Thesis (M.S.)--University of Michigan, 1991.

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [97]-109).

Thesis (M.S.)--University of Michigan, 1991.

Magister Curationis - MCur / Background: Patient satisfaction is a well-researched area in general medicine worldwide, yet a full exploration of patient satisfaction amongst psychiatric patients appears to be lacking in South Africa. Patient satisfaction has become important because of the awareness of the patient’s human rights. There is an increasing practice of applying a consumer viewpoint to health care, while safeguarding patients’ rights and taking their views into account. This has been brought about by the inception of the Mental Health Care Act no. 17 of 2002.Purpose: The purpose of this study was to describe psychiatric inpatients’ satisfaction with the care provided in a psychiatric hospital in Cape Town.Objectives : (1) To describe the psychiatric inpatients’ satisfaction with the care provided in a psychiatric teaching hospital in terms of their views on the: care provided by nurses (interpersonal/nurse-patient- interaction and technical skills); care provided by doctors (interpersonal/doctor-patient interaction and technical skills; and the nature of the environment of care, and (2) to describe the psychiatric inpatients’ overall satisfaction with the care received in a psychiatric teaching hospital in terms of the: quality of care received from nurses and doctors; nature of the environment of care; and the likelihood of future utilization of the hospital serviceMethod/Design: The study made use of the quantitative descriptive design using the Primary Provider Theory of patient satisfaction and the Batho Pele Principles served as the conceptual framework. Data were collected from discharged patients using a self-administered questionnaire which was mailed to individual participants. A five and a four point Likert scales were used for different sections in the questionnaire.The study made use of 120 participants between the ages of 18 and 60.Findings: Generally respondents were satisfied with the care provided in thispsychiatric hospital. Greater satisfaction was noted on aspects of staff-patient interactions. Low satisfaction scores were observed on nurses’ technical aspects of care. The Batho Pele principles of information, openness and transparency,consultation, access and redress seem not to have been adhered to.Conclusions: General inpatient satisfaction in psychiatric hospital care was good.However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be given to the implementation of the Batho Pele Principles and the protection of the patients’ rights.

Magister Curationis - MCur / Background: Patient satisfaction is a well-researched area in general medicine worldwide, yet a full exploration of patient satisfaction amongst psychiatric patients appears to be lacking in South Africa. Patient satisfaction has become important because of the awareness of the patient’s human rights. There is an increasing practice of applying a consumer viewpoint to health care, while safeguarding patients’ rights and taking their views into account. This has been brought about by the inception of the Mental Health Care Act no. 17 of 2002. Purpose: The purpose of this study was to describe psychiatric inpatients’ satisfaction with the care provided in a psychiatric hospital in Cape Town. Objectives : (1) To describe the psychiatric inpatients’ satisfaction with the care provided in a psychiatric teaching hospital in terms of their views on the: care provided by nurses (interpersonal/nurse-patient- interaction and technical skills); care provided by doctors (interpersonal/doctor-patient interaction and technical skills; and the nature of the environment of care, and (2) to describe the psychiatric inpatients’ overall satisfaction with the care received in a psychiatric teaching hospital in terms of the: quality of care received from nurses and doctors; nature of the environment of care; and the likelihood of future utilization of the hospital services. Method/Design: The study made use of the quantitative descriptive design using the Primary Provider Theory of patient satisfaction and the Batho Pele Principles served as the conceptual framework. Data were collected from discharged patients using a self-administered questionnaire which was mailed to individual participants. A five and a four point Likert scales were used for different sections in the questionnaire. The study made use of 120 participants between the ages of 18 and 60. Findings: Generally respondents were satisfied with the care provided in this psychiatric hospital. Greater satisfaction was noted on aspects of staff-patient interactions. Low satisfaction scores were observed on nurses’ technical aspects of care. The Batho Pele principles of information, openness and transparency,consultation, access and redress seem not to have been adhered to. Conclusions: General inpatient satisfaction in psychiatric hospital care was good. However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be given to the implementation of the Batho Pele Principles and the protection of the patients’ rights.

This phenomenological study was designed to explore the essential structure of caring and uncaring encounters, as perceived by recipients of nursing care in their interactions with nurses, with the aim of adding to the knowledge and understanding of these phenomena. Data were collected through 18 in-depth interviews with nine former recipients of nursing care. The interviews were tape-recorded and transcribed verbatim for each participant. The researcher saw the participants in the study as coresearchers and through inter-subjective interaction, or dialogue, the essential description of a caring and an uncaring encounter was constructed. The essential structures of both caring and uncaring encounters are composed of three basic components: the approach by the nurse, the presence or absence of relationship formation, and finally, the patient responses to the encounter. The first component in the essential structure of a caring encounter with a nurse — from the client's perspective, is the professional caring nurse approach. The nurse is perceived to be competent, administering her care with genuine concern for the patient as a person, giving him full attention when with him, and constituting a cheerful presence for the patient. The coresearchers reported that these characteristics, which were perceived by them as evidence of caring, had promoted in them a feeling of trust, which had facilitated a development of a nurse-patient relationship. The development of a nurse-patient relationship, or professional attachment, comprises the second essential component of a caring encounter. Developing a nurse-patient relationship was conceptualized in this study as a process involving five phases: initiating attachment, consisting of reaching out and responding by both nurse and patient; mutual acknowledgement of personhood, where nurse and patient recognize each others as persons; acknowledgement of attachment, involving confirmation of attachment; professional intimacy, when the patient feels safe enough in the relationship to reveal to the nurse particulars about his present condition and how he feels about them; and finally negotiation of care, when the nurse works collaboratively with the patient and truely takes his perspective into account when giving nursing care. Throughout the attachment development the professional nurse keeps a distance, an important dimension of professional attachment which the coresearchers clearly articulated had to be present in order to keep the nurse-patient relationship within the professional domain. This combination of intimacy and distance is referred to as nurse-patient attachment with professional distance. The professional caring nurse approach and the resulting nurse-patient attachment with professional distance form the essential structure of professional caring. The patient responses to professional caring comprise the last component in the structure of a caring encounter with a nurse. Five themes were identified in the coresearchers' accounts: sense of acceptance and self-worth; sense of encouragement and support; sense of confidence and control; sense of well-being and healing; and finally sense of gratitude and liking. The essential structure of an uncaring encounter with a nurse — from the client's perspective is also comprised of three basic components: the nurse's approach to the patient, which is perceived by the patient as indifference to him as a person; the resulting nurse-patient detachment with total distance between the nurse and the patient; and finally patient responses to uncaring. Four dimensions of an uncaring nurse approach were identified in the data, characterized by increased indifference, inattentiveness, and insensitivity to the patient and his needs: apathetic inattention, unconcerned insensitivity unkind coldness, and harsh inhumanity. Perceived nurse indifference to the patient as a person makes the patient distrustful of the nurse. The patient often perceives the nurse as an authoritarian person with a need to control, and the patient's encounter with her is characterized by a lack of professional attachment, limited verbal communication, negative nonverbal communication by the nurse, and a lack of collaboration and negotiation of care. This is referred to as nurse-patient detachment with total distance. It was the core searchers' unanimous perception that uncaring encounters with nurses were very discouraging and distressing experiences for them as patients. The coresearchers responses to the uncaring encounters were many-sided. Seven major themes were identified in their accounts: puzzlement and disbelief; anger and resentment; despair and helplessness; feelings of alienation and identity-loss; feelings of vulnerability; perceived effects on healing; and finally long-term effects of uncaring encounters. It was the coresearchers' unanimous perception that the uncaring encounters made an indelible impression on them, had a longer lasting effect than caring encounters, and tended to be both acid edged and memorable unresolved experiences. / Applied Science, Faculty of / Nursing, School of / Graduate

The patient's failure to cooperate effectively in the patient/physician (patient and physician) interaction has been shown to be a problem of significant magnitude. In the present study, an attempt was made to identify specific, patient behaviors which might be related to physician judgment of a good patient and progress of treatment. A checklist of 37 behaviors was compiled. A series of 100 patients was observed during their interaction with physicians and occurrences of behaviors from the checklist were noted by an experimenter. Physicians also indicated whether the patient was considered to be a good patient and whether treatment was progressing as expected. For every third patient, physicians noted the occurrence of behaviors from the checklist. An association was found between some behaviors from the checklist and the physicians' judgment. There was also shown to be a difference in the ability of the experimenter and the physicians involved to detect these behaviors.

Background: Patient experience has become an essential quality indicator in healthcare. Purpose: The purpose of this thesis was to conduct a concept analysis of the patient experience. Methods: Walker and Avant’s methodology served as the framework for this concept analysis. Data were retrieved from seven databases and one search engine. The literature search used keywords related to "patient experience" and included articles published at any time up until March 2018. A total of 257 articles and organizational websites were included in the analysis after meeting the inclusion criteria. Results: Twenty attributes were found to define the patient experience: communication, respect for patients, information/education, patient-centered care, comfort/pain, discharge from hospital, hospital environment, professionalism/trust, clinical care/staff competency, access to care, global ratings, medication, transitions/continuity, emotional dimension, outcomes, hospital processes, safety/security, interdisciplinary team, social dimension, and patient dependent features. Conclusion: The results of this study will guide and clarify the critical concepts towards an explicit definition of the patient experience.

Thesis (Ph.D.)--University of Melbourne, Dept. of Medicine (RMH/WH), 2010. / Typescript. Includes bibliographical references (p. 359-392)

SAMMANFATTNING BAKGRUND: För att hälso- och sjukvården ska kunna hålla en hög kvalitet och fortsätta att utvecklas är det viktigt att uppmärksamma när patienter anser sig felbehandlade av vården. Vårdgivaren är skyldig att granska och utreda händelser och klagomål rörande vårdskador (SFS 2010:659), och patientnämnden har som samhällsinstans en central roll att på landstingsnivå granska patientärenden och utgöra en opartisk bro mellan patient och hälso- och sjukvård. Det är viktigt att belysa förekomsten och typen av anmälningsärenden för att kunna bedriva kontinuerligt förbättringsarbete. SYFTE: Syftet med denna studie är att kvantitativt beskriva de anmälningar rörande vårdskador som inkommit till patientnämnden i ett landsting i Mellansverige under 2015. METOD: Denna studie är en empirisk retrospektiv studie med kvantitativ ansats. Ärendena inhämtades från patientnämnden. Totalt 893 ärenden inkom till patientnämnden år 2015 och samtliga ärenden granskades. Därefter inkluderades 229 ärenden som kategoriserades med hjälp av en modifierad granskningsmall. RESULTAT: De vanligaste förekommande anledningarna till anmälan om vårdskada är misstanke eller upplevelse av felbehandling respektive feldiagnos (54 %). Kirurgi- och onkologidivsionen är den division varifrån flest ärenden kommer (41 %). Majoriteten (74 %) av ärendena anmäls av patienten själv. Kvinnor står för fler anmälningar till patientnämnden än män (65 % vs 35 %).  I 41 % av de granskade fallen har berörd divison fastställt att vårdskada inträffat. SLUTSATS: Totalt 229 ärenden bedömdes som vårdskador. Det behövs vidare forskning för att bekräfta studiens resultat. Nyckelord: patientsäkerhet, vårdskador, patienträttigheter / ABSTRACT BACKGROUND: It´s important to acknowledge when patients consider themselves mistreated, in order to strive for better and safer health care. The caregiver is obliged to investigate events and complaints resulting in patient injuries (SFS 2010:659). Patientnämnden is an organizational unit within the county and it has a central role in reviewing patient complaint cases, being an impartial bridge between the patient and the health care. OBJECTIVE: The aim of this study is to describe the complaints regarding patient injuries from a county in mid Sweden 2015. METHODS: An empirical retrospective study with a quantative approach was conducted. The data was collected from patientnämnden. A total of 893 complaints were received by patientnämnden during the year 2015. All of the complaints were reviewed. Two hundred twenty-nine complaints were included and categorized with a modified examination instrument. RESULTS: The most common reason for complaints regarding patient injuries are mistreatment and misdiagnosis (54 %). Most of the complaints come from the surgery and oncology division (41 %). The majority (74 %) of the complaints is reported by the patient, and it´s more common for women compared to men to file complaints to patientnämnden (65 % vs 35 %). In 41 % of the cases, a medical injury was confirmed by the caregiver in some way. CONCLUSION: A total of 229 complaints was categorized as patient injuries. More research are needed to confirm the result of this study. Keywords: patient safety, patient harm, patient rights