Nurse practitioner consultations in primary health care: an observational interaction analysis of social interactions and consultation outcomes

To determine the discrete nature of social interactions occurring in nurse practitioner consultations and investigate the relationship between consultation social interaction styles (biomedical and patient-centred) and the outcomes of patient satisfaction, patient enablement, and consultation time lengths. A case study-based observational interaction analysis of verbal social interactions, arising from 30 primary health care nurse practitioner consultations, linked with questionnaire measures of patient satisfaction and enablement. A significant majority of observed social interactions used patient-centred communication styles (P=0.005), with neither nurse practitioners nor patients or carers being significantly more verbally dominant. Nurse practitioners guided the sequence of consultation interaction sequences, but patients actively participated through interactions such as asking questions. Usage of either patient-centred or biomedical interaction styles were not significantly associated with increased levels of patient satisfaction or patient enablement. The median consultation time length of 10.1 min (quartiles 8.2, 13.7) was not significantly extended by high levels of patient-centred interactions being used in the observed consultations. High usage levels of patient-centred interaction styles are not necessarily contingent upon having longer consultation times available, and clinicians can encourage patients to use participatory interactions, whilst still then retaining overall guidance of the phased sequences of consultations, and not concurrently extending consultation time lengths. This study adds to the body of nurse practitioner consultation communication research by providing a more detailed understanding of the nature of social interactions occurring in nurse practitioner consultations, linked to the outcomes of patient satisfaction and enablement

Nurse practitioner consultations in primary health care: a case study-based survey of patients' pre-consultation expectations, and post-consultation satisfaction and enablement.

Research has not yet fully investigated links to consultation duration, patient expectations, satisfaction, and enablement in nurse practitioner consultations. This study was developed to address some of these research gaps in nurse practitioner consultations, particularly with a focus on expectations, satisfaction, and enablement.AimTo explore the influence of pre-consultation expectations, and consultation time length durations on patient satisfaction and enablement in nurse practitioner consultations in primary health care. Survey component of a larger convergent parallel mixed methods case study designed to conjointly investigate the communication processes, social interactions, and measured outcomes of nurse practitioner consultations. The survey element of the case study focusses on investigating patients' pre-consultation expectations and post-consultation patient satisfaction and enablement. A questionnaire measuring pre-consultation expectations, and post-consultation satisfaction and enablement, completed by a convenience sample of 71 adults consulting with nurse practitioners at a general practice clinic. Initial fieldwork took place in September 2011 to November 2012, with subsequent follow-up fieldwork in October 2016. Respondents were highly satisfied with their consultations and expressed significantly higher levels of enablement than have been seen in previous studies of enablement with other types of clinicians (P=0.003). A significant, small to moderate, positive correlation of 0.427 (P=0.005) between general satisfaction and enablement was noted. No significant correlation was seen between consultation time lengths and satisfaction or enablement

Structured nursing educational programs improve quality of life outcomes in patients with Cushing's syndrome

Impaired quality of life (QoL) has been reported in patients with Cushing’s syndrome even after biochemical cure, with worse QoL outcomes compared to patients with other pituitary adenomas [1]. A variety of physical, neuropsychosomatic, psychological, and sociodemographic factors have been found to influence QoL parameters in patients with Cushing’s syndrome [1, 2]. A systematic review by Andela et al. found that QoL outcomes such as physical functioning, bodily pain, and general health improved after surgical or pharmaceutical interventions in 6 of the 8 studies involving patients with Cushing’s syndrome

Personal information documents for people with dementia: healthcare staff’s perceptions and experiences

Person-centred care is internationally recognised as best practice for the care of people with dementia. Personal information documents for people with dementia are proposed as a way to support person-centred care in healthcare settings. However, there is little research about how they are used in practice. The aim of this study was to analyse healthcare staff’s perceptions and experiences of using personal information documents, mainly Alzheimer’s Society’s ‘This is me’, for people with dementia in healthcare settings. The method comprised a secondary thematic analysis of data from a qualitative study, of how a dementia awareness initiative affected care for people with dementia in one healthcare organisation. The data were collected through 12 focus groups (n=58 participants) and 1 individual interview, conducted with a range of healthcare staff, both clinical and non-clinical. There are four themes presented: Understanding the rationale for personal information documents; Completing personal information documents; Location for personal information documents and transfer between settings; Impact of personal information documents in practice. The findings illuminated how healthcare staff use personal information documents in practice in ways that support person-centred care. Practical issues about the use of personal information documents were revealed and these may affect the optimal use of the documents in practice. The study indicated the need to complete personal information documents at an early stage following diagnosis of dementia, and the importance of embedding their use across care settings, to support communication and integrated car

An Anti-C1s Monoclonal, TNT003, Inhibits Complement Activation Induced by Antibodies Against HLA.

Antibody-mediated rejection (AMR) of solid organ transplants (SOT) is characterized by damage triggered by donor-specific antibodies (DSA) binding donor Class I and II HLA (HLA-I and HLA-II) expressed on endothelial cells. While F(ab')2 portions of DSA cause cellular activation and proliferation, Fc regions activate the classical complement cascade, resulting in complement deposition and leukocyte recruitment, both hallmark features of AMR. We characterized the ability of an anti-C1s monoclonal antibody, TNT003, to inhibit HLA antibody (HLA-Ab)-induced complement activation. Complement deposition induced by HLA-Ab was evaluated using novel cell- and bead-based assays. Human aortic endothelial cells (HAEC) were cultured with HLA-Ab and human complement; production of activated complement proteins was measured by flow cytometry. Additionally, C3d deposition was measured on single antigen beads (SAB) mixed with HLA-Ab and human complement. TNT003 inhibited HLA-Ab mediated complement deposition on HAEC in a concentration-dependent manner; C3a, C4a and C5a anaphylatoxin production was also diminished by TNT003. Finally, TNT003 blocked C3d deposition induced by Class I (HLAI-Ab)- and Class II (HLAII-Ab)-specific antibodies on SAB. These data suggest TNT003 may be useful for modulating the effects of DSA, as TNT003 inhibits complement deposition and split product formation generated by HLA-I/II-Ab in vitro

Educating a health service workforce about dementia: a qualitative study

Purpose People who are living with dementia are core health service users but there are ongoing concerns about the quality of their care and the need for improved education of healthcare staff. This paper reports on a qualitative study that investigated staff perspectives of an ethnodrama (‘Barbara’s Story’) which was used to educate an entire health service workforce and promote a person-centred approach to care. Design/Methodology/Approach The study used a qualitative, longitudinal design with focus groups held with clinical (nurses, allied health professionals, medical) and non-clinical staff. In Phase 1 there were 10 focus groups (n=67 participants) and one individual interview. In Phase 2 there were 16 focus groups (n=77 participants) and three individual interviews. Findings Barbara’s Story raised awareness of dementia, engaged staff emotionally and prompted empathetic responses and improved interactions. The project’s senior leadership, whole organisation and mandatory approach were well-supported, with a perceived impact on organisational culture. The project helped to embed practice developments and initiatives to support person-centred care. Barbara’s story is now well integrated into the organisation, thus supporting sustainability. Originality/value Whilst there are increasing resources for educating about dementia, there are fewer evaluations, particularly for large-scale initiatives, and there is a lack of focus on long-term effects. The study findings indicate that education about dementia can be delivered to a whole work force in a sustainable manner, to prompt empathy, raise awareness, support person-centred care and impact on individual behaviour and organisational culture