Health professionals' and patients' perceptions of patient-centered care : a comparison

Rationale, aims and objectives: This study aimed to compare health professionals’ and patients’ perceptions of patient-centered care (PCC) practice. Methods: PCC was operationalized into three components: (i) holistic, (ii) collaborative and (iii) responsive care. In a cross-sectional design, a sample of 401 health professionals and 500 patients in acute care settings in Ontario, Canada completed a valid and reliable measure of PCC. Results: The results showed that patients had lower ratings of PCC than health professionals, indicating that patients viewed their care as holistic, collaborative and responsive to a low-moderate extent; this contrasted with a more positive view by health professionals, suggesting a high level of PCC enactment (all p’s 0.05; effect sizes range: 0.38 to 0.88). Discussion and Conclusion: Although methodological, clinical and contextual factors have been suggested, additional research is needed to further explore the mechanisms underlying these differences. Collaboration among management, professionals and patients would promote a collective development of guidelines to deliver PCC

Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice

Background Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management. Methods A mixed-methods case study design was used. The case was a surgical unit in a pediatric academic-affiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion. Results Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up. Conclusions Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study

Nurse practitioner interactions in acute and long-term care : an exploration of the role of knotworking in supporting interprofessional collaboration

BACKGROUND: Interprofessional care ensures high quality healthcare. Effective interprofessional collaboration is required to enable interprofessional care, although within the acute care hospital setting interprofessional collaboration is considered suboptimal. The integration of nurse practitioner roles into the acute and long-term care settings is influencing enhanced care. What remains unknown is how the nurse practitioner role enacts interprofessional collaboration or enables interprofessional care to promote high quality care. The study aim was to understand how nurse practitioners employed in acute and long-term care settings enable interprofessional collaboration and care. METHOD: Nurse practitioner interactions with other healthcare professionals were observed throughout the work day. These interactions were explored within the context of "knotworking" to create an understanding of their social practices and processes supporting interprofessional collaboration. Healthcare professionals who worked with nurse practitioners were invited to share their perceptions of valued role attributes and impacts. RESULTS: Twenty-four nurse practitioners employed at six hospitals participated. 384 hours of observation provided 1,284 observed interactions for analysis. Two types of observed interactions are comparable to knotworking. Rapid interactions resemble the traditional knotworking described in earlier studies, while brief interactions are a new form of knotworking with enhanced qualities that more consistently result in interprofessional care. Nurse practitioners were the most common initiators of brief interactions. CONCLUSIONS: Brief interactions reveal new qualities of knotworking with more consistent interprofessional care results. A general process used by nurse practitioners, where they practice a combination of both traditional (rapid) knotworking and brief knotworking to enable interprofessional care within acute and long-term care settings, is revealed

Empirical testing of a conceptual model to evaluate psychoeducational interventions.

Psychoeducational interventions are designed to assist clients to learn about their condition, to enhance their self-care practices, to promote well-being and prevent complications and to ultimately maintain or improve their life quality. Although results of individual and of meta-analytic studies supported the beneficial effects of psychoeducational interventions on multiple health-related outcomes for various client population, investigators expressed concerns regarding the quality of single-study reports. The most important criticism is the lack of explicit reference to a theoretical model guiding the design of the study, the selection of expected outcomes of the interventions, and lack of explicitly stated causal linkages between interventions and outcomes. In this research project, a comprehensive framework was developed and empirically tested as a model for evaluating the effectiveness of psychoeducational interventions, namely self-help classes, uncertainty management, and a combined intervention. Direct and moderating effects of extraneous variables (personal characteristics, severity of illness and resources), intervening variable (state anxiety) and intervention variables (components of psychoeducation and strength of intervention) on outcome variables (cognitive, behavioral, psychological and quality of life) were hypothesized. An experimental repeated measures design was used to test the hypothesized effects. Fifty-six women with breast cancer receiving adjuvant therapy were randomly assigned to one of the experimental groups. Data were collected at six points in time. Hierarchical linear modeling approach was used to analyze the data. Results indicated that although the interventions were effective in producing desired changes in selected outcomes, their effects were moderated by various extraneous and intervening variables. Education, sense of mastery, symptom extension, work status, size and use of social support strengthened the effects of the interventions, while trait anxiety, marital status, and number of symptoms experienced weakened the effects of the interventions on cognitive, behavioral, and psychological outcomes. Based on these findings, clinicians are encouraged to attend to the mode of delivery, intensity, and timing for implementation of the intervention, and to the characteristics of the intervener and clients, when planning, implementing, and evaluating psychoeducational interventions

Effects of sedative music on the respiratory status of clients with chronic obstructive airways diseases

A quasi-experimental, pre-test post-test study was conducted to examine the effects of sedative music on the perception of dyspnea intensity, respiratory rate, pulse rate and oxyhemoglobin saturation level of clients with Chronic Obstructive Airway Disease (COAD). Data was collected on a convenience sample of 10 subjects who acted as their own control. After a six minutes walk, each subject was randomly exposed to a treatment (listening to music for 20 minutes) and to a control (resting for 20 minutes) situation. A series of paired t-tests was performed to analyze the data. Results indicated that the mean pulse rate and mean respiratory rate were significantly lower after listening to music than after resting only. Correlational analysis indicated that the perceived intensity of dyspnea is positively correlated with pulse and respiratory rates, and negatively correlated with oxygen saturation level. Encouraging clients with COAD to listen to music is a supplemental nursing intervention aiming at reducing dyspnea perception, pulse and respiratory rates

The Role of Treatment Perceptions in Intervention Evaluation: A Review

Introduction: With the emphasis on patient-centeredness, the interest in examining people’s perceptions of health interventions has resurged. Mounting evidence suggests that people’s perceptions play an important role in their pursuit and use of interventions in the practice and research contexts. In research, participants’ perceptions of the treatments under evaluation affect their behaviors reflected in enrollment, attrition, and treatment implementation (i.e., engagement and enactment by participants), all of which contribute to outcomes. Objectives: The objectives of this review are to generate a common understanding of treatment perceptions and to increase awareness of their role in intervention evaluation trials. Method: A literature review was conducted of conceptual and empirical articles that examined the contribution of participants’ perceptions of treatment to enrollment, attrition, as well as treatment implementation and outcome achievement in intervention evaluation studies. Results: In this paper, we clarify the conceptualization and operationalization of four types of perceptions: acceptability, preferences, credibility and expectancy. We also describe the way in which these perceptions influence participants’ behaviors (i.e., mechanism of action), and we summarize relevant empirical evidence. Implications and conclusion: Researchers are encouraged to account for participants’ perceptions in making inferences about interventions’ effectiveness or lack thereof.Introduction : Dans un contexte où l’accent est mis sur les soins centrés sur le patient, l’intérêt d’examiner les perceptions des personnes à l’égard des interventions de santé a refait surface. De plus en plus de preuves suggèrent que les perceptions des personnes jouent un rôle important pour s’engager dans l’intervention à la fois dans les contextes cliniques et de la recherche. En recherche, les perceptions qu’ont les participants des interventions évaluées affectent leurs comportements. Cela se reflète dans le recrutement, l’attrition, l’implantation et l’engagement dans l’intervention, lesquels contribuent aux résultats de la recherche. Objectifs : Les objectifs de cette revue sont de générer une compréhension commune des perceptions des interventions et d’accroître la sensibilisation quant à leur rôle dans les recherches évaluant des interventions. Méthode : Une revue de la littérature a été réalisée. Des articles conceptuels et empiriques examinant l’influence des perceptions des participants sur le recrutement, l’attrition, l’implantation et l’engagement dans l’intervention, ainsi que sur l’atteinte des résultats dans les études d’évaluation des interventions ont été synthétisés. Résultats : Dans cet article, nous clarifions la conceptualisation et l’opérationnalisation des quatre types de perceptions : l’acceptabilité, les préférences, la crédibilité et la perception de l’efficacité du traitement. Nous décrivons aussi la manière dont ces perceptions influencent les comportements des participants (c.-à-d. le mécanisme d’action) et résumons les preuves empiriques pertinentes. Implications et conclusion : Les chercheurs sont encouragés à prendre en considération les perceptions des participants en tirant des conclusions sur l’efficacité ou le manque d’efficacité des interventions