Understanding physician well-being may help prevent physician burnout, improve the quality of care they provide to their patients, reduce medical errors, and improve patient satisfaction. Using the biopsychosocial-spiritual theory as the conceptual framework, this quantitative study examined the relationship between: (a) physician well-being and patient satisfaction, (b) physician gender and physician well-being, (c) primary care providers' and specialists' well-being, (d) patient satisfaction based on physician specialty, and (e) the duration of practice and physician well-being. All of the 87 employed physicians in a Florida regional hospital were invited to respond to a physician well-being questionnaire; a response rate of 58.4% was achieved. Patient satisfaction information was obtained through archived data of 4,500 patient surveys. Data were analyzed utilizing linear regression to examine the relationship between patient satisfaction and duration of physicians' practice, with the dependent variable, physician well-being. Two logistic regression analyses were utilized to examine (a) differences between physician well-being, gender, and specialty; and (b) differences between patient satisfaction and physician specialty. There were no significant relationships evident; however, it was speculated that the nonsignificance may be due to the small available sample of physicians. Future research on physician well-being may use the current findings to refine the conceptual framework and increase the understanding of how physician well-being can prevent physician burnout, improve the quality of care they provide to their patients, reduce medical errors, and improve patient satisfaction. Future research in this area will have the potential to increase the quality of patient care that will address positive social change.

Cancer diagnoses affect millions of people in the United States each year. Today, cancer patients face many challenges when trying to navigate the complex healthcare system. Patient navigation programs were developed to address and overcome barriers patients may face as they make their way through the healthcare system. The purpose of this project was to provide an analysis and discussion of the current published literature to provide evidence for improving care coordination and patient satisfaction in the oncology clinical setting with a patient navigator program. The practice-focused question for this project asked if a patient navigator program for adult cancer patients improved patient outcomes. The systematic review, guided by Watson's theory of caring, included 11 studies published between 2010 and 2017 identified through Cochrane Library, CINAHL, ProQuest, PubMed, and Joanna Briggs Institute. Initially a total of 679 articles were identified; however the number reduced by removing duplicates and after review of titles and abstracts. The remaining articles were then evaluated by the level of evidence based on the Manly and Fineout-Overholt's guide on hierarchy of evidence. The results identified in this systematic review showed patient navigation can improve care coordination and patient satisfaction. This review offers findings on the impact of cancer care coordination and patient satisfaction, which may be used by healthcare leaders when determining how to improve cancer care and as a result may provide positive social change. If the organization implements a patient navigator program, it is expected that this change would benefit patients, families, healthcare providers and the organization.

Telehealth initiated a transformation in the realm of innovative strategies to meet the demands of an ever-changing health care system. Adapting provisions to new delivery care models such as telehealth is one way to improve access to care. The purpose of this project was to explore evidence of best practices in telehealth through an extensive, systematic literature review. The practice-focused question focused on identifying advantages of and barriers to the use of telehealth for improving patient satisfaction and quality of care. The plan-do-study-act cycle served as a model for accelerating quality improvement through improved systems of practice, and the Critical Appraisal Skills Program tool was used to identify factors in the literature that indicated the clinical effectiveness of telehealth and the contributions of information technology to patient outcomes throughout the care continuum. Applying Melnyk and Fineout-Overholt's model, which consists of 7 levels for grading evidence, 11 articles were identified as meeting the inclusion criteria. With respect to comparing telehealth services, this review identified areas for future research, including how telehealth can be used to bridge the gap between hospital and home with the integration of telehealth being integrated into routine care as a means to deliver medical, health, and educational services that contribute to improving patient outcomes. The implications of this project related to social change include supporting evidence that positive change is possible when modalities of health care delivery include the patient as part of care, benefiting both patient and provider.

Nurses' perceptions of their work environment and empowerment in relationship to patient satisfaction are well explored in the literature. Empowerment has been linked to improved job satisfaction and improving the elements of empowerment cam improve overall patient satisfaction. This project examined 2 nursing units, 1 with lower patient satisfaction scores (Unit A) and 1 with higher patient satisfaction scores (Unit B), in order to compare their structural empowerment scores as measured by the Conditions of Work Effectiveness Questionnaire II (CWEQ-II). A total of 29 nurses who worked full-time, part-time, or per diem on 1 of the 2 units were recruited to participate in the project (11 from Unit A and 18 from Unit B). Using Kanter's theory as a framework, the nurses were asked to complete the CWEQ-II and overall scores as well as subscale scores were calculated. Scores were estimated using a Mann-Whitney U test given the lack of normality and linearity of the data. Both units had a moderate overall empowerment level (Unit A: 19.55; Unit B: 21.47). Unit A had a significant difference in Access to Resources: Acquiring Temporary Help (z = -2.07, p < 0.05) as compared to Unit B. In comparing nurses with a Bachelor's and higher nursing degree to nurses with less than a Bachelor's degree, there was a significant difference in Access to Resources: Acquiring Temporary Help (z = -3.115, p < 0.05) and overall Resource Subscale (z = -2.157, p < 0.05). The project demonstrates the need for organizations to create a workplace that promotes empowerment among nurses as a strategy to improve patient and organizational outcomes. A work environment that promotes a nurse's control over his or her practice and decision-making ability may lead to higher patient satisfaction and may become the role model of a nursing practice environment as a result.

The clinical practice problems addressed by the DNP project were the low patient satisfaction scores and the high number of falls on a hospital neurological step-down unit. The purpose of this project was to improve the Hospital Consumer Assessment of Healthcare Providers and Systems score on one patient satisfaction question and decrease the number of patient falls by implementing hourly rounding, using a script related to patient comfort and toileting needs. The scripted questions were expected to increase the satisfaction of patients and decrease unassisted falls due to increased attention to patient pain and positioning and timely help with toileting and retrieving personal items. The project was guided by Rosswurm and Larrabee's change model and facilitated by the plan, do, study, act model for rapid change. The satisfaction scores on the survey question 'I received help as soon as wanted' and the number of falls were compared before and after hourly rounding with scripting was introduced. During the 3 months of the project, the average monthly number of falls increased from 3 to 3.6 and changes in the patient satisfaction score were within upper and lower control limits indicating normal variation in the process. These findings indicated that barriers to the change on the unit need to be examined further and another short-term, rapid change cycle initiated to meet or exceed the national benchmarks for patient satisfaction and falls incidence. The project may inform quality improvement efforts at other hospitals and assist in social change by increasing scripted communication between nursing staff and patients to ensure that patients' needs (pain, positioning, pottying, and proximity of personal items) are addressed during each hourly rounding encounter.

Nurses' job satisfaction affects work performance at the point of care in hospitals. The incoming nurses who are able to receive a comprehensive patient report at shift change are more prepared in comparison to incoming nurses who are not able to receive a comprehensive patient report to provide care that is safe. The purpose of this project, guided by the theory of organization change, was to explore whether the use of a bedside handover process impacts nurses' satisfaction in an adult postoperative orthopedic and spine unit. A post-implementation survey of the bedside handover process was conducted after one month and two months to examine registered nurses' (RN) (n = 50) satisfaction using a 7-question self-designed instrument with a reliability coefficient of 0.80. The Bedside Handover Report Staff Nurses' Satisfaction Survey consisted of 5-item Likert scale with scores ranging from 1 (strongly disagree) to 5 (strongly agree). The survey results found that RNs were satisfied with the bedside handover report process. Matched-pair t tests revealed significant differences between the first and second months after the handover report process was implemented. Specifically, 'Bedside handover report provides time for the incoming RN to verify patient's health issues' (p = .05),' I am satisfied with the handover report process conducted at the patient's bedside' (p = .01), and total score (p = .03) improved from the first to second month. A longitudinal study spanning 6 months to a year is recommended when the project will be implemented in the entire facility. A bedside handover report increases nurse satisfaction because the process allows the nurses to verify and address patient health issues that are essential for positive social change.

Patient dissatisfaction with the physician/patient relationship and medical care is well documented in both the lay press and the medical literature. This problem appears to stem from communication between physician and patient and is drawing increased attention from the communication discipline. Research conducted in interpersonal communication satisfaction theory provides a basis for this study of patient satisfaction with physician/patient communication and its relationship to the perceived quality of medical care. This paper reports two sets of interviews with a total of 108 respondents on the topic of physician/patient communication which resulted in the identification of nine salient issues which appeared to contribute strongly to patient communication satisfaction. These issues are explained in terms of three areas of communication theory: control, empathy and confirmation.

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Bakgrund: När det konstaterats att livsförlängande behandling inte längre är meningsfullt övergår vårdandet till den senare fasen, livets slutskede. Livets slutskede innebär att döden är ofrånkomlig inom en snar framtid och målet med behandling är då att lindra lidande. God palliativ vård bygger på de fyra hörnstenarna symtomlindring, multiprofessionellt samarbete, relation och kommunikation samt stöd till närstående. Tillsammans med ett personcentrerat förhållningssätt kan de fyra hörnstenarna tillämpas av all vårdpersonal i syfte att tillföra patienter ett förbättrat välmående och ökad livskvalitet i livets slut. Syfte: Syftet med denna litteraturöversikt var att beskriva hur patienter som befinner sig i livets slutskede upplever omvårdnaden på sjukhus. Metod: Vald design till uppsatsen var litteraturöversikt och 15 vetenskapliga artiklar ligger till grund för resultatet. Vid artikelsökningen användes databaserna Public Medline [PubMed] och Cumulative Index to Nursing and Allied Health Literature [CINAHL Complete]. Resultatet sammanställdes genom en integrerad analys. Resultat: Resultatet delades upp i huvudkategorier som beskrev patienters upplevelse av sjukhusmiljön, mötet med sjuksköterskan, symtomlindring samt existentiella behov. Tillsammans med underkategorier visar resultatet att patienter som befann sig i livets slutskede över lag var nöjda även om brister kunde pekas ut. De brister som fanns handlade om hur patienter upplevde sjukhusmiljön där exempelvis flerbäddssalar påverkade livskvaliteten på ett negativt sätt. Patienter beskrev även hur sjukvårdspersonal på sjukhuset upplevdes som stressade och oengagerade vilket bidrog till att patienterna kände sig som en belastning. Slutsats: Kunskap om palliativ omvårdnad på sjukhus till de patienter som befinner sig i livets slutskede är, baserat på resultatet i denna uppsats, ett viktigt ämne att belysa. Med en ökad medellivslängd samt ny forskning och teknik för livsuppehållande åtgärder kommer behovet av palliativ omvårdnad efterfrågas i allt större utsträckning. Brist på kunskapen att förmedla god omvårdnad till människor i livets slutskede medför ett försämrat välmående och nedsatt livskvalitet för patienter i det sena palliativa skedet. / Background: When it has been established that life-prolonging treatment is no longer meaningful, care goes to the latter phase, the final stage of life. The final stage of life means that death is inevitable in the near future and the goal of treatment is to alleviate the suffering. Good palliative care is based on the four cornerstones of symptom relief, multi-professional collaboration, relationship and communication, and support for close relatives. Together with a person-centered approach, the four cornerstones can be applied by all health care professionals with the aim of providing patients with improved well-being and improved quality of life at the final stage. Aim: The purpose of this literature review was to describe how patients who are at the final stage of life experience nursing care in hospitals. Method: The chosen design for the essay was a literature review and 15 scientific articles which form the basis for the result. In the article search, the databases Public Medline [PubMed] and the Cumulative Index to Nursing and Allied Health Literature [CINAHL Complete] were used. The result was compiled by an integrated analysis. Results: The results were divided into main categories that described the patients' experience of the hospital environment, the meeting with the nurse, symptom relief, and existential needs. Together with the subcategories, the results show that the patients who were in the final stages of life were generally satisfied, although deficiencies could be identified. The shortcomings that could be pointed out were about how the patients experienced the hospital environment where, for example, multi-bed rooms negatively affected their quality of life. The patients also described how they experienced the hospital staff being stressed and disengaged, which contributed to the patient feeling like a burden. Conclusions: Knowledge about palliative care in hospitals for patients at the final stage of life is, based on the results of this paper, an important topic to elucidate. With an increased life expectancy as well as new research and technology for life-sustaining measures, the need for palliative care will be increasingly demanded. Lack of knowledge to convey good care to people at the final stage of life results in impaired well-being and reduced quality of life for patients who are in the late palliative stage.