Patient Experience Journal (PXJ, The Beryl Institute)
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Homeless and marginally housed Veteran perspectives on participating in a photo-elicitation research study
Get PDFPhoto-elicitation interviewing (PEI) seems a valuable tool for engaging marginalized populations in research despite documented challenges. Given limited data on acceptability of PEI among homeless and marginally housed Veterans, this evaluation aimed to characterize their research experience. Veterans took photographs about health, health behaviors, and health care which facilitated semi-structured interviews. Their research study experience was assessed via a modified Reactions to Research Participation Questionnaire-Revised (RRPQ-R), along with additional survey and open-ended questions. Of the 20 participants who consented and participated, 16 (80%) completed the exit surveys. Most participants (\u3e88%) indicated favorable experiences and limited drawbacks. Respondents disagreed that participation was difficult or overly time consuming. Many indicated intense or unexpected emotionality. Open-ended responses indicated appreciation of photography, interview experiences, and connection with study staff. Transportation was the most cited barrier. Overall, experiences were reportedly emotionally challenging, but positive. PEI appears to be acceptable to homeless and marginally housed Veterans for eliciting their perspectives
What constitutes the patient experience of children? Findings from the photo elicitation and the video diary study
Get PDFPatient experience (PX) is getting attention among researchers and healthcare service providers, but little is known about the experiences of child patients and how to explore those. This paper reports findings from a study in which two participatory research methods, photo elicitation and video diary, were applied to investigate the elements of children’s PX in the context of children’s hospital. The aim was to find out what elements constitute the PX of children aged 7–16 years. The research data were gathered in 2016–2017. Twenty-two child patients participated in the study: eight children aged between 7 and 10 in the photo elicitation part, and fourteen children aged from 10 to 16 in the video diary part. In the analysis, the data were first analyzed per research method but afterwards combined and analyzed together. Based on the analysis, four main themes of PX of children were identified: 1) hospital facilities and entertainment, 2) medical care, 3) social relationships with the hospital personnel and other people, and 4) feelings and coping with the illness. Feedback on the research methods from the participated children was mainly positive. Further work is needed to validate the findings and introduce new creative approaches to research PX of children of different ages
A photo-elicitation study of homeless and marginally housed Veterans’ experiences with patient-centered care
Get PDFAs part of a qualitatively-driven mixed-methods study, this analysis aimed to describe Veterans Affairs (VA) Homeless Patient Aligned Care Team patients’ experiences with patient-centered care. Veterans participated in audio-recorded, semi-structured photo-elicitation interviews about their health and VA health care. Transcripts were analyzed by two coders using template analysis. In 31/36 interviews, 19/20 participants discussed patient-centered care. Veterans noted Picker’s Patient-Centered Care Principles; 1) access to care, 2) respect for patient-centered values, preference and expressed needs, 3) information, communication, and education, and 4) coordination and care integration were most commonly discussed, followed by 5) physical comfort, 6) transition and continuity, 7) emotional support and alleviation of fear/anxiety, and 8) family and friend involvement. They also identified 1) quality care and 2) being present with patient as central to patient-centered care. Improvement suggestions included the patient-provider relationship, VA services, and transportation. Photo-elicitation may be useful in understanding patient preferences, needs, and values to ensure patient-centered care delivery
Nursing transfer of accountability at the bedside: partnering with patients to pilot a new initiative in Ontario community hospitals
Get PDFThe transfer of accountability (TOA) for a patient from one nurse to another at change of shift is an important opportunity to exchange essential patient care information, as well as to enhance the safety and quality of patient care. This study was undertaken to explore nurses’, patients’ and family members’ perceptions associated with the implementation of bedside nurse to nurse TOA. Focus groups were conducted pre-implementation (two with nurses and two with patients and family members) and post-implementation (six with nurses and two with patients and family members). The focus groups were audio-recorded, transcribed and analysed using directed content analysis. Findings were divided into positive outcomes and challenges to bedside nurse to nurse TOA. Positive outcomes included increased patient safety, more informed patients more consistent use of whiteboards in the patient rooms, better engagement with family via the whiteboard and increased family involvement, confirmation of information between nurses, increased accountability between nurses, and personal introduction/icebreaker of the new nurse. The inclusion of the Patient Partners on the project team was a key success factor for the project. Challenges included a perception of lengthened time required for TOA and increased workload, lack of privacy and potential breaches of confidentiality, patient fear and lack of comprehension, lack of clarity in TOA processes, and inconsistent application of the procedures. Hospital administrators and nurse leaders can use these findings to anticipate and understand change associated with bedside TOA as seen by both nurses and patients/families
How to build a robust provider improvement partnership program to enhance patient experience – A case study
Get PDFPatient experience is emerging as a key differentiating factor in patients’ choice of healthcare system. Many healthcare organizations are attempting to improve their patient experience by data-driven, patient-centered initiatives. This involves engaging all staff along all the contact points of a patient’s journey in healthcare. Perhaps, the physicians or care providers are most important link in this chain but also the most challenging to engage in improvement efforts. Most healthcare organizations have some training or workshops to educate providers on communication skills and other tools to enhance patient experience. However, there seems to a paucity of a standardized approach or a roadmap to put together a robust physician or care provider coaching or improvement partnership program with patient experience (PX) staff. There seems to be several gaps in this process. The current article attempts to develop broad guidelines and suggest a roadmap to address these gaps. The article also suggests general templates for PX staff to use in conducting these improvement work with providers and suggestions for developing a standard physician observation or shadowing template for consistency. The article has woven several commonly used tools like motivational interviewing, change management (ADKAR model), and several communication tools to suggest a detailed blue print for provider patient experience improvement partnership
The Sherpa meets Maslow: Medicine and the hierarchy of needs
Get PDFA critical care physician returning to medicine after her own critical illness experiences a crisis of orientation. She finds she can no longer serve as the Voice of Medicine. She replaces the former construct with a more humble model, in which the physician serves as an intermediary. She equates this new role to that of the Sherpas of Nepal. Maslow’s hierarchy of needs forms the mountain, as she reimagines her role in her patients’ lives
What are the most important dimensions of quality for addiction and mental health services from the perspective of its users?
Get PDFThere is a need to better engage service users in improving their experience with the care received in Addiction and Mental Health (A&MH). Dimensions of patient experience that are most salient to A&MH service users still remain to be properly defined from the patient perspective. This research focuses on identifying key domains of service experience important to patients of Addiction and Mental Health using patient focus groups. In addition, through a patient and family advisory committee, patients were also engaged as co-partners of the research team. The patient advisors had a major role in overseeing the research project, assisting with the thematic analysis and identifying the service domains. A total of 48 individuals (60% female; mean age = 45 years) with lived experience using A&MH services participated in the focus groups. The major themes that emerged from the focus groups led to the identification of seven dimensions of service quality: 1) access, 2) humanity of care, 3) skill and quality of staff, 4) patient engagement, 5) internal and external program communication, 6) individualized treatment and 7) continuity of care. We found that these domains were similar across all service settings including addictions. Patient advisors provided a unique “insider” perspective on the data. Identifying common aspects of service is the first phase of this study. These findings will form the framework for the development of a patient experience survey for Addiction and Mental Health
Rules of engagement: Strategies used to enlist and retain underserved mothers in a mental health intervention
Get PDFPatient engagement has been identified as both a goal and strategy to lower health care costs and improve health care outcomes. However, a lack of consensus and clarity exists as to how the process of patient engagement is implemented in clinical practice. Research addressing the underlying and crucial components of effective patient engagement is limited, leaving a significant gap as to how providers engage patients as active collaborators in their health and health care.
This study provides specific, detailed insight and description into the processes through which advanced practice mental health nurses engaged low-income depressed mothers in a mental health intervention. The Interactive Care Model (ICM), a patient engagement framework, was used to examine and illuminate the key processes and partnership roles of patient engagement. Using a directed content analysis approach, we completed a secondary analysis of nursing narrative data using the 5 key processes and 7 partnership roles of the ICM to guide our analysis. The ICM demonstrated great utility in capturing the processes through which advanced practice nurses enlisted, engaged, and retained low-income depressed mothers in the mental health intervention. Additionally, the nursing narrative data provided specific detail and description as to how the ICM’s components were operationalized in practice. The ICM was validated by the nursing narrative data and provided sound organizational structure for the specific verbal and non-verbal engagement interventions nurses employed. Findings from this study can expand the knowledge base and understanding of the process of patient engagement and can help guide providers in executing behaviors that engage traditionally unengaged patients as active collaborators in their health and health care
Breaking bad news and the importance of compassionate palliative care of the infant
Get PDFBad news to parents regarding their infant is information that negatively impacts the parent’s feelings and view of the present and/or future. It is implemented in situations with feelings of no hope or those that induce a threat to a parent’s mental and physical well-being. The term is difficult to define as it is based on parent’s subjective feelings. However, it is important to be aware of the impact of bad news as it can cause severe anguish and stress on the parent’s emotional stability. The style of delivering bad news has a significant impact on the physician/parent relationship and the satisfaction of the family upon the healthcare team and palliative care system. In the case of an inevitable death of an infant, the implementation of palliative care follows the delivery of bad news. The strategy of palliative care and the philosophy of communication between the healthcare provider and family unit leave a lasting impression on the parents regarding the care of their infant. Clinicians should strive to educate themselves regarding the art of breaking bad news as well as the approach to palliative care to minimize the suffering and grief of the family in their time of sorrow
Tell Me More: Promoting compassionate patient care through conversations with medical students
Get PDFTell Me More® (TMM) is a medical student driven project that represents a movement amongst the rising generation of physicians to practice humanistic, patient-centered medicine through a collaborative approach. Students interviewed patients to create individualized posters designed to build rapport and trust between patients and clinicians, remind patients of their special strengths by highlighting their unique interests and qualities, and encourage more personal and compassionate patient-clinician interactions in order to enhance the patient experience. Students asked each patient three questions: 1. “How would your friends describe you?” 2. “What are your strengths?” 3. “What has been most meaningful to you?” and answers were recorded on a large poster, which was displayed prominently in the patient’s room for clinicians and staff to acknowledge. TMM engaged 5 students and 302 patients over 4 hospital settings throughout Northwell Health. Data collection included daily written reflections by students on their experiences, exit interviews with patients to assess the impact of the project on their stay, and staff surveys that addressed provider perception of the program. Descriptive outcomes supported a positive impact on students, patients, staff and clinicians. TMM succeeded in providing a bridge between patients and clinicians and is a cost-effective practice that lends to more personal patient-provider interactions. Bedside posters positively influenced the culture of a hospital organization and reminded providers of the meaning in their work, which literature shows can reduce provider burnout and improve quality of care