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 sa...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).展开更多
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 P...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.展开更多
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 healthc...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.展开更多
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,Chi...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.展开更多
目的:通过对医疗服务体系中财务导航的概念演化过程、概念界定、概念属性、前置因素、后置影响和典型案例等进行归纳总结,明确财务导航的概念内涵。方法:检索中国知网、维普、万方和中国生物医学文献服务系统、PubMed、Web of Science、...目的:通过对医疗服务体系中财务导航的概念演化过程、概念界定、概念属性、前置因素、后置影响和典型案例等进行归纳总结,明确财务导航的概念内涵。方法:检索中国知网、维普、万方和中国生物医学文献服务系统、PubMed、Web of Science、Embase、Cochrane Library数据库中的财务导航相关文献,采用Rodgers演化概念分析法对财务导航的概念进行分析。结果:共纳入37篇文献,财务导航的概念属性包括以患者为中心、通过教育促进高质量医疗决策、协调整合支持资源、持续动态优化;前置因素包括患者及其家庭相关因素、医疗服务体系因素、社会法规政策与福利因素,后置影响包括对患者及其家庭以及对医疗服务体系产生积极作用。结论:医疗服务体系中财务导航为降低疾病所致经济毒性产生积极影响,未来应加强政策保障、人员培训和资源整合,推动财务导航的规范化发展。展开更多
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....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.展开更多
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 ...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.展开更多
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 ...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.展开更多
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 participat...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.展开更多
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 patie...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.展开更多
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 refle...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.展开更多
文摘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).
文摘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.
文摘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.
基金The Guangdong Medical Scientific Research Fund(A2017375)Pingshan District Research Project(201710)
文摘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.
文摘目的:通过对医疗服务体系中财务导航的概念演化过程、概念界定、概念属性、前置因素、后置影响和典型案例等进行归纳总结,明确财务导航的概念内涵。方法:检索中国知网、维普、万方和中国生物医学文献服务系统、PubMed、Web of Science、Embase、Cochrane Library数据库中的财务导航相关文献,采用Rodgers演化概念分析法对财务导航的概念进行分析。结果:共纳入37篇文献,财务导航的概念属性包括以患者为中心、通过教育促进高质量医疗决策、协调整合支持资源、持续动态优化;前置因素包括患者及其家庭相关因素、医疗服务体系因素、社会法规政策与福利因素,后置影响包括对患者及其家庭以及对医疗服务体系产生积极作用。结论:医疗服务体系中财务导航为降低疾病所致经济毒性产生积极影响,未来应加强政策保障、人员培训和资源整合,推动财务导航的规范化发展。
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
