Poor interprofessional communication has been linked to decreased quality of patient care and increased numbers of medical errors. Increased occupational stress due to lack of effective interprofessional communication can lead to poor job satisfaction and burnout. The purpose of this study was to identify barriers to interprofessional communication as perceived by radiologic technologists. In particular, how did demographic data influence these perceptions? The research was conducted during June of 2009. The population for this survey consisted of registered radiologic technologists employed at hospitals in Northeast Tennessee. A locally developed survey questionnaire covering the subject of interprofessional communication was distributed to a cluster sample directly involved in patient care. Participants indicated that interprofessional communication effects their occupational stress and job satisfaction in addition to the quality of patient care. This analysis revealed that radiographers experienced the most difficulty communicating with nurses.

Purpose: The purpose of this study was to explore the efficacy of an interdisciplinary intervention on interdisciplinary teamwork and patient functional outcomes in an acute inpatient rehabilitation unit at a mid-sized regional hospital. Design: Pilot mixed-methods pre-post intervention study. Methods: Interdisciplinary teamwork and patient functional outcomes were measured before and after a teamwork intervention. Interdisciplinary teamwork was measured with the Healthcare Team Vitality Instrument (HTVI) and a qualitative staff questionnaire developed by a content expert. Patient functional outcomes were measured by aggregated Functional Independence Measure (FIM®) scores. Findings: Post-intervention FIM® gain scores increased significantly (p = .008). Staff questionnaire revealed improvement in interdisciplinary teamwork, with the major themes of teamwork and appreciation/respect. Post-intervention HTVI showed no significant change (p=.528). Conclusions: Initial results of this intervention are promising; additional research is needed to study the effectiveness of this intervention in a variety of acute rehabilitation settings. Clinical Relevance: Rehabilitation leaders can implement low-cost teamwork interventions to improve interdisciplinary teamwork and patient outcomes.

Healthcare-associated infections (HAI) are a significant issue in healthcare facilities worldwide. Hand hygiene (HH) remains the most effective method for preventing the incidence of HAI in routine patient care. Past and current interventions focused on the overall improvement of HH compliance, but studies found that the amount of time required to achieve full HH compliance with the existing guidelines may not be practical. Improving HH compliance at critical moments during patient care may be more effective than improving HH compliance at all opportunities. However, there are little to no studies on healthcare workers’ (HCWs) behavior regarding HH during the patient care process. Secondary data analysis on a prospective dataset from the STAR-ICU trial was completed to identify HCWs’ behavior patterns regarding HH during the patient care process. Multiple logistic regression for transitions with random effects using repeated measures and transition modeling was used to identify possible associations between HH compliance and patient care tasks, the order of tasks, and workload. The models adjusted for the effects of HCW type, glove use, and isolation precautions. The study identified 28,826 task sequences and 42,349 HH opportunities. HCWs were slightly less likely to do HH before critical tasks compared with other tasks (OR: 0.97, 95% CI: 0.96-0.99), but more likely to do HH after contaminating tasks compared with other tasks (OR: 1.12, 95% CI: 1.10-1.13). HCWs are also more likely to move from task sequences that have a relatively lower risk to patients to task sequences that have a relatively higher risk to patients than vice versa (65.4% versus 34.7%). HCWs are also less likely to do HH after moving from tasks that have a relatively lower risk to patients to tasks that have a relatively higher risk to patients than vice versa (OR: 0.93, 95% CI:0.92-0.95). HCWs’ HH compliance rates decreased as the workload level increased (OR: 0.93, 95% CI: 0.89-0.98). Workload did not appear to affect HH compliance before critical tasks or after contaminating tasks and did not affect the order in which HCWs perform patient care tasks. Increase in workload was associated with an increase in the odds of critical tasks occurring (OR: 1.55, 95% CI: 1.45-1.65). In conclusion, HCWs are more likely to perform HH after contaminating tasks to prevent contaminating themselves and to reduce the risk of transmission in subsequent task sequences. However, they do not perform tasks in an order that minimizes risk to the patient; instead, it appears that they perform tasks as they come up in routine care. Furthermore, HH is not being performed at critical moments during patient care. Lastly, workload did not affect the order in which HCWs perform patient care tasks, suggesting that HCWs behavior patterns contribute significantly to how they care for patients and perform HH. Interventions targeting the order in which HCWs perform patient care tasks and improving HH compliance before critical tasks may be more effective than those designed to improve HH compliance at all HH opportunities for reducing HAI rates.

Bakgrund: Personcentrerad vård (PCV) används allt oftare inom såväl somatisk som psykiatrisk vård, med övervägande positiva effekter för individen. Kliniska studier pågår men ett annat sätt att utvärdera arbetssättet är att följa hur indikatorer från patientregister utvecklas efter införande. Syfte: I denna studie analyseras indikatorerna utifrån kunskapen om att psykiatriska kliniken på Gotland har infört PCV 2016 och har därav haft möjligheten att närmare följa indikatorernas utveckling. Metod: Denna studie har genom deskriptiv analys identifierat resultat som tyder på att det sker förändringar i indikatorutvecklingen över tid som kan kopplas till införande av PCV år 2016. Resultat: Tydligaste resultatet är minskningen av antalet individer och vårdtillfällen inom slutenvården. Minskningen av Individuella planer är tydlig och borde analyseras närmare med genusperspektiv. Resultat inom områden säker vård är inte tydliga, men ingalunda negativa, med bibehållna låga värden. Slutsats: Resultaten i denna studie tyder på att det sker förändringar i indikatorutveckling över tid som kan kopplas till införande av PCV år 2016. / Background: Person-centered care (PCV) is increasingly used in both somatic and psychiatric care, with predominantly positive effects for the individual. Clinical studies are ongoing, but another way of evaluating methods is to follow how indicators from patient registries develop after implementation. Purpose: In this study, the indicators are analyzed based on the knowledge that the psychiatric clinic at Gotland has introduced PCV 2016 and has thus had the opportunity to closely monitor the indicators' development. Method: Through descriptive analysis, this study has identified results that indicate that there are changes in indicator development over time that can be linked to the introduction of PCV in 2016. Outcome: The clearest result is the reduction in the number of individuals and inpatient care. The reduction of Individual plans is clear and should be analyzed in more detail with a gender perspective. Results in areas of safe care are not clear, but by no means negative, with low numbers maintained. Conclusion: The results in this study indicate that there are changes in indicator development over time that can be linked to the introduction of PCV in 2016.

No description available.

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.

Although prior research has found differences in costs and financial performance across different types of hospital systems, there has been no systematic study of variations in patient quality of care or safety indicators across different systems. Our study examines whether five main types of health systems - centralized (CHS), centralized physician/insurance (CPIHS), moderately centralized (MCHS), decentralized (DHS), and independent (IHS) - as well as other hospital characteristics are associated with differences in quality of patient care. Data were assembled for 6 years (1995 - 2000) from multiple sources. We used 4 AHRQ risk adjusted inpatient quality indicators (IQIs) and 5 risk-adjusted patient safety indicators (PSIs) as dependent variables. Random effects models were used in the analysis.It was found that the IQI and PSI models have different patterns. In the IQI models, CHS hospitals have lower AMI, CHF, Stroke, and Pneumonia mortality rates than hospitals in other system types. The PSI models did not indicate any systems' effects on adverse event rates. It was also found that system hospitals' compliance with the JCAHO performance area indicator for availability of patient specific information was associated with lower rates of CHF, Stroke, Pneumonia, and Infection due to medical care.The findings suggest that centralization of hospital structures may improve internal clinical processes by enhancing coordination of activities, communication between providers, timely adjustments of processes of care delivery and structures to external pressures. A lack of systems' effect on adverse events may be explained by a newness of the patient safety issues for hospitals and possible changes in reporting patterns of medical errors after the Institute of Medicine report of 1999. A system hospitals' compliance with the JCAHO performance area indicator may indicate improvements in information and clinical record systems.Hospital systems hold much potential for hospitals in improving patient quality of care and safety because they provide a laboratory for studying the health care process and sharing lessons across multiple institutions. Based on our findings, we recommend that future studies use a combination of IQIs and PSIs when examining institutional quality of care because both provide different and complementary information.

Workplace mistreatment (bullying, horizontal violence, and incivility) has been shown to impact nurses’ work satisfaction, job turnover, and physical and mental health. However, there are limited studies that examine its effect on patient outcomes. A correlational descriptive study of 79 acute care nurses was used to test a social justice model for examining the relationship between workplace mistreatment, quantified as threats to dimensions of nurses’ well-being (health, personal security, reasoning, respect, attachment, and self-determination), and nurses’ ability to provide quality patient care. In addition, this study considered the moderating effect of caring work environment among co-workers on nurses’ ability to provide quality patient care in the face of workplace mistreatment. Stories of workplace mistreatment were collected anonymously and analyzed for alignment with threats to six dimensions of well-being. Ability to provide patient care was measured using the Healthcare Productivity Survey and a caring work environment was measured via the Culture of Companionate Love scale. The results demonstrated that threats to all six dimensions of well-being described by Powers and Faden (2006) were expressed in nurses’ stories of workplace mistreatment. Furthermore, 87% reported a decrease in ability to provide patient care after an incident of workplace mistreatment. Yet frequency of threatened dimensions did not have a significant relationship with ability to provide patient care. Moreover, there was a significant moderator effect of the caring work environment on the relationship between number of threatened dimensions of well-being and ability to provide quality patient care. Nurses in high caring environments loss less ability to provide care than nurses in low caring environments when one to three dimensions of well-being were threatened. However, this relationship reversed when four or more dimensions were threatened. Implications include further research on the relationship between workplace mistreatment and nurse well-being and changing practice to include fostering a caring work environment in healthcare facilities. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

This study was designed to identify the spiritual needs of multicultural Australians with a health problem, in order to understand the educational implications for health care professionals. The rationale for the research was supported by the Australian Council for Health Service (1997) requirement that health care professionals meet the spiritual needs of their patients and clients'. At the commencement of this study, no research had been published on what these spiritual needs might be. To discover what health care professionals needed to be taught in order to meet the spiritual needs of their patients, I required a suitable group of patients. Then, after identify their spiritual needs, I wanted to explore ways in which these needs could be met. For this to occur, I also needed to identify factors that would fulfill patients' spiritual needs or prevent them from being met. This research proceeded in two stages. The first involved collecting data from all spiritual groups in Western Australia. The second involved the recruitment and interviewing a small number of ex-patients to gain their perspective of health care related spirituality and needs. To gain data about the various spiritual groups in Western Australia, I wrote to all organisations and associations, asking for information and reference material. This data was analysed using HyperResearch (1995), and themes common to all spiritual groups were developed. The inter-relationship between these themes provided the framework for an emergent model of spirituality. / For the second part of the research which involved a case study of health care patients, a qualitative methodology was used. This approach enabled me to explore the phenomenon of spirituality from the perspective of eight participants, which involved identifying their spiritual needs, the care they desired, and the rite of passage they underwent when receiving health care. The qualitative methodology enabled me to explore the subject from a sensitive holistic perspective, and to protect the integrity of the participants. I wanted to know what patients understood about their spirituality and how spiritual care could be implemented not only in clinical practice but also into health care education programs. The participants' detailed subjective experience was especially important, because I wanted to know how they identified their spiritual needs, how they had requested their needs be met by health care professionals, and the extent to which health care professionals had reacted to those cues. I formulated an 'interpretive phenomenology research' design based on the philosophical writings of Heidegger and Bakhtin. Heidegger argued that people gain knowledge of a subject from their own subjective experience, and of the person being in their world (simultaneous past, present and future thoughts). Bakhtin stated that to bring about social change, the researcher needed to understand the social context of the people's language including their culture, politics, government-provided amenities (such as education and health care), employment and social interaction, both within and outside their communities in which they live. The eight participants were interviewed a number of times in order to explore the phenomenon of spirituality beyond the notions already published in the literature (i.e. from multicultural Australian's perspective). / They told of hospital or health care experiences that included: health care for childbirth, mental and psychiatric illnesses (depression, manic-depression, and anxiety), immunology (lymphoma), stroke, detoxification of alcohol, arthritis, coronary occlusion, hypertension, and peritonitis; surgical procedured/s such as repair of hernia, bowel obstruction, eye surgery, orchiopexy (removal of testes from inguinal canal into the scrotal sac), caesarian birth, appendectomy, and oophorectomy (removal of ovaries); treatments such as radiotherapy, chemotherapy, and physiotherapy; and hospital experiences in both large and small public and private acute hospitals, private and public mental health/psychiatric hospitals, intensive care and coronary care units. These situations demonstrate the diversity of contexts which people want their spiritual needs met. The study revealed that it is not only dying patients who have spiritual need; spiritual needs exist in widespread ordinary conditions and across a wide range of health care services. The eight participants - Ann, Athika, Garry, Red, Rosie, Scarlet, Sophie, and Tom (pseudonyms) - were drawn from many of the multicultural groups resident in Western Australia including Aboriginal, Chinese, English, European, Indian, and Irish peoples. Their spiritualities encompassed Judeo-Christian, Buddhist, Hindu, Pagan Romany, Society of Friends (Quaker), Humanist, Socialist, and Communist values and beliefs. The results of the research give insight into the eight participants' perspectives on being a person, their understanding of spirituality, perceived spiritual needs, their desired levels of spiritual care, and the rite of passage they experienced when undergoing health care treatment in hospital. / The participants' spiritual needs comprised of four categories: 'mutual trust', 'hope', 'peace' and 'love'. The levels of spiritual care spoke of desiring were: 'acknowledgement', 'empathy', and 'valuing'. Recommendations are given for health care professionals to provide spiritual care for the eight participants, and implications are considered for the spiritual education of future health care professionals in order to sensitise them to the wide range of healthcare related spiritual needs they might encounter in local multicultural communities. It is recognised that the scope of the implications is contingent on further research establishing the incidence of health-care related spiritual needs among the broader population of multi-cultural Western Australians. The richness and depth of the data and the very sensitive nature of the material that came from the eight people who shared their experiences with me has rendered this thesis an important document. The nature of the various incidents and situations they shared with me, I believe, demonstrated their preparedness to tell their story so that health care can be improved. On many occasions, I felt honoured that they had sufficient trust in me to enable them to report such deep and personal suffering. For example, Rosie told me of her mental torment and of not knowing if she was alive or dead; of how she burnt her legs to try to feel pain in order to see if she was alive. It was stories such as this that gave me the passion to write this thesis well in order to do justice to all people who want spirituality included in health care treatment.

The first goal of this investigation was to undertake a non-equivalent quasi-experimental design to test the effect of a total Quality management (TQM) approach to improve the appropriateness of clinical laboratory test utilisation in the management of early acute myocardial infarction (AMI). The study was conducted at 2 public hospitals in Sydney over a 30 month period, and in 2 stages- pre and post TQM intervention. Using specifically a Continuous Quality Improvement (CQI) FOCUS-PDCA model, a multidisciplinary team was empowered to make appropriate changes in order to improve a variety of problem areas that affected the total pathology service. Improvement was directed at the total system of pathology testing, not just test ordering. It was observed that the introduction of a TQM environment had provided a more committed, integrated and motivated clinical care effort towards improving the appropriateness of test ordering. Such team efforts were accompanied by demonstrated customer satisfaction at various aspects of the laboratory service and further benefits to patient care. Patient care benefited greatly from the highly significant changes towards more appropriate timing of blood collections for cardiac enzyme testing. Other improvements included overall improvements to the turnaround time of test results, reductions in specimen delivery delays, more appropriate use of clinical laboratory tests, a streamlined distribution of printed reports and marked improvements in communication between staff involved in the process of test ordering. Of major importance was the finding that CQI strategies resulted in substantial savings of 23.0% of the overall cost of pathology services. Adoption of the TQM approach appears to be a strategy worthy of exploration by laboratory directors and health administrators interested in improving patient care while at the same time reducing expenditure. / Doctor of Philosophy (PhD)