies for coping with their illness can constrain their wish for information and their efforts to obtain it. In developing recommendations, the government's cancer information strategy should attend to variations in patients' desires for information and the reasons for them. <br/

Pan-London tuberculosis services: a service evaluation

<p>Abstract</p> <p>Background</p> <p>London has the largest proportion of tuberculosis (TB) cases of any western European capital, with almost half of new cases drug-resistant. Prevalence varies considerably between and within boroughs with research suggesting inadequate control of TB transmission in London. Economic pressures may exacerbate the already considerable challenges for service organisation and delivery within this context. This paper presents selected findings from an evaluation of London’s TB services’ organisation, delivery, professional workforce and skill mix, intended to support development of a strategic framework for a pan-London TB service. These may also interest health service professionals and managers in TB services in the UK, other European cities and countries and in services currently delivered by multiple providers operating independently.</p> <p>Methods</p> <p>Objectives were: 1) To establish how London’s TB services are structured and delivered in relation to leadership, management, organisation and delivery, coordination, staffing and support; 2) To identify tools/models for calculating skill mix as a basis for identifying skill mix requirements in delivering TB services across London; 3) To inform a strategic framework for the delivery of a pan-London TB service, which may be applicable to other European cities. The multi-method service audit evaluation comprised documentary analysis, semi-structured interviews with TB service users (n = 10), lead TB health professionals and managers (n = 13) representing London’s five sectors and focus groups with TB nurses (n = 8) and non-London network professionals (n = 2).</p> <p>Results</p> <p>Findings showed TB services to be mainly hospital-based, with fewer community-based services. Documentary analysis and professionals’ interviews suggested difficulties with early access to services, low suspicion index amongst some GPs and restricted referral routes. Interviews indicated lack of managed accommodation for difficult to treat patients, professional workforce shortages, a need for strategic leadership, nurse-led clinics and structured career paths for TB nurses and few social care/outreach workers to support patients with complex needs.</p> <p>Conclusions</p> <p>This paper has identified key issues relating to London’s TB services’ organisation, delivery, professional workforce and skill mix. The majority of these present challenges which need to be addressed as part of the future development of a strategic framework for a pan-London TB service. More consistent strategic planning/co-ordination and sharing of best practice is needed, together with a review of pan-London TB workforce development strategy, encompassing changing professional roles, skills development needs and patient pathways. These findings may be relevant with the development of TB services in other European cities.</p