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

The purpose of this study was to assess parental and medical staff perceptions of the implementation of family-centered care during the surgical process at a pediatric hospital. Both children and parents experience hospitalization as a stressful process often characterized by painful, frightening medical procedures, interactions with strangers, and a loss of control and decision-making abilities. Medical staff members can play a vital role in alleviating parental distress by providing clear and consistent communication, support, and collaboration with parents throughout their child’s hospital care and recovery. Therefore, this study specifically sought to examine parental and medical staff members’ perceptions of the provision and importance of three types of social support: informational, emotional, and instrumental. This study also sought to examine the relationship between parental perceived provision and importance of social support and parental perceived stress. Qualitative questions were utilized to gather additional information regarding parents’ and medical staff members’ experiences throughout the surgical process. The sample for this study included 117 parents of surgical patients and 51 medical staff members (nurses, surgeons, and anesthesiologists) at a pediatric hospital in the southwestern United States. The quantitative data were analyzed using Mann-Whitney U Tests, Kruskal-Wallis Tests, and correlational analysis. Qualitative data were examined to identify major themes that have supported and contrasted with the quantitative results. The findings of this study revealed statistically significant differences between the perceived provision and importance of social support types among participant groups. Results also indicated statistically significant associations between parental perceptions of the provision and importance of social support type and parental perceived stress. These significant findings serve to inform care for families during the surgical process and guide future research in this area. / text

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Background: More people than ever before are now seeking refuge from war and terror in other countries (UNHCR, 2016). This has as a consequence that the health care in many Western countries faces new patient categories which don’t speak the language and are culturally different from what health professionals are familiar with. Ethical considerations are important, since being misunderstood and not met with dignity or respect can cause care-related suffering. This may increase the suffering already experienced due to loss of security, family and friends. Aim: To illustrate refugees’ experiences in the contact with health care. Method: This is a literature-based, qualitative study. 15 articles were selected to investigate refugees’ experiences of health care. The analysis resulted in 2 themes, each containing 3 subthemes. Results: The main themes that emerged were: Feeling acknowledged and respected, and Overcoming language and cultural barriers. The result mainly reveals that language barriers are common, and that refugees consider it important to be seen as individuals, which is not always the case in health care. Conclusion: The challenge in caring for refugees as a nurse consists in ensuring there is a common understanding. While being aware of a patient’s history, it is also important to see the individual in a person-centered approach. / Att bryta upp från familj och allt man känner sig trygg med försätter människan i en utsatt position. Den vilsenhet detta medför skapar ett lidande. Som sjuksköterska är det viktigt att vara medveten om detta. Författarna till detta litteraturbaserade arbete har studerat 15 vetenskapliga artiklar där flyktingars perspektiv av olika vårdmöten står i fokus. Resultatet visar att flyktingar upplever språket som det största problemet i mötet, men att även deras kultur och religion spelar in i vad de tycker är en bra vård. I många fall känner flyktingar sig förbisedda eller diskriminerade. Detta har i många fall att göra med att de inte blir bemötta som individer utan ses som en del av en annan kultur. För att undvika problem med språkförbistringar är det att föredra att anlita tolk. Detta är emellertid inte helt problemfritt. Tolkar påverkar mötet på olika sätt beroende på vem patienten är. Studiens resultat visar att många flyktingar föredrar en tolk av samma kön. Det bidrar till att de lättare kan öppna upp sig och att intima situationer, exempelvis avklädning, inte blir så svåra att hantera. Samma förhållanden råder när det gäller kön på vårdpersonal. Att undersökas av någon av motsatt kön kräver att detta upplevs som ofrånkomligt och väl förankrat. De upplevelser som har med kultur och religion att göra varierar mellan flyktinggrupper och enskilda personer. De berör hur man vill bli bemött och behandlad. Det visar sig att patienterna i många fall är ovana vid ett personcentrerat förhållningssätt. Att utveckla ett sådant förhållningssätt är dock viktigt, eftersom brister i detta gör att flyktingarna känner sig diskriminerade och förbisedda. Det kan även leda till att de går miste om viktig information om sin sjukdom och rekommenderade behandling. Om sjuksköterskor tillämpar personcentrerad vård där patientberättelsen och partnerskap ligger till grund kan vårdlidande undvikas.

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.

Scholars since the 19th century have focused on the provision of care in group homes and have demonstrated that structure (that is, the staff, facilities, and equipment), is critical in the delivery of care. The researchers, however, advocate doing for, rather than doing with the clients the activities that address the clients' welfare. The purpose of this study is to investigate how a client-centered approach would affect the quality of care delivered to the mentally challenged individuals (MCIs) in a group home. The study employed the quality-care framework in which the emphasis is on structure (skills), process (efficiency), and outcome (results). The research questions examined operational values underpinning company sanctioned work processes, how personal values underpin work processes of the direct caregivers, configuration of personal values the caregivers believe should be supported in the group home context, and how critical incidents shaped the value set of direct caregivers in regard to care processes. Using structured questionnaires and observing staff as they delivered care to their clients, data were collected from participants who were direct caregivers (n = 7), a facility administrator, and a nurse. The data were coded, categorized, and analyzed for emergent themes. The results of the analysis indicated that there was discord between staff and the organizational leadership. This discord could be improved through increased interaction between the mentioned stakeholders. The results further depicted that client-centered care may have a positive impact on the health of the MCIs that would enable the MCIs to make notable contributions to social change.

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

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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.