Walden University College of Management and Technology This is to certify that the doctoral study by Leanne Heppell has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Carol-Anne Faint, Committee Chairperson, Doctor of Business Administration Faculty Dr. Rocky Dwyer, Committee Member, Doctor of Business Administration Faculty Dr. Kenneth Gossett, University Reviewer, Doctor of Business Administration Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2016

This is a post-test only experimental design using an uncertainty reduction video to alleviate patient uncertainty, desire for information and increase self-concept to improve overall patient satisfaction with health care experience. The subjects were 80 cardiac consultation patients in a cardiology clinic in Northern California. Forty people were randomly assigned to a control group and forty people to the experimental group. A scale was given to each group which measured the patients' level of self-concept, level of uncertainties (medical setting, relational and illness), and desire for information. The experimental group received an uncertainty reduction video prior to filling out the questionnaire. The uncertainty reduction video was designed to debrief the patient on subjects that may be causing uncertainty for the patient. In conclusion, this study found that the uncertainty reduction video significantly reduced the patient's level of medical setting uncertainty. The study showed a relationship between medical setting uncertainty and relational uncertainty and a relationship between relational uncertainty and illness uncertainty. The study also indicated that patients have high levels of uncertainties in all uncertainty areas: illness, relational, and medical setting, and high a desire for information. However, the video did not show an ability to reduce a patient's level of relational or illness uncertainty. The study also did not show a relationship between self-concept and level of uncertainty and desire for information. Future areas of research suggest that for a similar study a series of illness specific videotapes may be more beneficial at reducing illness uncertainty. The patient's level of previous knowledge, its source, depth and credibility was also suggested for future research. Another area suggested for future research would be the correlation between uncertainties and anxieties.

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This study examined patient behavior in the emergency department and trained physicians to respond to that behavior. It demonstrated that physicians can increase patient satisfaction by responding to the thoughts, feelings and actions which the patients are experiencing. The literature provided variables for patient satisfaction and physician counseling techniques. These variables provided the base for a Patient Satisfaction Inventory (PSI) and a training module for the physicians. Patient behavior was evaluated through the clinical Thinking, Feeling and Acting interview, given to patients, before and after each patient was seen by the physician. This information was then provided to the physicians. For half of the patients, physicians responded according to patients thinking. feeling and acting components of behavior. For the others, physicians received no information other than the generic summary card summarizing thoughts, feelings and actions of the patients as a group. The PSI was completed by all patients after discharge from the emergency department. Pre and post training scores were compared on the PSI to determine if there was a difference in patient satisfaction. An increase in patient satisfaction was experienced after the physicians were trained to purposefully respond to patient behavior. On the PSI, patients perceived greater compassion, understood and communicated with the physician better, and perceived more accurate diagnoses and treatments. These increases in patient satisfaction were significant (p < .01) regardless of whether the physician had the actual patient information from the clinical TF A interview or just the generic summary. The physicians seemed to become sensitized to the patients needs by organizing the data they already had about the patients. Implications for the counseling field and training physicians to better serve their patients were discussed. / Ed. D.

Yes / Ambulatory and/or home monitoring are recommended in the UK and North America for the diagnosis of hypertension but little is known about acceptability. To determine the acceptability of different methods of measuring blood pressure to people from different ethnic minority groups. Design and setting : Cross sectional study with focus groups in primary care. Methods: People with and without hypertension of different ethnicities were assessed for acceptability of clinic, home and ambulatory blood pressure measurement using completion rate, questionnaire and focus groups. Results: 770 participants were included comprising white British (n=300), South Asian (n=241) and African Caribbean (n=229). White British participants had significantly higher successful completion rates across all monitoring modalities compared to the other ethnic groups, especially for ambulatory monitoring: white British (277 completed, 92%[89-95%]) vs South Asian (171, 71%[65-76%], p<0.001 and African Caribbean (188, 82%[77-87%], p<0.001) respectively. There were significantly lower acceptability scores for minority ethnic participants across all monitoring methods compared to white British. Focus group results highlighted self-monitoring as most acceptable and ambulatory monitoring least without consistent differences by ethnicity. Clinic monitoring was seen as inconvenient and anxiety provoking but with the advantage of immediate professional input. Conclusions: Reduced acceptability and completion rates amongst minority ethnic groups raise important questions for the implementation and interpretation of blood pressure monitoring in general and ambulatory monitoring in particular. Selection of method for blood pressure monitoring should take into account clinical need and patient preference as well as consideration of potential cultural barriers to monitoring. / NIHR