The purpose of this project was to evaluate the effects of relationship-based care (RBC) on patient satisfaction. RBC is a caring model that promotes a caring and healing environment by establishing and maintaining therapeutic relationships between patient, self, and coworker. The Centers for Medicare & Medicaid Services links Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores with reimbursement to hospitals. It is essential to not only achieve high patient satisfaction scores in order to ensure full financial reimbursement, but also to ensure high quality, patient-centered care. The current project assessed samples from 2 medical surgical groups, one system-wide and the other only patients from a single inpatient unit with sample sizes approximately 2,900 and 250 respectively. Data were collected retrospectively 3 times using the Press Ganey webpage at pre implementation, 6 months, and 12 months post RBC training. Results from an ANOVA indicated only a slight increase in post intervention HCAHPS scores with no statistical significant improvement. However, this increase indicates a positive trend, suggesting that the implementation of RBC may have assisted in improving patient responses. This evaluation has implications for the continued implementation for the enhancement of patient-centered care. These findings suggest that a nursing care model provides a collective belief to define a specific attitude to deliver care, facilitate professional development, and improve outcomes. By following RBC, nurses share a similar philosophy toward a caring environment.

The Patient-Centered Medical Home (PCMH) is an innovative, team-based health care model that was applied during the implementation of the Affordable Care Act (ACA). However, the competencies for PCMH health care social worker team members are not identified within this model. Thus, the purpose of this phenomenological study focused on identifying the core competencies that will enable social workers to perform competently in PCMHs. This study also explored the roles and training needs as related to improving the competence of social workers. Sandberg's and Parry's conceptualization of the competency model was used as the theoretical framework. Data were acquired through interviews with 10 PCMH social workers. These data were then inductively coded and analyzed using a modified Moustakas method. Key findings indicated that these social workers believed that improvements in competencies may include training and knowledge with mental health and physical health knowledge which consist of diagnoses, interventions, medications, symptoms, and terminology. It was also noted that knowledge of evidence-based practices for mental health interventions and patient-centered, team-based principles were essential to ACA policy implementation. The positive social change implications of this study include recommendations to health care leadership, educational institutions, and other PCMH providers to develop competency-based training for social workers. Recommendations are also put forth to adapt social work curriculum to ensure the effective implementation of the principles of the ACA policy and to improve social work practice in PCMH health care settings.

Syftet med studien var att undersöka hur sjuksköterskor på en allmänpediatrisk avdelning disponerar sin tid gällande administrativa arbetsuppgifter jämfört mot direkt och indirekt patientkontakt. För att granska detta fenomen utfördes en aktivitetsstudie. Metod designen var icke experimentell deskriptiv observationsstudie. Där sju olika sjuksköterskor följdes under femton dagar där tidmätning skedde av på förhand kategoriserade aktiviteter. Kategoriseringsschema innehöll nio olika kategorier. Resultatet visade att 19,53 procent av arbetspasset vilket motsvarar 97 minuter spenderades med direkt patientkontakt respektive de 24,3 procent vilket motsvarar 120 minuter per dag till administrativa göromål. Dessutom uppmättes det att sjuksköterskorna blev avbrutna i snitt 26 gånger under ett åtta timmars arbetspass vilket resulterar till 3,25 avbrott per timme. Forskarnas slutsats är att det finns flera fördelar med ökad tid för patientkontakt och att detta är synnerhet gällande på en allmänpediatrisk avdelning. / The aim of the study was to examine how nurses at a general pediatric unit dispose of their time regarding administrative duties compared to direct interaction with the patient. To appropriately survey this phenomenon an activity study was conducted. The method for data collection was a nonexperimental descriptive observational study where seven nurses were followed for a total of fifteen days where the amount of time of their activities where noted according to an activity schedule that was formed beforehand. The schedule contained nine categories including the amount of interruptions nurses where subject to. The result of the study showed that roughly 19,53 percent of the nurses’ time, which is the equivalent to 97 minutes, were spent directly with the patients compared to the 24,3 percent, which amounts to 120 minutes a day, she spent with administrative tasks. Furthermore it was found that a nurse is in average interrupted 26 times during an eight hour shift which gives an average of 3,25 interruptions every hour. In conclusion the authors found ground that there are many benefits with increased nurse-patient time and believe this is especially true in a general pediatric unit.

In this dissertation, we present a collection of manuscripts describing the development of prognostic models designed to assist clinical decision making. This work is motivated by limitations of commonly used techniques to produce accessible prognostic models with easily interpretable and clinically credible results. Such limitations hinder prognostic model widespread utilization in medical practice. Our methodology is based on Rough Set Theory (RST) as a mathematical tool for clinical data anal- ysis. We focus on developing rule-based prognostic models for end-of life care decision making in an effort to improve the hospice referral process. The development of the prognostic models is demonstrated using a retrospective data set of 9,103 terminally ill patients containing physiological characteristics, diagnostic information and neurological function values. We develop four RST-based prognostic models and compare them with commonly used classification techniques including logistic regression, support vector machines, random forest and decision trees in terms of characteristics related to clinical credibility such as accessibility and accuracy. RST based models show comparable accuracy with other methodologies while providing accessible models with a structure that facilitates clinical interpretation. They offer both more insight into the model process and more opportunity for the model to incorporate personal information of those making and being affected by the decision.

No description available.

Bakgrund: Kommunikation innebär en relation mellan en sändare och en mottagare samt ett möte på en jämlik nivå. Att lyssna aktivt är en grundläggande kunskap inom omvårdnad och lyssnandet leder till att sedan kunna kommunicera effektivt. Vårdprofessioner kommunicerar på varierande sätt, har olika mål med kommunikationen samt att det finns flera samtalstekniker. Ett hinder i kommunikationen beskrivs som avsaknad av ett gemensamt språk eller att tolk används till hjälp. Syfte: Att belysa kommunikation, samtalet och lyssnandet i mötet mellan patient och vårdare i vårdmiljö. Metod: En beskrivande litteraturstudie. Resultat: Indelades i tre olika kategorier: Tala är silver, Tiga är guld och Att inte förstå varandra. God kommunikation ledde till trygghet och följsamhet hos patienter. Patient-centrerad kommunikation stimulerade empowerment och gav bättre hälsa. Samtal som redskap var det viktigaste redskapet och krävde träning för att utföras. Aktivt lyssnande ledde till nöjdare patienter, färre återbesök och en ökad tillfredställelse hos patienten. Att avbryta eller leda samtalet ledde till ineffektiv kommunikation. Hinder i kommunikationen kunde äventyra patientsäkerheten samt öka patientens lidande. Med tolk kunde de kulturella skillnaderna försvåras, men även att vara tre i en vårdrelation kunde leda till missförstånd. Slutsats: Kommunikation var basen i vårdmötet. Tala var silver men att tiga var guld. / Background: Communication is a relationship between a transmitter and receiver, and a meeting on an equal level. Active listening is a basic knowledge in nursing and listening leading to communicate effectively. Health care professionals communicate in different ways have different goals with communication and that there is several conversations techniques. One obstacle in communication is described as the absence of a common language or interpreter is used to help. Aim: Highlighting communication, conversation and listening in the meeting between patient and caregiver in the healthcare environment. Method: A descriptive literature-review. Result: Divided into three categories: Speech is silver, silence is golden, and Not understanding each other. Good communication led to patients felt safe and adherence. Patient-centered communication stimulated empowerment and provided better health. Conversation as a gear was the main tool and required training to be performed. Active listening led to more satisfied patients, fewer return visits and increased patient satisfaction. To interrupt or lead the conversation leads to ineffective communication. Barriers in communication could jeopardize patient safety and increase patient suffering. With an interpreter could be the cultural aspects complicate but also to be three in a health care relationship could lead to misunderstanding. Conclusion: Communication was the basis of health meeting. Speech was silver but silence was golden.

No description available.

Bakgrund: En av grunderna för den palliativa vården är patienten, att patienten trots sin svåra situation får uppleva en god livskvalitet. Känsla av kontroll är även det en grund för den palliativa vården, vilket kan påverkas av personcentrerad vård. Vid en väl uppfylld personcentrerad vård kan en känsla av kontroll infinna sig hos patienten, vilket är en stor betydande del i den annars något svårt greppbara situationen. Syfte: Syftet är att sammanställa tidigare forskning om upplevelser hos patienter som erhåller palliativ vård i sitt eget hem. Metod: Detta är en litteraturöversikt som är baserad på 15 olika artiklar. Datainsamlingen har skett via sökningar i databaserna PubMed och CINAHL och är systematiskt analyserade innan de är sammanställda i resultatet. Resultat: Majoriteten av patienterna upplevde den palliativa vården i hemmet som positiv, vårdpersonalen ansågs vara trevliga, pålästa och engagerade. Patienterna poängterade även att för att behålla en god livskvalitet var en grundläggande del att patientens personlighet fick bevaras, att patienten ses som en person och inte som sin sjukdom. Det var också viktigt för patienterna att de fick känna sig självständiga och behövda. Konklusion: Patienterna upplevde att de blev väl omhändertagna samt att deras önskan sattes i fokus. För att detta skall uppnås var det viktigt att sjuksköterskan uppmuntrade och lyfte patientens åsikter, behov och vilja. / Background: One of the fundamentals of palliative care is the patient, to give the patient a decent quality of life despite their difficult situation. A sense of control is another essential part of palliative care, this can be obtained by person centered care. By well performed person centered care the patient may feel like they are in control, which is important in a situation that otherwise can be hard to handle. Aim: The aim of this study was to state previous research on how patients experiences palliative care in their own home. Methods: This is a literature review based on 15 articles. The articles who were found in the databases PubMed and CINAHL is systematically analyzed before they were compiled in the result. Results: The majority of patients experiences the palliative care in their own home as positive, they thought that the staff was kind, well prepared and committed. The patient also pointed that the essential part to maintain a good quality of life was to retaining the patients personality, and that the patient are being seen as a person and not as their disease. Other important things for the patients was to feel independent and to have a feeling of being needed. Conclusions: The patients felt that they were taken care of in a good way and that their wishes about their care was prioritized. For this to be achieved, the nurse encourages the patient's opinions, needs and will.

Bakgrund: Den perioperativa vården syftar till en individuellt anpassad vård som tillgodoser patientens unika behov. Kvalitativ forskning om ungdomars upplevelser av detta är begränsad.  Syfte: Syftet var att undersöka ungdomars tankar inför operation och upplevelser av den perioperativa vården.  Metod: Studien genomfördes som en kvalitativ intervjustudie med semistrukturerade frågor. Datan analyserades med hjälp av systematisk textkondensering (STC). Tio ungdomar i åldrarna 12 till 17 år som hade genomgått operation under generell anestesi intervjuades på ett universitetssjukhus i Mellansverige under våren 2018.  Resultat: Analysen resulterade i tre kategorier “tankar kring anestesi, kirurgi och livet”, “erfarenheter av den preoperativa informationen” och “faktorer som påverkar välbefinnandet”. Ungdomarna fokuserade på hur operationen skulle påverka det sociala livet. De hade frågor och tankar som berörde såväl anestesin och kirurgin vilket hanterades på olika sätt. De besked och den information ungdomarna fick under det preoperativa vårdförloppet upplevdes som bristfällig och oanpassad, vilket bidrog till stress och oro. Delaktighet och personcentrerad omvårdnad bidrog till trygghet och en bra relation mellan patient och vårdare.  Slutsats: Resultatet visade på att personalen som är involverad i den perioperativa vården behöver kunskap om ungdomars upplevelser och erfarenheter av den perioperativa vården och operation för att på så sätt kunna förstå vilka omvårdnadshandlingar som är viktiga att ta hänsyn till utifrån ett ungdomsperspektiv. Kunskapen kan användas för att utveckla riktlinjer och den perioperativa vården för att främja patientbemötandet utifrån ungdomars unika förutsättningar. / Introduction: The perioperative care aims at an individually adapted care that meets the patient's unique needs. Qualitative research on adolescents experiences in this subject is limited.  Aim: The purpose was to investigate the thoughts of adolescents on the operation and experiences of perioperative care.  Methodology: The study was conducted as a qualitative interview study with semistructured questions. The data was analyzed using systematic text condensation (STC). Adolescents aged 12 to 17 years who had undergone surgery under general anesthesia were interviewed at a university hospital in central Sweden in the spring of 2018.  Results: The analysis resulted in three categories "thoughts about anesthesia, surgery and life", "experiences of preoperative information" and "factors that affect well-being". The adolescents focused on how the operation would affect the social life. They had questions and thoughts that concerned both anesthesia and surgery, which was handled in different ways. The information the adolescents received during the preoperative stage were perceived to be inadequate and inappropriate, which contributed to stress and concern. Participation and person-centered care contributed to a feeling of safety and a good relationship between patients and caregivers.  Conclusion: The result showed that the personnel involved in the perioperative care need knowledge about the experiences of young people in perioperative care and surgery in order to understand which caring actions are important to take into account from an adolescent perspective. This knowledge can be used to develop guidelines and the perioperative care based on adolescents unique conditions.

abstract: Health and healing in the United States is in a moment of deep and broad transformation. Underpinning this transformation is a shift in focus from practitioner- and system-centric perspectives to patient and family expectations and their accompanying localized narratives. Situated within this transformation are patients and families of all kinds. This shift's interpretation lies in the converging and diverging trails of biomedicine, a patient-centric perspective of consensus between practitioner and patient, and postmodern philosophy, a break from prevailing norms and systems. Lending context is the dynamic interplay between increasing ethnic/cultural diversity, acculturation/biculturalism, and medical pluralism. Diverse populations continue to navigate multiple health and healing paradigms, engage in the process of their integration, and use health and healing practices that run corollary to them. The way this experience is viewed, whether biomedically or philosophically, has implications for the future of healthcare. Over this fluid interpenetration, with its vivid nuance, loom widespread health disparities. The adverse effects of static, fragmented healthcare systems unable to identify and answer diverse populations' emergent needs are acutely felt by these individuals. Eradication of health disparities is born from insight into how these populations experience health and healing. The resulting strategy must be one that simultaneously addresses the complex intricacies of patient-centered care, permits emergence of more localized narratives, and eschews systems that are no longer effective. It is the movement of caregivers across multiple health and healing sources, managing care for loved ones, that provides this insight and in which this project is keenly interested. Uncovering the emergent patterns of caregivers' management of these sources reveals a rich and nuanced spectrum of realities. These realities are replete with opportunities to re-frame health and healing in ways that better reflect what these diverse populations of caregivers and care recipients need. Engaging female Mexican American caregivers, a population whose experience is well-suited to aid in this re-frame, this project begins to provide that insight. Informed by a parent framework of Complexity Science, and balanced between biomedical and postmodern perspectives, this constructivist grounded theory secondary analysis charts these caregivers' processes and offers provocative findings and recommendations for understanding their experiences. / Dissertation/Thesis / Ph.D. Healthcare Innovation 2013