Background: Communication allows people to gain understanding of themselves and their surroundings, which is a prerequisite for good health. The nurse may in her communication help patients develop a feeling that they are not alone in their situation. If the patients cannot express themselves and make themselves understood, it can lead the patients to feel left out which emphasizes the suffering at having aphasia. Aim: The aim of this study was to identify the components which affect nurse’s communication with patients with aphasia. Analysis method: A literature review was made based on eleven scientific articles in which similarities were pointed out. Results: The result of this study is presented in three main categories: Time, Environment and Strategies. Eighth subcategory emerged: Knowledge and patient under Time; Physical and psychosocial under Environment; and Verbal, Nonverbal, Augmentative and Alternative Communication (AAC) and Individual Care under Strategies. Conclusion: This study reveals how nurses can provide the opportunity for patients to increase self-confidence. The result suggests that a person-centered communication care plan as a basic instrument to facilitate patient and caregiver interaction is needed.

Bakgrund: Patientcentrerad vård är ett viktigt begrepp i den svenska hälso- och sjukvården. Begreppet patientcentrerad vård innehåller olika delar som autonomi, integritet, empowerment och patientdelaktighet. Hälso- och sjukvårdslagen och Socialstyrelsen beskriver att dessa delar är viktiga för sjuksköterskor att följa. Syfte: Studiens syfte är att beskriva sjusköterskors erfarenheter av patientcentrerad vård. Metod: En kvalitativ metod användes tillsammans med ett sjuksköterskeperspektiv. Insamlingen av data gjordes med kvalitativa enkäter med öppna frågor. Datamaterialet analyserades med en kvalitativ innehållsanalys. Resultat: Resultatet presenteras med sex  teman; Att visa respekt för patientens autonomi och integritet, Att förstå patientens livsvärld, Att göra patienten delaktig, Att kunna kommunicera med patienten samt Att inte ha tid att lyssna på patienten. Dessa teman beskriver vikten av en god kommunikation och patientdelaktighet. Resultatet beskriver även hur sjuksköterskor kan visa hänsyn och respekt för patienten. Det framkom även att det ibland kan vara svårt att följa en patientcentrerad vård. Slutsats: Studien påvisar att sjuksköterskors erfarenheter av patientcentrerad vård främst är god. Faktorer som exempelvis stress kan dock påverka den patientcentrerade vården negativt. / Background: Patient-centered care is an important concept in Swedish healthcare. The concept of patient-centered care contains of different parts as autonomy, integrity, empowerment and patient participation. Hälso- och sjukvårdslagen and Socialstyrelsen is describing that these parts is important for nurses to follow. Aim: The aim of this study is to describe nurses' experiences of patient-centered care. Method: A qualitative method was used with a nursing perspective. To collect data qualitative questionnaires with open-ended questions was used. The data was analyzed with a qualitative content analysis. Results: The results is presented with six themes; To show respect for the patients autonomy and integrity, To understands the patients lifeworld, To make the patient participating, To communicate with the patient and Not having time to listen to the patient. Those themes describes the importance of a good communication and patient participation. The results also describes how nurses can show consideration and respect for the patient. It also emerged that it sometimes can be difficult to follow a patient-centered care. Conclusion: The study shows that nurses' experiences of patient-centered care is mainly good, but that factors such as stress can affect the patient-centered care negatively.

OBJECTIVE: This study investigated how upper limb post-operative patients defined quality care. We specifically assessed the following three aims: (1) determining patient expectations following upper limb surgery, (2) identifying patient recognized barriers to receiving quality care, and (3) analyzing patient identified areas of improvement in patient education. METHOD: In total, 52 patients, aged 19 – 89 years (mean age: 48 years) who received upper limb surgery were surveyed with an open-ended questionnaire during their six to eight week post-operative visit at Stanford Medicine Outpatient Center in Redwood City or Stanford Orthopaedic Surgery Clinic in Los Gatos. Responses were electronically transcribed to REDcap, Research Electronic Data Capture System, for analysis of responses to demographic questions. Open-ended questions were evaluated by thematic analysis until data saturation was reached. RESULTS: Thematic analysis of open-ended responses revealed three main themes: (1) Pain, (2) Function; and (3) Patient Unpreparedness. Both pain and function involved pre- and post-operative factors. Of our three identified themes, elimination of pain and regaining function were the two main health-outcomes that upper limb patients identified as successful treatments of their condition. Patient unpreparedness was recognized as a main barrier in patients receiving quality care and an important area to improve patient education about their problem and treatment. CONCLUSION: By understanding the desired health outcomes and limitations in achieving those outcomes for post-operative upper limb patients, we can improve how medical care is practiced. Our results highlighted that both process and outcome domains of care are important elements in patients’ definition of quality care when seeking medical treatment for their upper limb problems. Specifically, patients identified that elimination of pain and regaining function were important health outcomes during their care. In order to achieve those desired health-outcomes, we recognized that improvements need to be made with regard to patient education about their health condition and treatment process, in order to foster better physician-patient communication. Overall, our findings support the need for continued focus on patient-centered care to ensure the delivery of quality healthcare to all patients.

The purpose of this DNP project was to determine the feasibility of implementing a nurse practitioner led interprofessional collaborative management model of caring for patients with complex medical conditions who are at high risk for ED and hospital readmission. The target of the feasibility study was an accountable care organization (ACO) in Idaho. The ACO assumes greater financial risk for providing care to a population that includes Medicare Advantage patients - dual insured Medicare/Medicaid patients. The care management teams are currently led by physicians. The members of the population that suffer most from multiple chronic conditions often encounter barriers to accessing high quality primary care, in particular when transitioning between different levels of care. Interprofessional collaborative team based care coordination can address medical and social issues that can affect a patient’s ability to achieve/maintain wellness. The literature suggests that nurse practitioners are ideally suited to lead those teams Approval was given by leadership in the ACO to accomplish a study to determine the feasibility of successfully implementing an innovative NP led interprofessional collaborative care management model: the AEIØOU Bundle of Care Practices. Principles of qualitative descriptive methodology, using content analysis, were applied to explore the responses provided at individual interviews by thirteen key stakeholders. The data collected were not intended to be generalized, but rather to evaluate the potential for implementation of a new model of interprofessional collaborative care within the ACO. Findings suggest that implementation of this model is feasible within the ACO. Common themes uncovered include: (a) change is challenging, (b) coordinated patient care aligns with organizational goals, (c) success requires cost analysis, a comprehensive business plan, buy-in from primary care physicians, and a pilot program, and (d) strong support among all participants for NP and RN home visits was notable.

<p>Physicians must explain medical information to patients in a way that patients can understand, and physician use of analogies is one strategy that may help patients better understand health information. The present dissertation, guided by patient-centered communication, investigated whether the use of analogies by a physician within a medical encounter enhances participants’ objective understanding, perceived understanding, and perceptions of clarity regarding information about a health condition, and perceptions of the physician in areas of liking, similarity, satisfaction, and affective communication. The experiment consisted of eight conditions with a 2 (familiar/unfamiliar health condition) x 4 (no analogies, diagnosis analogies, treatment analogies, both diagnosis and treatment analogies) design, and the conditions varied by being exposed to the familiar or unfamiliar health issue first. An actor physician delivered a 1-2 minute video-recorded message, diagnosing the participants, serving as analogue patients, with the familiar or unfamiliar health issue. After watching the video and responding to the dependent variable measures based on their perceptions of the physician and video message, U.S. adult participants read a vignette of another physician diagnosing them with the other (familiar or unfamiliar) health issue, and answered the same dependent variable measures regarding the physician and vignette message. Open-ended questions sought to understand what participants remembered from the message and whether they recalled analogies in their retelling of the physician messages, whether they (dis)liked the analogies, what they (dis)liked about the physicians and whether these perceptions differed by analogy conditions, whether they remembered any analogies from their own clinicians, and in which medical situations they found provider analogies to be useful. Findings indicated when including health literacy as a covariate, analogies did not enhance perceptions of clarity, perceived understanding, or objective understanding. Regarding positive perceptions, analogies did not influence liking, similarity, satisfaction, or affective communication. There was no significant interaction between use of analogies and health issues, nor a difference in the effectiveness of the analogies based on whether they were used to describe diagnosis or treatment. Explanations containing analogies resulted in increased objective understanding for the vignette compared to the video format. When recalling the physician’s message, participants rarely recalled analogies, nor explicitly mentioned them as something they liked or disliked. However, some participants recalled clinician use of particular analogies, and most of them indicated they found clinician analogies to be useful, especially when describing complex health issues that are difficult for patients to understand. The dissertation results indicate that healthcare providers may want to use analogies when interacting with patients, which could potentially improve the doctor-patient relationship. </p>

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Indiana University-Purdue University Indianapolis (IUPUI) / Cognitive changes associated with cancer and its treatment have been well documented. However, the majority of research on cognitive symptoms in cancer has been conducted with early-stage breast cancer patients or survivors in remission. Little is known about cognitive symptoms in patients with late-stage or metastatic cancers. To address this gap in the literature, this study examines cognitive and related symptoms among metastatic breast cancer patients enrolled in a parent study of perceptions of symptom importance and interference. Eighty metastatic breast cancer patients were recruited from the Indiana University Simon Cancer Center to participate in this cross-sectional telephone interview study. The interview consisted of self-report measures, including measures of symptom severity, distress, and the importance of seeing improvement in specific symptoms post-treatment. I hypothesized that cognitive complaints would cluster with fatigue, sleep disturbance, depressive symptoms, anxiety, and pain. This hypothesis was tested using cluster analysis and was partially supported. Cognitive complaints were found to cluster with fatigue, sleep disturbance, depressive symptoms, and anxiety, but not pain. In addition, the extent to which ratings of symptom importance for cognitive symptoms differed from those of other symptoms (i.e., pain, fatigue, sleep problems, depressive symptoms, anxiety, nausea, lymphedema, hot flashes, and neuropathy) was explored using ANOVA and Tukey’s HSD tests. Cognitive complaints were rated as significantly more important than anxiety, depressive symptoms, neuropathy, swelling, nausea, and hot flashes. Importance ratings for cognitive complaints, pain, fatigue, and sleep problems were not significantly different. Developing patient-centered treatment approaches that take into account symptom clustering and patients’ treatment priorities may increase treatment adherence and optimize healthcare quality.

In this review, we discuss considerations and successful models for providing decentralized diagnosis, treatment, and prevention services for children and adolescents. Key approaches to building decentralized capacity for childhood TB diagnosis in primary care facilities include provider training and increased access to child-focused diagnostic tools and techniques. Treatment of TB disease should be managed close to where patients live; pediatric formulations of both first-and second-line drugs should be widely available; and any hospitalization should be for as brief a period as medically indicated. TB preventive treatment for child and adolescent contacts must be greatly expanded, which will require home visits to identify contacts, building capacity to rule out TB, and adoption of shorter preventive regimens. Decentralization of TB services should involve the private sector, with collaborations outside the TB program in order to reach children and adolescents where they first enter the health care system. The impact of decentralization will be maximized if programs are family-centered and designed around responding to the needs of children and adolescents affected by TB, as well as their families. / Revisión por pares

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