Analysing audio-recorded data : using computer software applications

Conventional methods of qualitative data analysis require transcription of audio-recorded data prior to conduct of the coding and analysis process. In this paper Alison Hutchinson describes and illustrates an innovative method of data analysis that comprises the use of audio-editing software to save selected audio bytes from digital audio recordings of meetings. The use of a database to code and manage the linked audio files and generate detailed and summary reports, including reporting of code frequencies according to participant code and/or meeting, is also highlighted. The advantage of using this approach in the analysis of audio-recorded data is that the process may be undertaken in the medium in which the data were collected. Though time-consuming, this process negates the need for expensive and time intensive transcription of recorded data.<br /

An Exploration of the Gross National Happiness Approach to Assure Patient Safety and Healthcare Quality in Bhutan

Although the principles of Gross National Happiness (GNH) are currently being used as the overall framework for Bhutan’s development programs (including healthcare services), little is known about how Bhutanese healthcare professionals perceive the relationship between GNH and patient safety or how the GNH principles could help in improving patient safety in Bhutan’s healthcare system. The aim of this study was to explore how Bhutanese healthcare professionals, educators, managers, and policy makers perceive the relationship between GNH and patient safety and what they believe should be done to improve patient safety in Bhutan. A qualitative exploratory descriptive study using in-depth interviews was undertaken. All audio-recordings were transcribed verbatim and analyzed using content and thematic analysis strategies. Four major themes were identified: patient safety being important for GNH; incorporating the concept of GNH in healthcare; adopting the GNH values, whereby everyone believes that “someone’s happiness would be our happiness”; and educating healthcare professionals about GNH. Incorporation of the concept of GNH in healthcare could help transform the attitudes and behaviors of healthcare professionals toward patient care by producing a “Bhutanized” doctors and healthcare professionals and creating a Bhutanized healthcare system

Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review

&nbsp;BackgroundProvision of high quality transitional care is a challenge for health care providers in many western countries. This systematic review was conducted to (1) identify and synthesise research, using randomised control trial designs, on the quality of transitional care interventions compared with standard hospital discharge for older people with chronic illnesses, and (2) make recommendations for research and practice.MethodsEight databases were searched; CINAHL, Psychinfo, Medline, Proquest, Academic Search Complete, Masterfile Premier, SocIndex, Humanities and Social Sciences Collection, in addition to the Cochrane Collaboration, Joanna Briggs Institute and Google Scholar. Results were screened to identify peer reviewed journal articles reporting analysis of quality indicator outcomes in relation to a transitional care intervention involving discharge care in hospital and follow-up support in the home. Studies were limited to those published between January 1990 and May 2013. Study participants included people 60 years of age or older living in their own homes who were undergoing care transitions from hospital to home. Data relating to study characteristics and research findings were extracted from the included articles. Two reviewers independently assessed studies for risk of bias.ResultsTwelve articles met the inclusion criteria. Transitional care interventions reported in most studies reduced re-hospitalizations, with the exception of general practitioner and primary care nurse models. All 12 studies included outcome measures of re-hospitalization and length of stay indicating a quality focus on effectiveness, efficiency, and safety/risk. Patient satisfaction was assessed in six of the 12 studies and was mostly found to be high. Other outcomes reflecting person and family centred care were limited including those pertaining to the patient and carer experience, carer burden and support, and emotional support for older people and their carers. Limited outcome measures were reported reflecting timeliness, equity, efficiencies for community providers, and symptom management.ConclusionsGaps in the evidence base were apparent in the quality domains of timeliness, equity, efficiencies for community providers, effectiveness/symptom management, and domains of person and family centred care. Further research that involves the person and their family/caregiver in transitional care interventions is needed

Establishing cultural integrity in qualitative research: reflections from a cross-cultural study

This article contributes to the growing body of literature on the methods and techniques that might be used to help ensure the cultural integrity and rigor of research that has a cross-cultural dimension. Drawing upon our experiences while conducting a study investigating patient safety concerns in Bhutan, we will reflect on how the study was conceptualized and framed around the elements of the Bhutanese traditional cultural values; how the researchers were positioned; and how the intercultural perceptions, representations, languages, and attitudes influenced the fieldwork processes. It is anticipated that the approach described in this article will help qualitative researchers to understand how important it is to recognize and be responsive to the cultural and linguistic nuances of given research settings to achieve cultural integrity

Patient safety issues and concerns in Bhutan\u27s healthcare system: a qualitative exploratory descriptive study

OBJECTIVES: To investigate what healthcare professionals perceived and experienced as key patient safety concerns in Bhutan\u27s healthcare system. DESIGN: Qualitative exploratory descriptive inquiry. SETTINGS: Three different levels of hospitals, a training institute and the Ministry of Health, Bhutan. PARTICIPANTS: In total, 140 healthcare professionals and managers. METHODS: Narrative data were collected via conversational in-depth interviews and Nominal Group Meetings. All data were subsequently analysed using thematic analysis strategies. RESULTS: The data revealed that medication errors, healthcare-associated infections, diagnostic errors, surgical errors and postoperative complications, laboratory/blood testing errors, falls, patient identification and communication errors were perceived as common patient safety concerns. Human and system factors were identified as contributing to these concerns. Instituting clinical governance, developing and improving the physical infrastructure of hospitals, providing necessary human resources, ensuring staff receive patient safety education and promoting \u27good\u27 communication and information systems were, in turn, all identified as processes and strategies critical to improving patient safety in the Bhutanese healthcare system. CONCLUSION: Patient safety concerns described by participants in this study were commensurate with those identified in other low and middle-income countries. In order to redress these concerns, the findings of this study suggest that in the Bhutanese context patient safety needs to be conceptualised and prioritised

Implementation of an audit with feedback knowledge translation intervention to promote medication error reporting in health care: a protocol

Abstract Background Health professionals strive to deliver high-quality care in an inherently complex and error-prone environment. Underreporting of medical errors challenges attempts to understand causative factors and impedes efforts to implement preventive strategies. Audit with feedback is a knowledge translation strategy that has potential to modify health professionals’ medical error reporting behaviour. However, evidence regarding which aspects of this complex, multi-dimensional intervention work best is lacking. The aims of the Safe Medication Audit Reporting Translation (SMART) study are to: 1. Implement and refine a reporting mechanism to feed audit data on medication errors back to nurses 2. Test the feedback reporting mechanism to determine its utility and effect 3. Identify characteristics of organisational context associated with error reporting in response to feedback Methods/design A quasi-experimental design, incorporating two pairs of matched wards at an acute care hospital, is used. Randomisation occurs at the ward level; one ward from each pair is randomised to receive the intervention. A key stakeholder reference group informs the design and delivery of the feedback intervention. Nurses on the intervention wards receive the feedback intervention (feedback of analysed audit data) on a quarterly basis for 12 months. Data for the feedback intervention come from medication documentation point-prevalence audits and weekly reports on routinely collected medication error data. Weekly reports on these data are obtained for the control wards. A controlled interrupted time series analysis is used to evaluate the effect of the feedback intervention. Self-report data are also collected from nurses on all four wards at baseline and at completion of the intervention to elicit their perceptions of the work context. Additionally, following each feedback cycle, nurses on the intervention wards are invited to complete a survey to evaluate the feedback and to establish their intentions to change their reporting behaviour. To assess sustainability of the intervention, at 6 months following completion of the intervention a point-prevalence chart audit is undertaken and a report of routinely collected medication errors for the previous 6 months is obtained. This intervention will have wider application for delivery of feedback to promote behaviour change for other areas of preventable error and adverse events.http://deepblue.lib.umich.edu/bitstream/2027.42/111741/1/13012_2015_Article_260.pd

Cultural considerations at end of life in a geriatric inpatient rehabilitiation setting

Aim: To explore the impact of cultural factors on the provision of end-of-life care in a geriatric inpatient rehabilitation setting. Background: Australia’s ageing population is now also one of the most culturally diverse. Individuals from culturally and linguistically diverse backgrounds may have specific care needs at the end of life according to various aspects of their culture. Design: A mixed method approach using a retrospective audit of existing hospital databases, deceased patients’ medical records, and in-depth interviews with clinicians. Findings: Patients’ and families’ cultural needs were not always recognised or facilitated in end-of-life care, resulting in missed opportunities to tailor care to the individual’s needs. Clinicians identified a lack of awareness of cultural factors, and how these may influence end-of-life care needs. Clinicians expressed a desire for education opportunities to improve their understanding of how to provide patient-specific, culturally sensitive end-of-life care. Conclusion: The findings highlight that dying in geriatric inpatient rehabilitation settings remains problematic, particularly when issues of cultural diversity further compound end-of-life care provision. There is a need for recognition and acceptance of the potential sensitivities associated with cultural diversity and how it may influence patients’ and families’ needs at the end of life. Health service organisations should prioritise and make explicit the importance of early referral and utilisation of existing support services such as professional interpreters, specialist palliative care and pastoral care personnel in the provision of end-of-life care. Furthermore, health service organisations should consider reviewing end-of-life care policy documents, guidelines and care pathways to ensure there is an emphasis on respecting and honouring cultural diversity at end of life. If use of a dying care pathway for all dying patients was promoted, or possibly mandated, these issues would likely be addressed. © 2018 Published by Elsevier Ltd on behalf of Australian College of Nursing Ltd

Patient perceptions of deterioration and patient and family activated escalation systems-a qualitative study

Aims and objectivesTo investigate the experiences of patients who received a medical emergency team review following a period of clinical deterioration and their views about the potential use of a patient and family activated escalation system.BackgroundDelay or failure by health professionals to respond to clinical deterioration remains a patient safety concern. Patients may sometimes identify subtle cues of early deterioration prior to changes in vital signs. In response to health professional and system failures, patient and family activated escalation systems have been mandated and implemented in Australia. However, little research has evaluated their effectiveness nor taken patients&rsquo; perspectives into account.DesignQualitative exploratory descriptive design was used.MethodsPurposive sampling was used. Semistructured interviews were undertaken in 2014 with 33 patients who required medical emergency team intervention. Data were collected from one private and one public hospital in Melbourne, Victoria, Australia. The framework method was used to analyse the data.ResultsAll patients stated that it was the clinician who detected and responded to deterioration. Private patient participants were unaware of the medical emergency team system, and felt escalating care was not their responsibility. These patients reported being too sick to communicate prior to and during medical emergency team review and did not favour a patient and family activated escalation system. Public patients were well informed about the medical emergency team system yet expressed concerns around overriding clinicians if activating a patient and family activated escalation system.ConclusionPatient participation during a period of deterioration is restricted by their clinical condition and limited medical knowledge. Patients felt comfortable to communicate concerns to clinicians but felt they would not activate the patient and family activated escalation system. This behoves clinicians to actively listen and respond to patient concerns.<br /