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BMC Psychiatry Oct 2023Medication-free treatment within mental health care aims to offer therapeutic support as an alternative to psychotropic medication. Introducing milieu therapy for...
BACKGROUND
Medication-free treatment within mental health care aims to offer therapeutic support as an alternative to psychotropic medication. Introducing milieu therapy for severely mentally ill persons in a medication-free unit requires significant changes to the traditional medication-based psychiatric setting. The present study examines how milieu therapists experience working with medication-free treatment for people with severe mental health challenges. The research question was "What may be required to succeed with medication-free treatment in milieu therapeutic settings?"
METHODS
A qualitative study with four focus groups were conducted with 23 milieu therapists from three inpatient units in two mental health institutions. Thematic analysis was performed.
RESULTS
One main theme was identified: medication-free treatment involves therapists and patients working together on holistic and personal health promotion. This common thread links the four themes: helping patients to make changes in their life; having time to focus on the individual patient; being a professional companion; and working together as a team with the patient.
CONCLUSIONS
A holistic approach is necessary for medication-free treatment to succeed. This requires working together in multidisciplinary teams with a focus on the individual patient. Milieu therapists must engage and take more responsibility in the patient's process of health promotion. A change from a medical to a humanistic paradigm within mental health care is needed.
Topics: Humans; Mental Health; Focus Groups; Qualitative Research; Inpatients; Social Behavior
PubMed: 37784096
DOI: 10.1186/s12888-023-05193-x -
BMC Health Services Research Mar 2020Cancer control programs have added patient navigation to improve effectiveness in underserved populations, but research has yielded mixed results about their impact on...
BACKGROUND
Cancer control programs have added patient navigation to improve effectiveness in underserved populations, but research has yielded mixed results about their impact on patient satisfaction. This study focuses on three related research questions in a U.S. state cancer screening program before and after a redesign that added patient navigators and services for chronic illness: Did patient diversity increase; Did satisfaction levels improve; Did socioeconomic characteristics or perceived barriers explain improved satisfaction.
METHODS
Representative statewide patient samples were surveyed by phone both before and after the program design. Measures included satisfaction with overall health care and specific services, as well as experience of eleven barriers to accessing health care and self-reported health and sociodemographic characteristics. Multiple regression analysis is used to identify independent effects.
RESULTS
After the program redesign, the percentage of Hispanic and African American patients increased by more than 200% and satisfaction with overall health care quality rose significantly, but satisfaction with the program and with primary program staff declined. Sociodemographic characteristics explained the apparent program effects on overall satisfaction, but perceived barriers did not. Further analysis indicates that patients being seen for cancer risk were more satisfied if they had a patient navigator.
CONCLUSIONS
Health care access can be improved and patient diversity increased in public health programs by adding patient navigators and delivering more holistic care. Effects on patient satisfaction vary with patient health needs, with those being seen for chronic illness likely to be less satisfied with their health care than those being seen for cancer risk. It is important to use appropriate comparison groups when evaluating the effect of program changes on patient satisfaction and to consider establishing appropriate satisfaction benchmarks for patients being seen for chronic illness.
Topics: Adult; Cultural Diversity; Early Detection of Cancer; Female; Health Services Accessibility; Humans; Insurance Coverage; Insurance, Health; Middle Aged; Patient Navigation; Patient Satisfaction; Patients; Program Evaluation; United States
PubMed: 32143726
DOI: 10.1186/s12913-020-5009-x -
The Oncologist Nov 2017As patients age, caregivers increasingly provide essential support and patient information. We sought to determine if patient-caregiver assessments of patient health...
BACKGROUND
As patients age, caregivers increasingly provide essential support and patient information. We sought to determine if patient-caregiver assessments of patient health differ and if differences contribute to burden in caregivers of older adults with cancer.
MATERIALS AND METHODS
One hundred patients, aged ≥65, and their caregivers independently assessed patient function, comorbidity, nutrition, social activity, social support, and mental health. Caregivers completed the Caregiver Strain Index (CSI). Patient-caregiver assessments were compared using the Wilcoxon signed rank test and paired test. Association between caregiver burden and differences between patient-caregiver assessments was examined using generalized linear regression.
RESULTS
Median patient age was 70 (range 65-91) and 70% had advanced disease. Sixty percent of patients reported requiring help with instrumental activities of daily living (IADLs); most had good social support (median Medical Outcomes Study [MOS]-Social Support Survey score 92) and mental health (median Mental Health Inventory score 85).Caregivers were a median age of 66 (range 28-85), 73% female, 68% spousal caregivers, and 79% lived with the patient. Caregivers rated patients as having poorer physical function (more IADLs dependency [ = .008], lower Karnofsky Performance Status [ = .02], lower MOS-Physical Function [ < .0001]), poorer mental health ( = .0002), and having more social support ( = .03) than patients themselves. Three-quarters of caregivers experienced some caregiver burden (mean CSI score 3.1). Only differences in patient-caregiver assessment of the patient's need for help with IADLs were associated with increased caregiver burden ( = .03).
CONCLUSION
Patient-caregiver assessments of patient function, mental health, and social support differ. However, only differences in assessment of IADLs dependency were associated with increased caregiver burden.
IMPLICATIONS FOR PRACTICE
As patients age, there is a higher incidence of frailty and cognitive impairments. As a result, caregivers play an increasingly vital role in providing information about patient health to healthcare providers, which is used to help healthcare providers tailor treatments and optimize patient health. These findings highlight that caregiver reporting in older adults with cancer may not replace patient reporting in those older adults who are otherwise able to self-report. Furthermore, clinicians should check for caregiver burden in caregivers who report providing more help with instrumental activities of daily living than patients themselves report and provide appropriate support as needed.
Topics: Activities of Daily Living; Adaptation, Psychological; Aged; Aged, 80 and over; Caregivers; Cost of Illness; Female; Geriatric Assessment; Humans; Male; Neoplasms; Patient Health Questionnaire; Patients; Quality of Life; Social Support
PubMed: 28808093
DOI: 10.1634/theoncologist.2017-0085 -
Worldviews on Evidence-based Nursing Dec 2020Safe health care of good quality depends on structured and unceasing efforts to progress, promoting strategies tailored to the context, including elements such as...
BACKGROUND
Safe health care of good quality depends on structured and unceasing efforts to progress, promoting strategies tailored to the context, including elements such as patients' preferences. Although patient participation is a common concept in health care, there is yet limited understanding of the factors that facilitate and hinder it in a healthcare context.
AIMS
This paper identifies what patients and health professionals depict in terms of enablers and barriers for patient participation in dialysis care.
METHODS
An explorative qualitative design was applied with seven focus group discussions with patients, staff, and managers across different types of hospitals, with the texts analyzed with content analysis.
RESULTS
The dialysis context represents three key elements-people, resources, and interactions-that can both enable and hinder patient participation. Both barriers and facilitators for patient participation were found to reside at individual, team, and organizational levels, with a greater number of enabling factors implied by both patients and staff.
LINKING EVIDENCE TO ACTION
While the dialysis context comprises opportunities for progress in favor of patient participation, a shared understanding of the concept is needed, along with how contextual factors can facilitate conditions for participation by patient preferences. In addition, the most favorable strategy for implementing person-centered care is not yet known, but to facilitate patient participation from a patient perspective, creating opportunities to enable staff and patients to share a common understanding is needed, along with tools to facilitate a dialogue on patient participation.
Topics: Adult; Aged; Aged, 80 and over; Dialysis; Female; Focus Groups; Health Personnel; Humans; Male; Middle Aged; Patient Participation; Patients; Qualitative Research; Sweden
PubMed: 32696513
DOI: 10.1111/wvn.12452 -
Current Treatment Options in Oncology Jan 2023The specialty of palliative care has evolved over time to provide symptom management, psychosocial support, and care planning for patients with cancer throughout the... (Review)
Review
The specialty of palliative care has evolved over time to provide symptom management, psychosocial support, and care planning for patients with cancer throughout the disease continuum and in multiple care settings. This review examines the delivery and impact of palliative care in the outpatient, inpatient, and community-based settings. The article will discuss how these 3 palliative care settings can work together to optimize patient outcomes under a unifying model of palliative care "anywhere, anytime" and how to prioritize palliative care services when resources are limited. Many patients with advanced cancer receive care from each of the 3 branches of palliative care-outpatient, inpatient, and community-based settings-at some point along their disease trajectory. Early on, outpatient clinics provide longitudinal supportive care concurrent with active disease-modifying treatments. Telemedicine appointments can serve patients remotely to minimize their need to travel. When patients experience functional decline, community-based palliative care services can provide support and monitoring for patients at home. When patients develop acute symptomatic complications requiring admission, inpatient care consultation teams are essential for symptom management and goals-of-care discussions. For patients in severe distress, receiving care in a palliative care unit that provides intensive symptom control and facilitates complex discharge planning is ideal. Under a unifying model of palliative care designed to offer care "anywhere, anytime," the 3 branches of palliative care could work in unison to support each other, minimize gaps in care, and optimize patient outcomes.
Topics: Humans; Palliative Care; Neoplasms; Inpatients; Outpatients; Quality of Life
PubMed: 36576706
DOI: 10.1007/s11864-022-01044-1 -
BMC Health Services Research Aug 2023The identification of safety incidents and establishment of systematic methodologies in health services to reduce risks and provide quality care was implemented by The...
BACKGROUND
The identification of safety incidents and establishment of systematic methodologies in health services to reduce risks and provide quality care was implemented by The World Health Organization. These safety incidents allowed the visualization of a vast panorama, ranging from preventable incidents to adverse events with catastrophic outcomes. In this scenario, the issue of fall(s) is inserted, which, despite being a preventable event, can lead to several consequences for the patient, family, and the healthcare system, being the second cause of death by accidental injury worldwide, this study aims to identify the variability inherent in the daily work in fall prevention, the strategies used by professionals to deal with it and the opportunities for improvement of the management of work-as-imagined.
METHOD
A mixed method approach was conducted, through process modeling and semi-structured interviews. The study was conducted in a public university hospital in southern Brazil. Study steps: modeling of the prescribed work, identification of falls, modeling of the daily work, and reflections on the gap between work-as-done and work-as-imagined. Medical records, management reports, notification records, protocols, and care procedures were consulted for modeling the work process, and semi-structured interviews were conducted with 21 Nursing professionals. The study was conducted between March 2019 and December 2020.
RESULTS
From July 2018 to July 2019, 447 falls occurred, 2.7% with moderate to severe injury. The variability occurred in the orientation of the companion and the assurance of the accompanied patient's de-ambulation. The professionals identified individual strategies to prevent falls, the importance of multi-professional work, learning with the work team, and the colleague's expertise, as well as suggesting improvements in the physical environment.
CONCLUSION
This study addressed the need for fall prevention in the hospital setting as one of the main adverse events that affect patients. Identifying the variability inherent to the work allows professionals to identify opportunities for improvement, understand the risks to which patients are subjected, and develop the perception of fall risk as a way to reduce the gap between work-as-imagined and work-as-done.
Topics: Humans; Accidental Falls; Patients; Brazil; Hospitals, Public; Perception
PubMed: 37653512
DOI: 10.1186/s12913-023-09956-w -
Dying persons' perspectives on, or experiences of, participating in research: An integrative review.Palliative Medicine Apr 2018Conducting research with dying persons can be controversial and challenging due to concerns for the vulnerability of the dying and the potential burden on those who... (Review)
Review
BACKGROUND
Conducting research with dying persons can be controversial and challenging due to concerns for the vulnerability of the dying and the potential burden on those who participate with the possibility of little benefit.
AIM
To conduct an integrative review to answer the question 'What are dying persons' perspectives or experiences of participating in research?
DESIGN
A structured integrative review of the empirical literature was undertaken.
DATA SOURCES
Cumulative Index Nursing and Allied Health Complete, PsycINFO, MEDLINE, Informit and Embase databases were searched for the empirical literature published since inception of the databases until February 2017.
RESULTS
From 2369 references, 10 papers were included in the review. Six were qualitative studies, and the remaining four were quantitative. Analysis revealed four themes: value of research, desire to help, expression of self and participation preferences. Dying persons value research participation, regarding their contribution as important, particularly if it provides an opportunity to help others. Participants perceived that the potential benefits of research can and should be measured in ways other than life prolongation or cure. Willingness to participate is influenced by study type or feature and degree of inconvenience.
CONCLUSION
Understanding dying persons' perspectives of research participation will enhance future care of dying persons. It is essential that researchers do not exclude dying persons from clinically relevant research due to their prognosis, fear or burden or perceived vulnerability. The dying should be afforded the opportunity to participate in research with the knowledge it may contribute to science and understanding and improve the care and treatment of others.
Topics: Health Knowledge, Attitudes, Practice; Humans; Palliative Care; Patient Participation; Patients; Research; Terminally Ill
PubMed: 29235418
DOI: 10.1177/0269216317744503 -
Yakugaku Zasshi : Journal of the... 2016For prevention of the aggravation of diabetic nephropathy, a treatment method that combines self-care with medical guidance is becoming increasingly important, leading... (Review)
Review
For prevention of the aggravation of diabetic nephropathy, a treatment method that combines self-care with medical guidance is becoming increasingly important, leading to the development of programs for lifestyle modification for the patients. To assess the effectiveness of such programs, we have conducted a feasibility study of a patient self-care support program with medical collaboration by registered pharmacists in community pharmacies involving patients with diabetic nephropathy who are under treatment at medical institutions, including our hospital. This study evaluated the two primary measurements, which are A) the actual execution rate versus planned programs, and B) the patient satisfaction rate. In addition, the achievement rate of behavioral objectives, satisfaction rate of diabetes treatment, degree of concerns (Diabetes Treatment Satisfaction Questionnaire; DTSQ, Problem Areas in Diabetes; PAID) and other physiological indicators have been evaluated. With the approval of the IRB at Kitasato University, sixteen out of 18 patients have continued to participate in the support program, and the study has shown high patient satisfaction with pharmacist coaching support. Patients have gained interest in managing their lifestyles, thereby increasing self-efficacy. Also, information shared between the pharmacists and the physicians has clarified patients' issues and concerns pertaining to their lifestyles, which were effectively utilized in the coaching program. Through meetings with pharmacists, patients have been reassured of the expertise of the pharmacist and thus gained mutual trust, which leads to the patient's behavioral change. We believe that the collaboration of patients, pharmacists and physicians has resulted in effective team-based patient care.
Topics: Diabetic Nephropathies; Humans; Intersectoral Collaboration; Japan; Life Style; Mentoring; Patient Care Team; Patient Participation; Patient Satisfaction; Patients; Preventive Health Services; Professional-Patient Relations; Self Care
PubMed: 26831803
DOI: 10.1248/yakushi.15-00268-3 -
International Journal of Environmental... Jan 2023Patient participation is a cornerstone of the debate concerning healthcare professionals and patients of mental health centres. It constitutes an objective in government...
INTRODUCTION
Patient participation is a cornerstone of the debate concerning healthcare professionals and patients of mental health centres. It constitutes an objective in government health policy in Scandinavia and other Western countries. However, little is known about the experiences of healthcare professionals in mental healthcare practices involving patients under their treatment and care.
OBJECTIVE
This study aimed to explore the experiences of healthcare professionals with patient participation in the context of a mental health centre.
METHODOLOGICAL DESIGN
Four focus group interviews with healthcare professionals reflected differing experiences with unfolding patient participation in clinical practices in four wards of a mental health centre. A content analysis developed and framed themes.
RESULTS
Patient participation was based on structural conditions, which shows that predetermined structural methods predominantly control involvement. The structural methods are seen as promoting participation from the patient's perspective. At the same time, the methods also enable taking account of the individual patient's wishes and needs for involvement.
DISCUSSION AND CONCLUSION
This study illuminates the meaning of patient participation in a mental health centre based on the social interactions among nurses and other healthcare professionals. The approach can contribute to dealing with the challenges of incorporating patient participation as an ideology for all patients in a psychiatric context, which is important knowledge for healthcare professionals.
Topics: Humans; Patient Participation; Patients; Hospitals, Psychiatric; Palliative Care; Qualitative Research; Health Personnel; Mental Health Services
PubMed: 36767331
DOI: 10.3390/ijerph20031965 -
BMC Health Services Research Aug 2023Patient engagement is seen as a necessary component in achieving the triple aim of improved population health, improved experience of care, and lower per capita health...
BACKGROUND
Patient engagement is seen as a necessary component in achieving the triple aim of improved population health, improved experience of care, and lower per capita health care costs. While there has been a substantial increase in the number of tools and patient-centered initiatives designed to help patients participate in health decisions, there remains a limited understanding of engagement from the perspective of patients and a lack of measures designed to capture the multi-faceted nature of the concept.
METHODS
Development of a concept map of patient engagement followed a five-step modified Group Concept Mapping (GCM) methodology of preparation, generation, structuring, analysis and interpretation. We engaged a Project Advisory Committee at each step, along with three rounds of survey collection from clinicians and patients for element generation (272 clinicians, 61 patients), statement sorting (30 clinicians, 15 patients), and ranking and rating of statements (159 clinicians, 67 patients). The survey of three separate samples, as opposed to focus groups of 'experts,' was an intentional decision to gain a broad perspective about the concept of patient engagement. We conducted the structure and analysis steps within the groupwisdom concept mapping software.
RESULTS
The final concept map comprised 47 elements organized into 5 clusters: Relationship with Provider, Patient Attitudes and Behaviors, Access, Internal Resources and External Resources. There was considerable agreement in the way elements in each cluster were rated by patients and clinicians. An analysis of the importance of the constitutive elements of patient engagement relative to their addressability highlighted actionable items in the domain of Relationship with Provider, aimed at building trust and enabling patients to ask questions. At the same time, the analysis also identified elements traditionally considered barriers to engagement, like personal access to the internet and the patient's level of digital literacy, as difficult to address by the healthcare system, but also relatively less important for patients.
CONCLUSIONS
Through our GCM approach, incorporating perspectives of both patients and clinicians, we identified items that can be used to assess patient engagement efforts by healthcare systems. As a result, our study offers specific insight into areas that can be targeted for intervention by healthcare systems to improve patient engagement.
Topics: Humans; Patients; Health Facilities; Focus Groups; Software; Patient Participation
PubMed: 37563581
DOI: 10.1186/s12913-023-09785-x