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AMA Journal of Ethics Jun 2023Over the past decade, ways of defining self in relation to gender identity and forms of expression have widely expanded. Along with this expansion of identifying...
Over the past decade, ways of defining self in relation to gender identity and forms of expression have widely expanded. Along with this expansion of identifying language, there has been an increase in medical professionals and clinics specializing in providing gender care. Yet many barriers to providing this care still exist for clinicians-including their comfort with and knowledge about collecting and retaining a patient's demographic information, respecting the name and pronouns a patient goes by, and providing overall ethical care. This article shares one transgender person's numerous health care encounters over 20 years as both a patient and a professional.
Topics: Humans; Male; Female; Transgender Persons; Gender Identity; Health Personnel; Patients
PubMed: 37285300
DOI: 10.1001/amajethics.2023.452 -
BMJ Open Quality May 2023A satisfactory patient care culture model can help improve most patients' quality of care in a hospital. This study aims to improve patients' experiences (PX) by...
A satisfactory patient care culture model can help improve most patients' quality of care in a hospital. This study aims to improve patients' experiences (PX) by implementing a culture model at King Abdul-Aziz Armed Forces Hospital in Dhahran, Saudi Arabia. To achieve the research aim, a set of interventions were implemented that included a patient and family advisory council, empathy training, recognition of the PX, leadership-patient interviews, PX champions and quality improvement. These interventions were further measured using the Hospital Consumer Assessment of Healthcare Providers and Systems survey in the inpatient, outpatient and emergency departments. The improvement project was conducted in 2020, focusing mainly on transforming the culture and launching activities targeting specific touchpoints identified as priority areas. After making these changes, the hospital saw improvements in all patient relationships, with an average score across all dimensions collectively increasing by more than 4%. The quality improvement project using the PX culture model approach demonstrated significant improvements. In addition, employee involvement in patient care has become a significant factor in improving the quality of care. The critical elements for improving the PX and culture included recognising staff and creating networks across the system through effective leadership, employee engagement and engagement of patients and their families.
Topics: Humans; Organizational Culture; Inpatients; Outpatients; Emergency Service, Hospital; Patient Outcome Assessment
PubMed: 37220993
DOI: 10.1136/bmjoq-2022-002076 -
Nursing Open Jan 2022This scoping review aimed to identify and map the signs and symptoms-apart from vital signs-that trigger nurses' concerns about the deteriorating conditions of... (Review)
Review
AIM
This scoping review aimed to identify and map the signs and symptoms-apart from vital signs-that trigger nurses' concerns about the deteriorating conditions of hospitalized paediatric patients.
DESIGN
A scoping review was conducted in accordance with the Joanna Briggs Institute methodology.
METHODS
Six databases, including MEDLINE, CINAHL, Embase, Scopus, Swemed and ProQuest Dissertations and Theses databases, were searched systematically. Of 5795 citations, seven matched the inclusion criteria.
RESULTS
Objective observations, such as the patient's colour, pain-level changes, and behavioural observations, were identified as signs that would trigger nurses' concerns. Nurse's intuitive feelings or gut feelings when seeing a patient was also identified as an important factor for identifying a deteriorating paediatric patient. A "gut feeling" was described as both a reaction to patient signs and a feeling based on the nurse's intuition gained through experience. The signs or symptoms that would trigger this "gut feeling" were not identified.
Topics: Child; Humans; Intuition; Nurses; Patients; Precipitating Factors; Vital Signs
PubMed: 34761544
DOI: 10.1002/nop2.1105 -
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 -
BMC Health Services Research May 2020Fingolimod is an oral multiple sclerosis drug that is considered a specialty drug due to its high cost and safety issues. The Fingolimod Patient Support Program (F-PSP)...
BACKGROUND
Fingolimod is an oral multiple sclerosis drug that is considered a specialty drug due to its high cost and safety issues. The Fingolimod Patient Support Program (F-PSP) is a specialty pharmacy service developed to ensure the responsible use of fingolimod by promoting patient safety and medication adherence. This study aims to explore the satisfaction, experiences and perceptions regarding the F-PSP among patients currently involved in this program or recently withdrawn.
METHODS
A qualitative study was conducted via individual, face-to-face semistructured interviews with patients involved in the F-PSP. The interviews were audio-recorded, transcribed verbatim, coded and analyzed via thematic content analysis.
RESULTS
The main themes identified from the interviews (nā=ā17) were overall perception of the F-PSP, perception of the pharmacist-led consultations, perception of the tools (electronic monitor and drug intake graph), reasons to participate or potentially withdraw, and suggestions for improvements. Participants perceived the F-PSP as a reassuring support that complemented their medical care, providing a more human, personalized and person-centered approach than usual pharmacy care. Pharmacist-led consultations were valued for the medication-related and holistic support they provided. The importance of the pharmacist's attitude was emphasized. The electronic monitor was valued for promoting daily medication adherence and allowing the involvement of relatives, which reassured participants and their relatives. The participants appreciated the drug intake graph because it provided an objective overview of medication adherence, thereby reassuring, rewarding, and motivating them. The main reason to join the program was to be supported, especially with respect to medication adherence.
CONCLUSIONS
Participants were satisfied with the F-PSP, each for different reasons. Their feedback enabled the identification of measures for the optimization of the F-PSP and should facilitate its dissemination and transfer to other drugs/diseases/populations. Essential elements of generic pharmacist-led patient support programs considered valuable from the patients' perspective were identified.
Topics: Adult; Attitude of Health Personnel; Female; Fingolimod Hydrochloride; Humans; Male; Medication Adherence; Middle Aged; Patient Safety; Patient Satisfaction; Patients; Pharmaceutical Services; Pharmacists; Program Evaluation; Qualitative Research; Switzerland
PubMed: 32410681
DOI: 10.1186/s12913-020-05278-3 -
BMJ (Clinical Research Ed.) Nov 1992
Topics: Communication; Humans; Patient Education as Topic; Patients; Writing
PubMed: 1477564
DOI: 10.1136/bmj.305.6864.1242 -
AMA Journal of Ethics Dec 2023Turfing is a colloquialism that refers to what clinicians do to patients whose needs do not fit neatly and tidily into typical clinical placement protocols, especially...
Turfing is a colloquialism that refers to what clinicians do to patients whose needs do not fit neatly and tidily into typical clinical placement protocols, especially during inpatient admissions from a hospital's emergency department. This term and this practice are both clinically and ethically problematic because a patient is rarely, if ever, "turfed" to their advantage. Ethically speaking, turfing constitutes deferral of responsibility for a patient's admission or care to colleagues. This article suggests when and under which circumstances it is clinically and ethically appropriate to defer a patient's care and suggests why turfing happens despite its negative influence on both physicians and patients.
Topics: Humans; Hospitalization; Emergency Service, Hospital; Physicians; Inpatients; Students
PubMed: 38085991
DOI: 10.1001/amajethics.2023.885 -
BMJ (Clinical Research Ed.) Aug 1991
Topics: Attitude to Health; Humans; Patients; Perception; Physician-Patient Relations
PubMed: 1888922
DOI: 10.1136/bmj.303.6797.261 -
Family Medicine Jan 2015
Topics: Health Personnel; Hospitalization; Hospitals; Humans; Patients; Professional-Patient Relations
PubMed: 25646880
DOI: No ID Found -
BMC Health Services Research Sep 2020Communication failures involving test results contribute to issues of patient harm and sentinel events. This article aims to synthesise review evidence, practice... (Review)
Review
BACKGROUND
Communication failures involving test results contribute to issues of patient harm and sentinel events. This article aims to synthesise review evidence, practice insights and patient perspectives addressing problems encountered in the communication of diagnostic test results.
METHODS
The rapid review identified ten systematic reviews and four narrative reviews. Five practitioner interviews identified insights into interventions and implementation, and a citizen panel with 15 participants explored the patient viewpoint.
RESULTS
The rapid review provided support for the role of technology to ensure effective communication; behavioural interventions such as audit and feedback could be effective in changing clinician behaviour; and point-of-care tests (bedside testing) eliminate the communication breakdown problem altogether. The practice interviews highlighted transparency, and clarifying the lines of responsibility as central to improving test result communication. Enabling better information sharing, implementing adequate planning and utilising technology were also identified in the practice interviews as viable strategies to improve test result communication. The citizen panel highlighted technology as critical to improving communication of test results to both health professionals and patients. Patients also highlighted the importance of having different ways of accessing test results, which is particularly pertinent when ensuring suitability for vulnerable populations.
CONCLUSIONS
This paper draws together multiple perspectives on the problem of failures in diagnostic test results communication to inform appropriate interventions. Across the three studies, technology was identified as the most feasible option for closing the loop on test result communication. However, the importance of clear, consistent communication and more streamlined processes were also key elements that emerged.
REVIEW REGISTRATION
The protocol for the rapid review was registered with PROSPERO CRD42018093316 .
Topics: Communication; Diagnostic Tests, Routine; Health Personnel; Humans; Patients; Professional-Patient Relations; Systematic Reviews as Topic
PubMed: 32967682
DOI: 10.1186/s12913-020-05737-x