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Person-centered care (PCC) has been recognized by the Institute of Medicine as a critical element in the redesign of our nations healthcare system. Evidence suggests that the physical environment contributes to a more person-centered inpatient healthcare experience. This study explored the relationships among demographic characteristics of individuals receiving care in skilled nursing facilities, satisfaction with nursing care, perceived ambiance of the healthcare environment, and the perception of PCC. Descriptive statistics, Pearson’s correlation, Spearman’s rho, and hierarchical linear regression were used to analyze the data and answer the research questions. In addition, content analysis was used identify possible themes from the comments by the participants regarding the overall care experience. The sample consisted of 71 individuals (48 women) between the ages of 38 and 97 (M = 71.34, SD = 11.51) having received rehabilitation and/or nursing care in fourteen short-stay SNFs in Texas. A small positive significant relationship was found between the perception of personalized care and years of education (r = .27, p = .012). Moreover, a strong positive significant relationship was found between satisfaction with nursing care and PCC (r = .76, p <. 001), perceived ambiance and PCC (r = .57, p < .001), and satisfaction with nursing care and ambiance (r = .52, p < .001). Hierarchical linear regression only included years of education, satisfaction with nursing care, and ambiance since they were the only variables that had a significant relationship with the outcome variable. The analysis showed that satisfaction with nursing care was the strongest predictor of PCC accounting for 53% of the variance. In addition, ambiance was identified as a significant predictor of the perception of PCC after controlling for education and satisfaction with nursing care. Overall, the three variables accounted for 64% of the variance in the perception of PCC. This was the first study to explore the relationship between perceived ambiance of an inpatient healthcare setting and the perception of person centered care. These findings indicate that the physical environment is an important element that can influence the perception of personalized care in a short-stay SNF setting. / text

Accountable care units (ACU-?¢) provide a new model for integrated patient care. The ACU-?¢ promotes patient centeredness in nursing units as team members work collaboratively with physicians to improve patient outcomes and reduce unwarranted variations. A health system in the southeastern United States incorporated the ACU-?¢ as part of their care model. These units were held accountable for their clinical, service, and cost outcomes but lacked a validation process to demonstrate the effective utilization of their data. The purpose of this DNP project was to create a patient centered care (PCC) certification process, guided by the Donabedian model, that would provide hospital units the opportunity to access their process and quality improvement outcome data and to improve patient care. For this project, 12- key individuals were interviewed to gain their perspectives and input on the development and implementation of the PCC certification process. Results from the interviews were compiled and reviewed for common themes, which included Magnet-?¢ recognition, patient experience, current unit goals, and hospital strategic plan. Using the results of the interviews, a PCC certification procedure was created to outline the steps required to achieve certification; and, an application was developed to provide a standard format for quality and process improvement projects and associated outcomes reporting. The certification procedure will be implemented in the health system in the next fiscal year. Evaluation of the effectiveness of the program and future refinement will be controlled by the Nursing Shared Governance. The project may promote positive social change as the staff nurses on the individual units use the unit metrics to improve patient outcomes and reduce variations in care.

BACKGROUND: Pregnant and parenting women consistently show low rates of engagement and retention in substance use disorder (SUD) treatment. While pregnancy enhances motivation and commitment to treatment, this population faces unique barriers to accessing care. Co-design is an approach that proactively engages service users to create a care system shaped to meet their needs. This study evaluated an adapted experience-based co-design (EBCD) process involving SUD treatment staff and parenting women with SUD (WWLE). METHODS: Semi-structured interviews with WWLE and SUD treatment staff were conducted to develop content for the co-design process and identify barriers and facilitators to treatment. These data were analyzed using the principles of Trauma Informed Care (TIC). Multiple data sources were utilized to evaluate the co-design implementation, including semi-structured interviews, ethnographic observation, and discussion transcripts of EBCD launch events. The Integrated Promoting Action on Research in Health Services (i-PARIHS) framework informed tool development and data analysis of the co-design implementation. RESULTS: The full sample across all stages of the EBCD implementation totaled 34 individuals (WWLE =13 and SUD staff = 21). Findings highlighted the importance of TIC in small pivotal moments that either enhance or diminish treatment engagement and retention. For the evaluation, WWLE reported having a valued voice in the co-design process and attributed their comfort level to small, equally represented workgroups, skilled facilitation and pre-existing, respectful relationships with staff. Professionals expressed commitment to the concept of co-design, but displayed mixed perspectives about the value of EBCD. Complex regulations, limited funding, and uncertainties during start-up presented challenges to the co-design process. Use of a remote platform created accessibility for participants, but presented challenges to communication and relationship building. CONCLUSION: This research demonstrates how the core components of EBCD foster meaningful engagement of WWLE and can effectively create a collaborative co-design process that manages inherent power disparities between WWLW and treatment staff. The TIC analysis provides insight into aspects of care that encourage or deter women from treatment. This research illuminates the importance of integrating a TIC approach throughout a co-design initiative. Co-design presents an opportunity to create women-centered care and health equity in SUD treatment. / 2024-11-08T00:00:00Z

Acknowledgements First and foremost, I am very grateful to my supervisor, Dr. Kerstin de Wit, for her mentorship and guidance throughout my time as a graduate student. It has been a pleasure to work with someone so innovative and passionate about clinical research. Her ability to bridge thrombosis and emergency medicine research to improve and change clinical practice is inspiring. I am grateful to my supervisory committee members, Dr. Teresa Chan, Dr. Lori-Ann Linkins, and Dr. Mathew Mercuri, for their continuous support throughout this process. Our scientific discussions were always insightful, and motivated me to push myself as a researcher. I am very thankful to the entire EMeRGE Research Group for creating such a helpful and friendly environment. Their diligence and commitment to conducting high-quality research motivated me to do the same, and greatly expanded my knowledge on clinical research. Working with this team made my experience as a graduate student very memorable. I would like to thank my family and friends for all of the support they gave me throughout this entire process. Their constant encouragement and emotional support helped me overcome challenges and persevere, for which I am infinitely grateful. / Background: There is an evidence-practice gap between guidelines for diagnosing pulmonary embolism (PE) and emergency physician practice. This is concerning because computed tomography (CT) scanning is being overused to exclude PE in the emergency department (ED). It is possible that the answer behind this lies within the physician-patient relationship. Past research on shared decision-making strategies have shown to decrease use of hospital resources, and improve patient outcomes. Objective: The aim of this three-part MSc thesis was to achieve a patient-centered approach to the testing of PE in the ED. Method: 1) A systematic review on existing shared decision-making models used for testing and/or treatment of medical decisions in the ED was conducted. 2) Qualitative interviews with ED patients being tested for PE identified patient-specific values and preferences which may present as barriers to patient-centered care in the ED. 3) Both the systematic review and patient interviews informed the development of a new shared information tool to be used in the ED. Results: The systematic review found that shared decision-making interventions in ED patients tested for acute coronary syndrome and clinically-important traumatic brain injuries can potentially reduce hospital admissions and increase discharge rates without negatively affecting health outcomes. The qualitative interviews highlighted four major themes: 1) patient satisfaction comes from addressing their primary concern; 2) preference for imaging over clinical examination; 3) patients expect 100% certainty when given a diagnosis; and 4) patients expect individualized care throughout their entire ED visit. This data led to the formation of a shared information sheet which ensures that testing decisions for low-risk PE patients align with patient-specific values. Conclusion: By placing the focus on patient-centered care, this study incorporates evidence-based medicine with patient priorities in order to improve patient outcomes in the ED. / Thesis / Master of Science (MSc) / Pulmonary embolism occurs when blood clots form in veins of the legs, and travel to the lungs, causing chest pain and shortness of breath. There are well-established, evidence-based guidelines on how to diagnose pulmonary embolism. Diagnostic tools such as the Wells score and D-dimer have been proven to be safe and effective in ruling out pulmonary embolism in low risk patients preventing the need for a CT scan. However, CT scans are still being overused to diagnose pulmonary embolism in low risk patients. Unnecessary testing in the emergency department (ED) exposes patients to the harms associated with CT scanning: such as increased risk of cancer, and diagnosing blood clots that are not actually there, resulting in unnecessary treatment. It is possible that the answer behind the over-testing of PE in the ED lies within the physician-patient relationship. This three-part study first reviewed all prior studies on shared decision-making strategies, which are techniques used to help physician align medical decisions with patient-specific values, in the ED. Second, we employed qualitative methods to identify patient-specific values and preferences on PE testing in the ED. Finally, both of these aims informed the development of a patient-centered shared information tool to overcome barriers to patient-centered care. Ultimately, the goal of this study is to achieve a patient-centered approach to the testing of pulmonary embolism in the ED.

Submitted by admin tede (tede@pucgoias.edu.br) on 2017-02-23T17:48:27Z No. of bitstreams: 1 VANESSA DOS SANTOS PICÃO.pdf: 1451406 bytes, checksum: b3d821582fccdf2cf2fd9e4d0c796781 (MD5) / Made available in DSpace on 2017-02-23T17:48:27Z (GMT). No. of bitstreams: 1 VANESSA DOS SANTOS PICÃO.pdf: 1451406 bytes, checksum: b3d821582fccdf2cf2fd9e4d0c796781 (MD5) Previous issue date: 2016-02-26 / In Brazil, policies concerning women’s health are relatively new in Brazil, and in many states a program called Rede Cegonha is only gradually being realized. The present dissertation focuses the experience of obstetric intake at a service in hinterland of the state of Bahia. Objective: to investigate the experience of women in an obstetric unit during the moments immediately before childbirth. Method: Grounded Theory (GT) was chosen as theoretical and methodological reference for this study. Eleven women who had recently given birth were interviewed about their perception, feelings and experiences about the intake in the unit. Results: The analysis suggests three axes: Starting point, the Person in her context and e the Physical environment. These were constructed based on nine categories. The “Starting point” unites experiences and difficulties of transport to the unit. Many reported troubles in getting to the unit. The “Person in her context” describes vulnerabilities of the intake process, feeling cared for or not, valued or neglected. The recent mothers were sensitive to the interpersonal relation with the team, and to the rejection of their request to have a partner accompany them. However, most of them valued the service and the help they received. The axis “Physical environment” contains important ambient elements that positively or negatively influence the experience of the intake. Conclusion: Policies of personcentered care in obstetrics still have not been able to meet women’s real needs. Failure to meet the needs of women giving birth in the obstetric context leads to maladjustment in the process of delivery and birth. The perspectives analyzed in this study show that women are sensible to aspects like the personal relationship with the health professionals, care centered on the person with her vulnerabilities and the adequacy of the physical environment. Such factors can impact positively or negatively, depending on the experience of the woman giving birth. The same factors, when linked to the nursing practice, can also, aid or hinder adequate patient care. / As políticas de atenção à saúde da mulher no Brasil são relativamente novas e em muitos estados a Rede Cegonha ainda se encontra em fase de implantação. Esta dissertação enfoca a vivência do acolhimento à parturiente num serviço de obstetrícia no interior do estado de Bahia. Objetivo: investigar a vivência da parturiente em uma unidade obstétrica até os momentos que antecedem o parto. Método: a Grounded Theory (GT) ou Teoria Fundamentada nos Dados (TFD) foi escolhida como referencial teórico e metodológico para a realização deste estudo. Onze puérperas foram entrevistadas e as entrevistas concerniram à sua percepção, sentimentos e vivências acerca do acolhimento na unidade. Resultados: da análise das entrevistas surgiram três eixos norteadores, a saber: Ponto de partida, A pessoa no seu contexto e Ambiente físico; estes foram construídos a partir de nove categorias. O “Ponto de partida” abarcou vivências e complicações do deslocamento. Grande parte das parturientes apresentou dificuldade no transporte. “A pessoa no seu contexto” descreveu as fragilidades do processo, de sentir-se ou não assistida, valorizada ou negligenciada. As parturientes mostraram-se sensíveis à relação interpessoal com a equipe e à não permissão de acompanhante; contudo, quase todas valorizaram o serviço e o atendimento prestado, mesmo quando o percebiam de forma incompleta. O eixo “Ambiente físico” abarcou elementos importantes da ambiência que influenciam a vivência do acolhimento, positiva ou negativamente. Conclusão: as políticas e os programas de humanização na área obstétrica ainda não atendem às necessidades das parturientes. Falha em atender às necessidades das parturientes no contexto parto culmina em desajustes no processo de parto e nascimento. As perspectivas analisadas neste estudo mostram que as mulheres são sensíveis a aspectos como relacionamento com os profissionais, cuidados centrados na pessoa com suas fragilidades e adequação do ambiente físico. Tais fatores podem implicar positiva e/ou negativamente, a depender da vivência da parturiente. Essas mesmas vertentes, quando relacionadas à prática do enfermeiro, podem também, facilitar ou dificultar a assistência de enfermagem.

Learning Objectives: Describe the concept of patient ‐centered care from the pharmacist’s perspective. Summarize the science of patient ‐centered communication in pain management. Describe pharmacogenetic tests that are available to guide the use of opioids in pain management. Discuss research opportunities related to patient ‐centered care and genetic testing in pain management. Describe strategies used by pharmacists to implement genetic testing in clinical pharmacy practice.

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.