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

Introducing a device to assist in the application of anti-embolism stockings

Using a device to help with the application and removal of anti-embolism stockings, often called thromboembolic deterrent stockings (TEDS), can potentially facilitate greater adherence to the use of stockings, and potentially reduce the risk of deep-vein thrombosis (DVT). This article describes a quality improvement project which used the Plan, Do, Study, Act (PDSA) cycle to facilitate the introduction of a device to aid in the application of thromboembolic deterrent stockings in an orthopaedic ward. The project findings showed that Neo-slip, a product designed to facilitate the use of compression stockings, can be effectively introduced into an orthopaedic ward, with positive feedback from both staff and patients

How does the length of day shift affect patient care on older people's wards? A mixed method study

Background: Internationally, studies have focused on whether shift length impacts on patient care. There are also ongoing concerns about patient care for older people in hospital. The study aim was to investigate how length of day shift affects patient care in older people’s hospital wards. Objectives: 1) To explore how length of day shift affects patient care in older people’s wards; 2) To explore how length of day shift affects the quality of communication between nursing staff and patients/families on older people’s wards Design: A mixed method case study. Settings: The study was based on two older people’s wards in an acute hospital in England. One ward was piloting two, overlapping 8 hour day shifts for 6 months while the other ward continued with 12 hour day shifts. Participants and Methods: Qualitative interviews were conducted with 22 purposively recruited nursing staff (17 registered nurses; 5 nursing assistants). An analysis of patient discharge survey data was conducted (n=279). Twenty hours of observation of nursing staff’s interactions with patients and families was conducted, using an adapted version of the Quality of Interaction Schedule (301 interactions observed), with open fieldnotes recorded, to contextualise the observations. Results: There were no statistically significant differences in patient survey results, or quality of interactions, between the two wards. There were three overall themes: Effects of day shift length on patient care; Effects of day shift length on continuity of care and relationships; Effects of day shift length on communication with patients and families. Nursing staff believed that tiredness could affect care and communication but had varied views about which shift pattern was most tiring. They considered continuity of care was important, especially for older people, but had mixed views about which shift pattern best promoted care continuity. The difficulties in staffing a ward with an 8 hour day shift pattern, in a hospital that had a 12 hour day shift pattern were highlighted. Other factors that could affect patient care were noted including: ward leadership, ward acuity, use of temporary staff and their characteristics, number of consecutive shifts, skillmix and staff experience. Conclusions There was no conclusive evidence that length of day shift affected patient care or nursing staff communication with patients and families. Nursing staff held varied views about the effects of day shift length on patient care. There were many other factors identified that could affect patient care in older people’s wards

The Experience of Older People in the Shared Decision-Making Process in Advanced Kidney Care

This qualitative descriptive study was designed to understand the experiences of older people (>70 years) when making a decision about renal replacement therapy. This was a coproduced study, whereby patients and carers were involved in all aspects of the research process. Methods. A Patient and Carer Group undertook volunteer and research training. The group developed the interview questions and interviewed 29 people who had commenced dialysis or made a decision not to have dialysis. Interview data were transcribed and analysed, and common themes were identified. Results. 22 men and 7 women (mean age 77.4 yrs) from two hospitals were interviewed. 18 had chosen haemodialysis, 6 peritoneal dialysis, and 5 supportive care. The majority of patients were involved in the dialysis decision. Most were satisfied with the amount of information that they received, although some identified that the quality of the information could be improved, especially how daily living can be affected by dialysis. Conclusion. Our findings show that overall older patients were involved in the dialysis decision along with their families. Our approach is innovative because it is the first time that patients and carers have been involved in a coproduced study about shared decision-making

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

Honest advocacy for nature: presenting a persuasive narrative for conservation.

Conservation scientists are increasingly recognising the value of communicating policy-relevant knowledge to policy-makers. Whilst considerable progress has been made in offering practical advice for scientists seeking to engage more closely with decision-makers, researchers have provided few tangible examples to learn from. This paper uses an English case study, but draws out important high-level messages relevant to conservation scientists worldwide. The case study looks at how the Lawton Review presented knowledge persuasively about the suitability of England's ecological network to deal with future pressures. Through skilful framing of rigorous scientific knowledge it was able to make a significant impact on government policy. Impact was achieved through: (1) selecting politically salient frames through which to communicate; (2) using clear, accessible language, and; (3) conducting rigorous science using an authoritative team of experts. Although its publication coincided with a favourable policy window, the Lawton Review seized on this opportunity to communicate a rigorously argued, persuasive and practical conservation message; in other words, it performed 'honest advocacy'. Thus, whilst it remains important to conduct scientific research with technical rigour, conservation scientists could also benefit from identifying salient frames for conservation and communicating clearly.This work is taken from a PhD project in the Department of Geography funded by ESRC (grant number ES/I901957/1) and Homerton College (Charter Scholarship). Thomas Pryke is studying for a PhD in the Department of Geography funded jointly by ESRC and NERC (No: ES/J500033/1).This is the final version of the article. It first appeared from Springer at http://dx.doi.org/10.1007/s10531-016-1163-1