Relationship-centred care in health: A 20-year scoping review

Relationship-centred care (RCC) is a framework for conceptualizing health care which recognizes that the nature and quality of relationships in health care influence the process and outcomes of health care. Our goal was to undertake a scoping review of the peer-reviewed and grey literature on RCC in health. Using Arksey and O’Malley’s scoping review methodology we identified literature about RCC in teaching, learning and clinical practice. Electronic databases were searched, and targeted searches were also conducted for grey literature to capture unpublished material. Subsequently, data abstraction tools were used with eligible studies for analysis. Sixty-nine publications originated mainly from the United States and the United Kingdom by authors from various academic disciplines, of which medicine and nursing were dominant. Thematic analysis revealed that the most commonly cited definition of RCC emerged from the Pew-Fetzer report and focused on the central role of relationships between practitioners and their patients, the community and other practitioners in providing quality care and improving outcomes. The concept of RCC was found to be influenced by theories of sociology, social psychology and psychiatry. The practice of RCC was demonstrated through organizational environments that model RCC, practice settings that focus on the patient or family in care planning, and health professional education that is based on RCC principles. RCC is important to: humanize health care and improve patient care. Our review identified three sub-categories that could add to the relational dimension of the practitioner-organization: practitioner–education, practitioner–profession, and practitioner–practice. Recommendations for future research include: outcome and process studies of health professions education and health care that focuses on RCC. The RCC approach provides a paradigm to move beyond the patient-centred care model by focusing on the central role of all relationships in the delivery and outcomes of care

The use of organizational assessments in improving patient and staff experiences in the ambulatory care setting

As the needs of patients evolve, healthcare organizations must diversify their approach to improving patient experience. Their programs should encompass the medical, mental, spiritual, and emotional needs of patients and their family members and the staff who care for patients. This case study examines the results of the evaluation to assess the effectiveness of organizational patient experience efforts. The Beryl Institute’s Experience Assessment was the evaluation tool administered and revealed the areas in which the organization was performing well and where improvements were needed. In collaboration with Ambulatory Care and Finance, the Office of Patient Experience targeted the Adult Primary Care and Orthopedic outpatient clinics for this assessment and followed-up with improvement projects to address the areas of opportunities identified. We administered the Extended DiSC® Assessment to the leaders in all departments that function within Ambulatory Care, to support the success of the improvement projects. The DiSC® assessment enables each leader to understand their communication style and gain an understanding of the ways they could improve communication with the leaders they collaborated with, who have different communication styles. Both assessments are geared towards self-examination and prodded the organization towards taking an honest look at how they functioned collectively and on an individual level and helped to clarify their perspective and reiterate their core values as a patient experience organization. The use of the Experience Assessment enabled an objective evaluation of the team’s readiness for patient experience improvements, in conjunction with the insights gleaned from the Extended DiSC® assessment. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Perfil sociodemográfico y psicopatológico de los menores acogidos en Valencia

Removing a child from the biological family is the best option in cases of abuse, neglect or mistreatment, but this resource can be a new stressor, because of its possibility to cause imbalances in different areas. The aim of this study is to value how this situation impacts the children. In order to achieve our aim, we have carefully analyzed children’s sociodemographic and psychopathological characteristics, especially anxiety, depression and social stress. The study involved 116 children from Valencia, aged between two weeks and 18 years old received by foster families. Results, structured into three age levels, show that the foster care, although emerges as a temporary and preventive measure with the aim to return to the biological family, becomes as permanent. In addition, the child does not stabilize in a family and many of them are moved to a care-residency. Tutors consider higher levels of pathology in children under 12 years old than parents. However, between 13 and 18, this trend is reversed and the parents are who report higher levels of pathology, for both depression and anxiety.La separación de un menor de su familia biológica es la mejor opción en casos de abuso, negligencia o maltrato pero este recurso puede suponer en sí mismo un nuevo estresor capaz de provocar desajustes en diferentes áreas. El objetivo de este estudio es ver cómo afecta esta situación a los menores para lo cual hemos analizado detalladamente sus características sociodemográficas y psicopatológicas especialmente la ansiedad, depresión y estrés social. En el estudio han participado 116 menores de Valencia de edades comprendidas entre dos semanas y 18 años acogidos por familias educadoras. Los resultados, estructurados en tres niveles de edad, muestran que el acogimiento, aunque surge como una medida preventiva y temporal cuyo fin es el retorno con la familia biológica, se acaba cronificando. Además, el menor no se estabiliza en una familia, sino que se producen ceses y muchos pasan por residencias. Los tutores consideran niveles más altos de patología en los menores de 12 años que los padres. Sin embargo, entre los de 13 a 18, esta tendencia se invierte y son los padres los que reportan niveles más altos de patología, tanto para la depresión como para la ansiedad

Serum inflammatory markers as predictors of neurological status in patients with stroke in the course of hypertension: a two-center study

Introduction. Every year, 60.000 people have stroke incidents in Poland. Despite the fact that it can be prevented, stroke remains the leading cause of morbidity and mortality worldwide. Hypertension is one of the leading risk factors for the stroke incident. The aim was to assess the relationship between inflammatory markers and clinical status of hypertensive patients with the stroke. Material and methods. 713 patients with stroke in the course of hypertension from the Departments of Neurology in Bytom and Zabrze were enrolled in the retrospective study. They were divided into groups: N1, R1 (with improvement in NIHSS and Rankin results, respectively) and N2, R2 (with deterioration or no changes in NIHSS and Rankin between the day of admission and discharge). Results. The majority of patients were females [%] (51.5 vs 48.5). Women were significantly older than man [years] (78.0 vs 69.0, P = 0.001, respectively) and had higher NIHSS results at admission [points] (6.0 vs 5.0, P = 0.001, respectively). There were significant differences in the serum CRP [mg/l] (4.75 vs 9.40, P = 0.001) and WBC [103/μL] (8.58 vs 9.02, P = 0.006) between N1 and N2, respectively and between R1 and R2: WBC (8.50 vs 9.00, P = 0.006) and CRP (4.20 vs 8.70, P = 0.001), respectively. A significant correlation between CRP and NIHSS on admission was observed (R = 0.191, P < 0.05). NIHSS and Rankin score on admission were correlated with age (R = 0.212, and R = 0.231, P < 0.05, respectively). CRP was related with the volume [cm3] of lesions in CT (R = 0.170, P < 0.05). Conclusions. Inflammation seems to be associated with the worse neurological status of patients with stroke and hypertension. Age and sex affect the clinical course of stroke. CRP may indicate the size of changes in CT

Concentration- and time-dependent effects of isothiocyanates produced from Brassicaceae shoot tissues on the pea root rot pathogen Aphanomyces euteiches

Isothiocyanates (ITCs) hydrolyzed from glocosinolates (GSLs) in Brassicaceae tissue are toxic to soil organisms. In this study, the effect of aliphatic and aromatic ITCs from hydrated dy Brassicaceae shoot tissues on the mycelium and oospores of the pea root rot pathogen Aphanomyces euteiches was investigated. The profile and concentrations of GSLs in two test Brassicaceae species, Sinapis alba and Brassica juncea, and the ITCs from the dominant hydrolyzed parent GSLs were monitored. The concentrations of dominant ITCs and pathogen exposure time were evaluated in in vitro experiments. The greatest effect on the pathogen was observed from aliphatic ITCs hydrolyzed from B. juncea tissue, and the effect depended on the ITS concentration and exopsure time. ITCs were more effectively hydrolyzed from B. juncea GSLs than from S. alba GSLs; i.e., the ITC/GSL ratio was higher in B. juncea than in S. albatissue, giving a different release pattern. The release of phenylethyl isothiocyanate, which was common to both species, followed a pattern similar to that of the dominant ITC in each crop speices. This suggests that trait other than GSL content, e.g., plant cell structure, may affect the release of ITCs ans should therefore influence the choice of speices used for biofumigation purposes

Virtual Community Health Workers: Outreach Calls During COVID-19

The “Clinical Experience” program at the Sidney Kimmel Medical College, established in 2017, provides pre-clerkship students with an opportunity to identify and address patients’ needs for social determinants of health (SDoH). The COVID-19 pandemic led to a suspension of the student program in the clinical environment, but the CHWs continued to address patients’ social needs from a remote setting. In the absence of established best practices regarding patient outreach calls from a remote setting, we sought to develop an effective workflow that would mask the CHWs’ personal cell phones while leading to fewer “unable to reach” scenarios and improved case resolution rates