The Empathic Patient Centered Approach in the Anesthetic Preoperative Interview

Background: Multiple studies in the primary care field have indicated the benefits of using a patient centered approach in communication with the patient;such interviewing methods have been shown to improve patient satisfaction and adherence. There is a scarcity of anesthetic literature regarding communication skills in the perioperative period. The goal is to analyze to what extent empathic patient-centered communication methods are being used by anesthesia providers. Communication scores will be compared among providers, as well as to providers across several different subspecialties. Methods: This study is an observational descriptive study at a large tertiary care center, University Hospital in Newark, NJ. The observer observes and grades patient interviews, scoring against established criteria using an adapted version of the Kalamazoo grading tool. The researcher observes and grades the preoperative interview using the adapted Kalamazoo scale. At the end of the observed encounter, the anesthesia providers are asked to fill out a brief form detailing their demographic history, details regarding the providers’ length and type of clinical education and training, undergraduate education, previous communication training, number of years of practice, primary language, gender, and age will be obtained. Results: Anesthesia providers included in the study were physician anesthesiologists, residents, and nurse anesthetists. The average Kalamazoo score was 28.7 amongst all providers. There was no significant effect of provider level on the score at the p Conclusions: The data revealed anesthesia providers provide patient-centered encounters with a mean score of 28.7, which is higher than the average for providers from multiple different specialties observed in Joyce, et al. study (mean score of 25.25). The subcategories “Understanding patient’s perspective” and “reaches agreement” scored 3.86, and 3.83, respectively. This may indicate that anesthesia providers can improve on allowing the patient to communicate their understanding of anesthesia, as well as collecting information from the patient that can affect their anesthesia (i.e., severe nausea following previous anesthesia).

Challenges for Nurses in Providing Patient-Centered Care in Rural Primary Health Care Clinics in Nigeria

Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in Primary Health Care (PHC), and have recently gained prominence in nursing practice and applied nursing research. However, nurses are faced with challenges in achieving the desired results in the PHC system. Thus, the study aimed to explore the factors that influence PCC utilization in the PHC facilities in Nigeria. A qualitative exploratory-descriptive design was used for this study. Data collection was conducted with the nurses from PHC facilities through individual interviews. Data saturation was achieved with 35 participants from 30 PHC facilities in Osun State, Nigeria, using a purposive sampling technique. All interviews were audio-recorded, later transcribed verbatim, and analyzed using the thematic analysis approach. NVivo 12 software was used for data management. The results from this study were categorized into two factors: Organizational factors and individual factors. Six themes that emerged from the study include inadequate management support, insufficient opportunities for further training, work overload and time constraints, health personnel readiness to use PCC, dearth enthusiasm for change, and poor nurses’ Accountability. The study shows that nurses encountered diverse challenges in providing patient-centered care. To improve the quality of healthcare delivery in the PHC facilities, there is a need to reinforce adequate management support, education, continued training, and the internal motivation of nurses to achieve transformative health outcomes in the community.

Factors Influencing Patient-Centered Care in the Primary Health Care Settings: The Impact of the Pandemic Crisis and Nurses’ Experience

Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthcare and services to the patient is the nurses’ ability to create a friendly rapport with the patients. Yet, the majority in the rural Primary Health Care facilities are still facing many challenges in demonstrating patient-centeredness services to the community. Thus, the objective of this study is to explore and describe the factors influencing patient-centered care provision and nurses’ experience in Primary Health Care facilities. An exploratory qualitative approach with purposive sampling was used to gather data. Individual interviews with 35 nurses were conducted using a semi-structure interview guide question in the Primary Health Care settings in Nigeria. Each of the interviews with the nurses lasted for 25 minutes to one hour. All interviews were audio-taped, and transcribed verbatim using Microsoft Word. The transcripts were read and re-read, coded using NVivo version 12 software to organize the relevant information and categorized them into themes and sub-themes. Thematic analysis guided this study. The findings revealed three themes and sub-themes. The impact of environmental factors with two subthemes—suitable working environment and coordinated care;resources—shortage of staff and inadequate resources as sub-themes, and lastly, cultural sensitivity and religious influence—communication. Poor implementation of PCC strategies in most of the PHC facilities could lead to poor patient care and a lack of job satisfaction among nurses. This study identified that nurses have both negative and positive experience in providing patient-centered care health services. Providing patient-centered care in the Primary Health Care setting promotes the goal of achieving universal health coverage in Nigeria if the government would prioritize nurses’ pay, employ more staff, provide a conducive working environment, and opportunities for further training programs for nurses to enable and empower them with the necessary knowledge and skills. This, in turn, will translate into a range of outcomes that are socially valued, such as health responsiveness, health coverage and fairness.

Analysis on influencing factors of patients experience in community health centers of Shenzhen,China

Objective To investigate the patients experience in community health centers( CHCs) and explore its associated factors. Methods A cross-sectional study was conducted among 330 patients who visited CHCs in Shenzhen,China from January to March 2018. Dependent variable was patient experience. Key descriptive variables were age,gender,marital status,working status groups,visits frequency for the past 6 months,whether patients had signed a family doctor,whether trusted in family doctor,whether had chronic diseases. Results Questionnaires for 300 patients were assessed. In the univariate analysis,patients experience total score was significantly associated with marital status( P < 0. 1),working status groups( P < 0. 1),frequency of visit for the past 6 months( P < 0. 05),whether had signed a family doctor( P < 0. 05),whether trusted in family doctor( P < 0. 05),whether had chronic diseases( P < 0. 05). The multivariate analysis showed that unmarried patients( P = 0. 011,OR = 2. 96,95% CI: 1. 24-5. 43) and had signed a family doctor( P = 0. 023,OR = 0. 44,95% CI: 0. 22-0. 85) were more likely to get a higher score. Conclusions Findings of this study showed a medium-level score of patients experience in the community. Patients had a quite good experience and more interventions should be focused upon the influence factors to improve patients experience.

Clinical Communication, Cancer Patients &Considerations to Minimize the Challenges

Clinical communication is a multidimensional concept, which encompasses the core of effective clinical practice. Communication in cancer patients is particularly challenging and yet a less focused area in cancer care. Various barriers and challenges in communication may affect the management protocol of cancer patients. Challenges may arise in various dimensions of cancer care including breaking bad news to delivery of complex clinical information, determination of appropriate treatment strategies, dealing with uncertainties, end of life counseling as well as cultural and language barriers affecting the whole communication dynamics. Effective communication is the basic foundation for responsive treatment decisions, positive health outcome, patient driven compliance and overall high quality of care. Thus, there is a need for acknowledging and actively deciphering the challenges and developing and promoting various protocols of effective communication skills in cancer patients.

Patient Experience during Hospital Stay: A Pilot Survey

Introduction: Hospital inpatient care is provided to individuals who have a condition that requires them to stay in hospital. Patient experience is an important aspect of high-quality patient-centered care. Aim: With this pilot survey we aimed to obtain patient feedback on their experiences during their hospital stay, highlight areas of best practice and areas for improvement and provide a basis for a hospital-wide inpatient experience survey. Patients and Methods: Anonymous patient experience questionnaires were given to patients who were discharged from hospital during the month of May 2016. Patients were asked to answer 45 questions concerning their experience during hospital stay using the five-point Likert scale, and hand back the questionnaire before leaving the hospital. A suggestion box was provided for comments and suggestions for improvement. Results: Fifty-six questionnaires were handed out and 50 (from 27 males, 17 females and 6 patients who did not specify their gender) questionnaires were returned (89% response rate). Most of the responses fell within the “agree” to “strongly agree” range indicating a positive patient experience for most of the items addressed. Patients also provided useful comments and suggestions. Conclusion: Results of this survey indicate that patients generally had a positive experience during their hospital stay. This survey has revealed areas for improvement, and highlights the importance of patient experience when assessing a patient-centered service.

Views and Experience on Patient Engagement in Healthcare Professionals and Patients—How Are They Different?

A patient-centered approach is used to build a therapeutic alliance between patients and the healthcare professionals in care process which should be supported by a good engagement of both parties. The study aimed to explore the gap between healthcare professionals and patients on patient engagement in hospital. It was a cross-sectional survey. 2774 doctors and nurses from Department of Medicine of public hospitals completed the self-administered questionnaire and 1042 patients discharged from corresponding wards completed the telephone interviews. Participants were interviewed using structural questionnaires. The Mann-Whitney test or Pearson’s chi-square test was used to analyze the agreement between health-care professionals and patients on the views and experiences of patient engagement. A difference was considered to be statistically significant when the p-value was <0.05. Although both groups valued the importance of patient engagement, there was a discrepancy on understanding, views and experiences. More healthcare professionals particularly in nursing were concerned about the possible negative impact of the engagement. The majority of healthcare professionals reported that they engaged well with patients, and perceived more difficulties than patients did. The findings highlighted the mutual understanding of patient engagement, involvement and challenges encountered by both groups in Department of Medicine, which was crucial in efforts to provide meaningful patient engagement in regards to jurisdictions, health system, specialty, discipline and background of patients. It provided insight that a collaborative strategy involving both healthcare professional and patients might be an alternative approach to improving patient engagement.

Patient-Provider-Relationship in the Hospital Care of the Elderly—A Qualitative, Multi-Perspective Study

For many years, there has been a growing demand for patient-centered care in inpatient settings, but a lack of clear consensus on how to exactly implement such programs. The main aim of this study was to analyze patient-centered care in the acute-care setting in a multidimensional manner from the perspectives of elderly patients, their relatives, and an independent observer. A multi-method design was used to capture the three perspectives. Passive observations and post-situational interviews with patients were integrated with semi-structured interviews with patients and their relatives. 18 elderly patients and their relatives (n = 8) were recruited on wards for internal medicine of six hospitals. The data show significant deficits in patient-centered care in the acute-care setting. Although individual patients have different needs, certain categories of deficits emerge as universally relevant, one being the patient-provider-relationship. Patients express a desire for more frequent contact with the hospital staff. Access to doctors and nurses is particularly limited at night and on weekends. The patients are aware of these limitations and often do not draw attention to their own needs to reduce the workload on the staff. The wishes and needs of patients are not always adequately addressed. However, patients, relatives and the independent observer take positive notice of some employees because of their patient-centered attitude. The results show that there is still a need for improvement of patient-centered care. Participants from all three perspectives described differences between employees within the same institutional setting. This finding suggests that patient-centered care strongly depends on the personality of the individual caregiver.

Increased physical activity, physician recommendation, and senior center participation

Physical activity is a recognized preventive health measure for seniors and an important focus for senior centers. This paper employs the Andersen Behavioral Model to explore increased physical activity and participation in three types of senior center activities: physical fitness, dance/aerobic classes, and chair exercises. Data were collected in 2006 on 798 and in 2007 on 742 participants at 21 multipurpose senior centers in a large urban county. Logistic regression analysis (PROC RLOGIST in SAS-callable SUDAAN) was employed to predict increased physical activity, with modes of center participation in physical activity as mediating factors. Predisposing and enabling factors predicted both engaging in center-based exercise programs and increases in physical activity;but the strongest predictors of increases in physical activity were needed factors: physician recommendations to increase exercise and to lose weight. Implications are that both SCs and healthcare providers are important to promote physical activity in the older population.

Listen and talk to the older patients:a critical emancipatory reflection on the practice of communication issues

Objective: Reflection is a process of deliberating thinking and examining one's practice in the past and thereby encouraging nurses to make improvements in future care delivery. This work outlines a piece of reflection involving the practice of communication between nurses and the elderly, to emancipate the authors from their constraints, help to find values as practitioners, and gain a greater understanding of the nurse-patient relationship.Methods: Using Smyth's four-stage model as a guide, as well as empirical and theoretical knowledge on nurse-patient relationships, this paper presents a deep reflection on the relationship that the authors developed with elderly patients and their families, encountered during the practice as a nurse. By applying the four main stages consisting of describe, inform, confront, and reconstruct, this model enabled the authors to frame, describe the practice issue, and explore the meaning behind it, which helps to facilitate a structured reflection.Results: Critical emancipatory reflection, in association with the Espoused theory and Theory-in-use, as well as reflexivity, critical social theory, and hegemony, was applied to uncover the various power relationships and constraining forces in the authors' practice involved in communicating with the elderly, such as the underlying false consciousness, hegemony, hidden assumptions, influential values, and dominant power structure, which are subtle and persuasive. By applying this process of critical reflection, transformative practice could be achieved.Conclusions: The process of critical reflection facilitated the development of the abilities required to develop and maintain the nursepatient relationship. It helps to enhance the care of old patients and their families, which illuminates the future nursing practice.

去中心化临床试验的挑战、对策及伦理审查要点

去中心化临床试验正给临床试验带来新的变革,必须坚持以患者为中心的核心理念,充分保障研究参与者的安全和权益。去中心化临床试验与传统临床试验有相同之处,但去中心化临床试验并不适合所有临床试验,更适用于口服给药、研究参与者病情稳定、疗程较长的临床试验。必须根据临床试验的特点选用去中心化临床试验元素,并在改善研究参与者的获得感、安全、权益和尊严与收集的数据质量之间取得平衡。当前中国去中心化临床试验面临诸多挑战,为积极推进中国去中心化临床试验,应完善监管法规和指导原则,基于以患者为中心的设计原则,首次讨论需实时在线交流,研究者提供更多临床试验服务,风险控制和医疗援助的可及性,使用第三方便捷支付,确保公平招募研究参与者,考虑依从性,数字健康技术的验证,远程监查和电子知情同意合规化,确保收集、传送和分析数据的安全性,以及加强多方培训。伦理审查是保护研究参与者安全和权益的重要手段之一,伦理委员会应关注符合以患者为中心的恰当去中心化临床试验元素,电子知情同意的合规、有效,安全性信息处理与报告,数据收集的隐私保护,远程监查的合规性,家庭健康随访,生物样本管理,试验性医疗产品的管理,以及培训计划。与传统临床试验的互补与结合将使去中心化临床试验元素更容易、更顺利地落地。去中心化临床试验借助科技进步力量,将助推中国药物和医疗器械研发的速度,增强国际竞争力,造福更多患者。

急诊医疗实践中的伦理冲突与探讨

医学伦理学在急诊临床实践中遇到的具体问题非常复杂,其中良好的医患关系、以患者为中心是医学伦理学的基石。医疗工作围绕最大程度地改善患者的疾病预后,最大可能地实现患者及其家庭的幸福,照顾患者及家庭的情感需求,不能威胁医生执业安全来开展。医疗本身复杂、专业,患者个案处在不同的场景下,因不同的人、不同的家庭、不同的理念,具体的诊疗行为必然有所不同,没有完全统一的标准。对四个典型案例进行伦理学探讨,以期为临床工作中遇到的复杂伦理学问题提供思考方法。

“我的健康我做主”:宏观叙事医学视域下医患交流患者争取权力言语行为研究

近年来,中国医患冲突问题引起世界范围内的关注,从本质上改进医患交流质量刻不容缓。从广义叙事医学视角出发,结合社会语言学领域对语言与权力关系的探究,聚焦患者的主体性,致力于探讨医院情境医患交流过程中患者是否以及如何通过话语来展开权力协商。采用交际民族志方法对辅助生殖医学领域内的医患交流进行实地考察,收集田野笔记医患会话录音材料。在扎根理论的指导下对数据进行了编码分析。研究发现:患者在交流中采纳了七类言语行为来“争取权力”:“寻求诊疗建议”“寻求医疗信息”“确认行动指导”“提供信息”“参与决策”“建立关系”以及“维护隐私权”。每一类言语行为都具有多样化的表现形式,在医院特定场景中呈现出不同的分布特征。关注医患交流中的患者视角,丰富对患者主体性的考察,是对“以患者为中心”的交流模式的具体化补充和发展。

将叙事医学渗透到全科医学教学查房的思考

全科医学追求全人理念,十分重视将人文精神有机融入医疗过程。因此,培养全科医生、提升医学人文素养显得尤为重要。叙事医学是真正体现人文关怀和尊重患者人性的学科,有利于将人文精神融入临床实践。以上二者存在天然耦合性。文章从叙事医学视角出发,介绍了叙事医学的发展、作用及意义,分析了目前全科医学住院医师规范化培训中教学查房存在的一些问题,提出以叙事医学为专题教学查房的设想,助力解决全科医学中人文精神技能教育不足的问题,为今后将叙事医学融入全科医学人才培养体系提供参考。

乳腺癌患者自我倡权体验的质性研究

目的 深入了解乳腺癌患者自我倡权的真实体验。方法 采用现象学研究方法,对20名乳腺癌患者进行半结构式访谈,并采用Colaizzi 7步分析法分析资料。结果 提炼出4个主题和11个亚主题:自我倡权意识薄弱(症状报告不主动和过度依赖医生)、自我倡权积极性受多种因素影响(存在逃避心态、信心不足、病耻感严重和害怕破坏医患关系)、自我倡权过程中面临诸多挑战(医护态度欠缺、家庭成员不支持和害怕增加经济负担)及自我倡权积极体验(增强战胜疾病的信心和提高疾病应对能力)。结论 乳腺癌患者自我倡权意识薄弱、积极性较差,在自我倡权过程中面临各种挑战,部分患者积极体验自我倡权。医务人员应多关注自我倡权意识薄弱和积极性较差的乳腺癌患者,给予其更多的帮助和鼓励,同时也应树立“以病人为中心”的服务理念,营造良好氛围促进患者自我倡权。

ACSI模型视角下医院运送服务群体工作满意度的质性研究

目的运用ACSI模型探讨影响医院运送服务群体工作满意度的因素。方法依据ACSI模型拟定访谈题纲,通过现象学研究方法,于2023年2-6月采用目的抽样法选取南京某三级甲等医院的运送服务人员进行半结构式访谈,借助NVivo12Plus软件对访谈所得文本进行定向内容分析。结果共提炼3个主题,8个亚主题:运送工作期望(对运送工资报酬的期望、对运送工作性质的期望);运送工作感知质量(对运送工作量的感知、对运送纠纷处理困难的感知、对运送工作身体劳累的感知、对运送岗位胜任力的感知);运送工作感知价值(同等工作付出所获报酬的感知、同等报酬所需工作付出的感知)。结论运送服务群体的工作满意度受多种因素影响,各因素之间相互影响并处于动态变化之中。因此建议管理人员帮助运送员工建立合理的工作期望、采用精益化管理方式提高运送工作感知质量,从而进一步提升运送工作感知价值。

以患者为中心加强医院文化建设分析

在实施医院文化建设之时,需要加入以患者为中心的相关工作内容,将其作为指导思想,可以使院内各项服务工作质量获得一定程度上的提升,对医院整体形象也具有提升作用。本文主要针对医院文化的内涵、特点以及现状展开说明,明确医院文化建设重要性,同时对以患者为中心加强医院文化建设的对策进行综述。

基于患者体验的护理提升行动与思考

随着医疗服务模式转向以患者为中心,患者体验提升行动已成为公立医院高质量发展的重点任务。介绍了四川大学华西医院为改善患者体验实施的护患共情关爱行动、护患共同决策行动及患者照护连续化行动三大护理举措。结合实践成效,提出了针对文化塑造、患者赋权和数据监测方面的思考及建议。

基于“医-患-学”三方的公立医院住院患者医学人文关怀评价工具的构建及信效度检验

目的:构建以患方为使用主体,基于“医-患-学”三方意见的公立医院住院患者医学人文关怀评价工具并检验其信效度。方法:运用文献法和半结构式访谈法初步构建维度和条目池,再基于德尔菲法经过两轮专家咨询(专家包括患方、医方和学者三方)形成评价工具初稿;进而,对东莞市某三级医院387位患方进行问卷调查和信效度检验。结果:总量表Cronbach's α系数为0.926,折半信度为0.940,重测信度为0.947,说明该评价工具的信度较好;探索性因子分析得出5个公因子,与所设维度基本相符,经调整和合并最终维度为:便捷性、舒适性、关怀性、服务性和传递性,累计方差贡献率为61.311%;验证性因子分析结果显示χ^(2)/df=1.956,CFI=0.903,RMSEA=0.069,模型拟合较好。结论:本研究以患者为中心,将患者纳入专家之一,从“医-患-学”三方角度构建5个维度、22个条目的有着较好信效度的公立医院住院患者医学人文关怀评价工具。