Psykisk ohälsa är ett växande problem i samhället och allmänsjuksköterskan möter i sitt arbete dagligen människor med psykisk ohälsa. Dessa människor upplever sig ofta osynliga i samhället och upplever även förutfattade meningar i mötet med sjuksköterskan. Forskning idag utgår mindre ofta från perspektivet hos människor med psykisk ohälsa, vilket behövs för att omvårdnaden ska kunna utvecklas. Problematiken är att sjuksköterskan många gånger möter människor utifrån deras psykiska diagnos, istället för att möta dessa människor utifrån ett helhetsperspektiv. Examensarbetet beskriver hur vuxna människor med psykisk ohälsa kan uppleva mötet med sjuksköterskan. Två teman framkommer efter sammanställning av befintlig forskning. Vuxna människor med psykisk ohälsa upplever antingen sig sedda i mötet med sjuksköterskan eller en känsla av osynlighet. Känslan av att vara sedd uppkommer när sjuksköterskan bekräftar individen genom att vara öppensinnad. Sjuksköterskan lägger ner tid i mötet genom att lyssna och att försöka förstå personens situation. En känsla av osynlighet i mötet uppkommer när sjuksköterskan förminskar personen till en diagnos. De med psykisk ohälsa upplever hinder i relationen genom att sjuksköterskan utövar makt och behandlar dem som barn. De känner sig ensamma när sjuksköterskan inte har tid för dem och inte tyckts bryr sig om dem. Genom denna studie kan sjuksköterskan få en ökad förståelse för hur vuxna människor med psykisk ohälsa upplever mötet med dem. Ökad förståelse kan förbättra relationen mellan människor med psykisk ohälsa och sjuksköterskan. Det kan även leda till en ökad känsla av hälsa hos människor med psykisk ohälsa. / Background: Mental illness has in recent years increased in society. It has since centuries been seen as a shameful disease and mental illness has not been a high priority in health care. Aim: The aim of this study was to describe how adult humans with mental illness experiences the meeting with the nurse.Method: The method that was used was a literature based study with basis in analysis of qualitative research. 11 articles with a qualitative approach was analyzed. Result: The result showed two main theme. The first theme was a feeling of being seen in the meeting when an open dialogue was used and a relationship was created. The second theme was a feeling of invisible because they felt reduced to a diagnosis and encountered obstacles in the relation. Conclusion: Adult humans with mental illness could experience the meeting in different ways. A good meeting with the nurse could increase the human with mental illness trust in healthcare. It could improve the care and relationship between human with mental illness and the nurse.

Thesis advisor: Barbara E. Wolfe / Patient quality outcomes in the United States (U.S.) healthcare system are largely stagnant or making minimal improvements, resulting in unnecessary morbidity, mortality, and costs (AHRQ, 2012 National Healthcare Quality Report). As the US implements the 2010 Patient Protection and Affordability Act, there is fiscal pressure to attain and sustain significant improvements to patient quality outcomes. This necessitates an understanding of how the processes and structures of care influence patient quality outcomes (Donabedian, 1966) in a complex care environment. To begin addressing this gap, this investigation examined the influence of unit-level authentic leadership (AL) and structural empowerment (SE) on staff nurse decisional involvement (DI) and patient quality outcomes on general care units in the acute-care hospital setting. This study used a cross-sectional survey design. Participants were staff nurses working on 105 general care units across eleven US hospitals. The surveys measured staff nurse perceptions of AL, SE, and DI at the care unit level. The patient quality outcomes of interest were falls with injury, hospital acquired pressure ulcers and patient satisfaction. Care unit level AL and SE had a significant influence on actual staff nurse DI (p = .002 and < .001, respectively) and the degree of dissonance between actual and preferred DI (p < .001). AL and SE had a significant inverse relationship with patient falls with injury (p = .017 and .028, respectively), yet a positive relationship with HAPU rates (p = .051 and .026, respectively). While AL did not have a significant relationship with any of the three patient satisfaction metrics, a significant positive relationship with SE was found (p = .002, .001, and .002, respectively). There was no support for a relationship between actual staff nurse DI and any of the patient quality outcomes. This study extends previous research in this area in that it is the first to examine actual patient quality outcomes at the care unit level. These findings provide support for the unique contributions to patient quality outcomes at the care unit level, indicating the need to develop AL among front-line nurse managers and SE in nurse work environments. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Health plans are constantly seeking ways to assess and improve the quality of patient experience in various ambulatory and institutional settings. Standardized surveys are a common tool used to gather data about patient experience, and a useful measurement taken from these surveys is known as the Net Promoter Score (NPS). This score represents the extent to which a patient would, or would not, recommend his or her physician on a scale from 0 to 10, where 0 corresponds to "Extremely unlikely" and 10 to "Extremely likely". A large national health plan utilized automated calls to distribute such a survey to its members and was interested in understanding what factors contributed to a patient's satisfaction. Additionally, they were interested in whether or not NPS could be predicted using responses from other questions on the survey, along with demographic data. When the distribution of various predictors was compared between the less satisfied and highly satisfied members, there was significant overlap, indicating that not even the Bayes Classifier could successfully differentiate between these members. Moreover, the highly imbalanced proportion of NPS responses resulted in initial poor prediction accuracy. Thus, due to the non-linear structure of the data, and high number of categorical predictors, we have leveraged flexible methods, such as decision trees, bagging, and random forests, for modeling and prediction. We further altered the prediction step in the random forest algorithm in order to account for the imbalanced structure of the data.

Florence Nightingale used the principles of patient-centered care as the foundation for nursing practice. Today, patient-centered care delivery is part of the healthcare reform process that extends interprofessionally throughout all settings of healthcare in the United States (U.S.). Patient satisfaction measurement is one primary determinant of effective patient-centered care. The standardized Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and methods is a nation-wide tool used to measure patient satisfaction. However, this method of patient satisfaction assessment relies on recollections of patients’ hospital experiences and requires accurate memory and recall. This study sought to examine the effect of the memory-experience gap on patients’ perceptions of their hospital experiences and address this research question: Are there any statistical differences between in-hospital and two-week post-discharge perceptions of patient-centered care as measured with HCAHPS patient satisfaction ratings on (a) the composite scores for communication with nurses, communication with physicians, communication about medicines, pain management, staff responsiveness, (b) the individual scores for the hospital environment’s cleanliness and quietness, and the inclusion of patient and family preferences in the plan of care, and (c) the overall global rating score? The design was a non-experimental, prospective, descriptive correlational study. The setting was a 255-bed regional hospital that serves individuals from eight surrounding rural counties in southern middle Tennessee. The case-mix contained diverse individuals with multiple economic, environmental, physical, social and spiritual dynamics. A convenience sample of 82 adult patients ages 26 - 93 represented mainly Caucasian females with mostly cardiovascular and respiratory illnesses who had a minimum one-day stay.

Background: The correction of Class II malocclusions is one of the most common treatments performed in the United States. Despite Class II malocclusions being one the most commonly presented problems for orthodontists, there is no consensus of which non-surgical treatment modality best impacts a patient’s quality of life long term. Purpose: This study examines the different non-surgical treatment approaches for patients with severe Class II division 1 and the impact of treatment outcomes on patient satisfaction and quality of life long term. Study Design: This study retrospectively analyzed the different treatment approaches and outcomes of class II division 1 with severe overjet, while prospectively assessing patient satisfaction and quality of life long term. Initial and final cephalometric and clinical variables for 83 patients (38 at Harvard School of Dental Medicine, 30 at the University of Iowa, and 15 in private practice in Iowa) treated non-surgically were recorded and analyzed. A retention clinical exam, at least 6 months post-debond, was done for final measurements, assessment of practitioner and patient satisfaction, and patient quality of life questionnaires. Results: Non-surgical treatment of severe Class II division 1 malocclusions yielded 5.54 mm overjet reduction and 0.51 mm of relapse in retention on average. Patients with more overjet at their long term retention check demonstrated significantly poorer satisfaction scores with the appearance of their bite (p<0.001), the appearance of their face (p<0.001), and with their overall orthodontic treatment (p<0.001). Extraction treatment was associated with significantly lower patient satisfaction scores of overall orthodontic treatment (p=0.023) and appearance of bite (p=0.018) but not facial appearance. Patients treated with extractions also showed higher QOL scores on the OHIP-14 (p=0.022) and CPQ (p=0.002) surveys, indicating that extraction therapy of severe Class II division 1 patients led to a significantly poorer quality of life. Conclusion: Non-surgical treatment of severe Class II division 1 malocclusions can yield excellent results and stability long term. Overjet can be dramatically reduced with non-surgical treatment but there is a tendency for overjet to relapse in retention. While treatment outcomes yielded high results of patient satisfaction, patients with more overjet in retention displayed significantly less satisfaction of the appearance of their bite, appearance of their face, and with their overall orthodontic treatment. Extraction treatment was associated with significantly lower patient satisfaction scores of overall orthodontic treatment and appearance of bite but not facial appearance. Patients treated with extractions showed poorer quality of life scores in retention compared to those treated nonextraction.

Patient satisfaction has become increasingly important to medical facilities as a result of reimbursement rates being tied to patient satisfaction scores. Music therapy’s potential to enhance patient satisfaction scores has been explored and several studies exist examining its impact in the medical setting. No studies exist, however, examining how music therapy contributes to patient satisfaction scores in the behavioral health setting. Therefore, the purpose of this study was to compare overall patient satisfaction scores of inpatient psychiatric patients who received group music therapy services with those at the same facility who did not receive group music therapy services. Participants who attended music therapy group (n=14) received an anonymous, voluntary survey with 10 questions based on the facility’s satisfaction survey and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Participants who did not attend music therapy group (n=15) received the same survey. Results showed that patients who attended music therapy group reported overall satisfaction scores that were on average 3.02 points higher than participants who did not attend music therapy group. Age correlation and gender differences which may affect patient satisfaction scores are described. The implications for future research and current clinical practice are also discussed.

This thesis examines the relationship between physician communication style and patient satisfaction in the diagnostic medical interview. Patient satisfaction is a critical issue for health care organizations today. Health care organizations are coping with the recruitment and maintenance of patient consumers in a competitive and costly market. The literature indicates that effective communication between the physician and the patient is important to patient satisfaction. The physician needs to structure the medical visit in order to acquire medical information and, at the same time, invite communication with patients to determine their concerns and needs. Patient satisfaction may ensue if the patient perceives the physician as possessing a positive communication style.

Healthcare administrators can improve patient care and safety by stimulating nurse engagement as a means of improving internal relationships. The purpose of this case study was to explore engagement strategies that healthcare administrators use to stimulate nurse engagement. Data were collected using semistructured interviews with 4 healthcare administrators in a Missouri hospital setting. The engagement theory informed the conceptual framework of the study. Data were analyzed using Yin's 5-step process that included compiling, disassembling, reassembling, interpreting, and concluding. Analysis revealed 4 major themes: teamwork, nurse and administrator communication, nurse recognition, and nurse empowerment. Strategies were identified through the exploration and analysis of the 4 themes, and the major findings included healthcare administrators increase trust with nurses by forming teams, and administrators who increase communication are more likely to stimulate nurse engagement. The social change implication for this study was that findings of nurse engagement may lead to improved patient care and contribute to a positive patient experience, which benefit patients and their families. Improved patient care may lead to greater faith and credence in medical care benefiting citizens, practitioners, and healthcare administrators.

The present study examined the effect of information about patient's dental anxiety on patient satisfaction, patient discomfort, and patients' perceptions of dental student behaviors. The validity of patients' perceptions was examined by independent observation of dental student behaviors on videotaped dental screening visits. Thirty dental students each examined two dentally anxious female patients. Each student received information about one of the patient' s dental anxiety and no information about the other. The order of presentation of the conditions information and no information was counterbalanced. The dependent measures were the Dentist Behavior Checklist, the Dental Visit Satisfaction Scale, the Patient Discomfort Item, and independent observations of seven specific dental student behaviors. Results of the present study suggest that patients' perceptions of specific dental student behaviors are only moderately correlated with independent observation for three of the behaviors. The presentation of information about patient dental anxiety resulted in no significant differences in patients' perceptions of behaviors. A significant interaction effect was found, however, between information and order of presentation for the independent observations of Took Patient Seriously and Was Calm. These findings suggest that when nonverbal behaviors were examined, dental students were more responsive to patients. This was only true, however, when students received information in the Information/No Information order. No significant differences were found in either patient satisfaction or patient discomfort as a result of providing information about patient anxiety. Lastly, none of the dental student behaviors as independently observed were related to patient satisfaction. However, patients' perceptions of Encouraged Questions and Took Patient seriously were significant predictors of patient satisfaction. Suggestions for further research include continued attempts to delineate dentist behaviors which are correlated with patient satisfaction.

Magister Commercii - MCom / The South African democratic government is mandated by the constitution to provide quality healthcare services to the citizens of the country. Therefore, healthcare in South Africa is considered as a basic human right. The existing healthcare system exhibits extreme inequality, which translates into inequity in health outcomes across different demographic factors. Even though quality healthcare is a basic human right, problems related to the quality of healthcare remain, which poses a major challenge for the South African government. This dissertation investigates patient perceptions of the quality of public healthcare in South Africa, using General Household Survey data (2009-2016), with the objective of determining the level and trends of patient satisfaction and complaints reported when accessing public healthcare services in South Africa and identifying the correlates of these perception. This study found that patient satisfaction with public healthcare services in South Africa has increased over time while complaints have decreased over time. This study refrains from drawing conclusion on these findings at face value, since they may be other factors that explain the observed trends. The most common complaint was long waiting time at public healthcare facilities. On average, White individuals, male household heads, individuals residing in rural areas and individuals from smaller household were more likely to report to being satisfied with healthcare services received at public healthcare facilities in South Africa. Therefore, patient satisfaction survey approach should be used in conjunction with other healthcare quality measures such as direct observation, vignettes and standardised or mystery patient.