Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-02-15T15:20:03Z No. of bitstreams: 1 Daniela Cristina Silva Bianchini_.pdf: 718572 bytes, checksum: a96f287904a4545e0ab4534c47f2282c (MD5) / Made available in DSpace on 2016-02-15T15:20:03Z (GMT). No. of bitstreams: 1 Daniela Cristina Silva Bianchini_.pdf: 718572 bytes, checksum: a96f287904a4545e0ab4534c47f2282c (MD5) Previous issue date: 2015-04-24 / UNISINOS - Universidade do Vale do Rio dos Sinos / Esta dissertação é composta por dois artigos empíricos escritos a partir da pesquisa realizada sobre a comunicação profissional–paciente em oncologia. O primeiro estudo refere-se à percepção da comunicação profissional-paciente sob o enfoque dos pacientes com câncer. Foram entrevistados 14 pacientes adultos que estavam realizando quimioterapia, em diferentes estágios da doença (sete metastáticos). Destes, oito eram homens. O segundo estudo apresenta a percepção dos profissionais que atendem pacientes com câncer no que tange o processo de comunicação. Foram entrevistados 14 profissionais de diferentes áreas que trabalham com pacientes com câncer, entre elas: medicina, psicologia, enfermagem, terapia ocupacional, odontologia, fisioterapia e nutrição. Ambos os estudos foram qualitativos exploratórios. Os instrumentos utilizados foram uma ficha de dados sociodemográficos, clínicos e profissionais e um roteiro de entrevista semi-estruturada elaborado para cada grupo de entrevistados. As entrevistas foram gravadas em áudio e transcritas na íntegra. Os dados foram analisados em três etapas: a) leitura inicial sem julgamentos (“naive”); b) análise estrutural e categorização do conteúdo; e c) interpretação crítica e discussão. Por fim, dois juízes independentes avaliaram os conteúdos da entrevista quanto às categorias emergentes. Obteve-se um índice Kappa de 0,834, para análise do estudo 1 e 0,842 para o estudo 2, representando alta concordância. Foram criadas três categorias, que foram utilizadas nos dois estudos: 1) Comunicação Técnica: provisão de informação sobre o diagnóstico, tratamento e/ou prognóstico, de forma técnica, orientada para a doença do paciente; 2) Comunicação Técnica com Suporte Emocional: provisão de informação orientada para a doença e também suporte emocional; 3) Comunicação Insuficiente: comunicação com falhas ou que carece de informações, deixando o paciente com dúvidas e/ou inseguro. No estudo 1, os resultados evidenciaram que a comunicação com suporte emocional contribuiu para uma maior satisfação e saúde psicológica do paciente durante o tratamento oncológico. Percepções mais negativas em relação à comunicação com os profissionais de saúde estavam vinculadas às falhas na troca de informações, sensação de distanciamento emocional e ausência de interesse por aspectos pessoais do paciente. No estudo 2, os resultados apontaram para a importância do trabalho interdisciplinar e, a partir disso, à maior facilidade em estabelecer uma comunicação efetiva que contemple as complexas demandas do paciente oncológico. Ademais, a empatia, a provisão de esperança e a escuta ativa foram apontadas como qualidades essenciais para a comunicação efetiva entre profissional-paciente em oncologia. Os achados de ambos os estudos podem ser úteis no planejamento de estratégias comunicacionais que favoreçam o aumento da satisfação e bem-estar do paciente com câncer. / This dissertation consists of two empirical articles written from the survey conducted about professional-patient communication in oncology. The first study is about the perception of professional-patient communication from the standpoint of cancer patients. Fourteen adult patients who were taken chemotherapy were interviewed. They were in different stages of the disease (seven metastatic) and eight were men. The second study presents the perceptions of professionals who treat cancer patients regarding the communication process. Fourteen different professionals who work with cancer patients were interviewed, including: medicine, psychology, nursing, occupational therapy, dentistry, physiotherapy and nutrition. Both studies were qualitative and exploratory. The instruments used were: a sociodemographic, clinic and professional data questionnaire and a semi-structured interview designed for each group of respondents. The interviews were audio-recorded and transcribed. The data were analyzed in three stages: a) initial reading without judgment (“naive”); b) structural analysis and categorization of content; and c) critical interpretation and discussion. Finally, two independent judges evaluated the interview content as emerging categories. The Kappa index were 0,834 in the first study and 0,842 in the second study, representing strong agreement. Three categories were created and used in both studies: 1) Technical Communication: information provision about diagnosis, treatment and/or prognosis in a technical way oriented for the disease; 2) Technical Communication with Emotional Support: information provision oriented to disease and emotional support; 3) Insufficient Communication: failed communication which leaves the patient with questions and/or unsafe. In study 1, results showed that communication with emotional support contributed improving satisfaction and psychological health during cancer treatment. Negative perceptions regarding communication with health professionals were linked with failures in the exchange of information, sense of emotional detachment and lack of interest on personal aspects. In study 2, results point the importance of interdisciplinary work and the establishment of an effective communication that incorporates the complex demands of cancer patients. Moreover, empathy, providing hope and active listening were identified as essential qualities for effective communication between professional-patient. The findings of both studies may be useful in planning communication strategies to encourage an increase of satisfaction and well-being of patients with cancer.

Made available in DSpace on 2016-04-27T18:11:49Z (GMT). No. of bitstreams: 1 Erika Biscaro Laperuta.pdf: 2313322 bytes, checksum: 9caf96532a2498962dbaa4d747aee7e2 (MD5) Previous issue date: 2011-02-21 / Introduction: After the implementation of the Hearing Health Directive in 2004, the quality of services in Brazil based on patient satisfaction and benefits provided by hearing aid became crucial for the compliance with it. Goal: Analyze the relation between subjective and objective measures for users of hearing aid. Method: Twenty-two elderly individuals were assessed after joining the selection and adaptation process for hearing aid in a high complexity service. Research was conducted on the occasion of hearing aid fitting and on follow-up appointments one, three and six months later. It was comprised of objective (speech recognition percent index SRPI) and subjective assessments (SADL questionnaire - Satisfaction With Amplification in Daily Life). Results: There was improvement in SRPI accuracy rates and in the SADL score in the period between first use of the amplifier and the following six months. Findings indicate co-relation between SRPI and negative factors after six months of use and co-relation between the number of hours of daily use and the positive effects after three and six months of use. Conclusion: SRPI and user satisfaction rates showed improvement through the six months of amplification use, thus indicating the importance of the acclimatization period / Introdução: Com a implantação da Portaria de Saúde Auditiva em 2004, no Brasil, a qualidade dos serviços - baseada na satisfação do paciente e nos benefícios proporcionados pelos AASI (Aparelho de Amplificação Sonora Individual) - passou a ser fundamental para garantir o cumprimento da mesma. Objetivo: Analisar a relação entre as medidas subjetivas e objetivas no usuário de AASI. Método: Foram avaliados 22 idosos que iniciaram o processo de seleção e adaptação de AASI em um serviço de alta complexidade. A pesquisa foi realizada no dia da adaptação dos AASI e nos retornos de um mês, três meses e seis meses do paciente à instituição e constou de avaliações objetivas (índice percentual de reconhecimento de fala IPRF) e subjetivas (aplicação do questionário SADL - Satisfaction With Amplification in Daily Life). Resultados: Houve melhora na porcentagem de acertos do IPRF e do escore do SADL no decorrer do período entre entrega e seis meses de uso de amplificação. Os resultados indicaram correlação do IPRF com os fatores negativos após seis meses de uso e correlação do número de horas de uso diário com os efeitos positivos em três e seis meses de uso. Conclusão: O IPRF e o grau de satisfação do usuário aumentaram ao longo de seis meses de uso da amplificação

O transplante de fígado é considerado o tratamento de eleição para o paciente com doença hepática progressiva, irreversível e terminal, o qual não encontra outro tipo de tratamento. O ensino é uma importante estratégia para o preparo dos candidatos ao transplante de fígado e constitui-se como papel relevante do enfermeiro. Para a condução da presente investigação adotou-se os pressupostos de Gagné e Ohler. O objetivo geral delimitado foi analisar o conhecimento de candidatos ao transplante de fígado, antes e depois da implementação de uma intervenção educativa. A investigação foi conduzida em duas fases. Na primeira fase realizou-se um estudo descritivo para identificar as características sócio-demográficas, clínicas e as necessidades de informação dos candidatos. Na segunda fase procedeu-se um estudo piloto, para analisar o conhecimento dos candidatos antes e depois da aplicação da intervenção educativa, e avaliar a satisfação destes com as informações recebidas. Frente a uma casuística de 55 candidatos na primeira fase, observou-se uma predominância do sexo masculino, com idade média de 50,25 anos, média de 8,49 anos de estudo, 70,91% dos sujeitos estavam afastados de atividades laborais e a renda predominante foi de dois a seis salários mínimos. A maioria dos candidatos era CHILD B, com MELD médio de 14,91 pontos, 72,72% estavam acima do peso e apresentavam uma evolução da doença crônica do fígado de 101,21 meses em média. A maioria da amostra apresentava cirrose causada por vírus e alcoolismo. O tempo médio de fila de espera foi de 1199,58 dias. Dentre as principais manifestações clínicas, destacou-se a presença de ascite (58,18%), varizes esofágicas (81,82%), encefalopatia hepática (50,91%) e hemorragia digestiva prévia (47,27%). As necessidades de informação relacionadas com o período pré-operatório foram as que obtiveram as pontuações médias maiores. As complicações após o transplante e os cuidados necessários após o transplante também foram necessidades de informação indicadas como relevantes pelos candidatos. Diante de uma amostra de 15 pacientes para a segunda fase do estudo, observou-se um ganho cognitivo significativo após a intervenção, com uma melhora de quase 20% no desempenho dos candidatos (p<0,05). Em relação à satisfação dos candidatos, observou-se uma avaliação positiva da satisfação com as informações recebidas. As informações que geraram índices maiores de satisfação foram relacionadas ao período pós-operatório e os cuidados necessários por toda a vida. A relação entre o conhecimento após a intervenção e o grau de satisfação mostrou uma correlação significativa (p<0,05). O estudo fornece evidências de que a provisão de informações de qualidade é capaz de aumentar o conhecimento e proporcionar satisfação para os candidatos ao transplante de fígado. / Liver transplant is considered the preferred treatment for patients with progressive, irreversible and terminal liver disease, who cannot find any other treatment type. Teaching is an important strategy to prepare liver transplant candidates and represents a relevant role for nurses. This research is based on Gagné and Ohlers premises. The general aim was to analyze liver transplant candidates knowledge before and after an educative intervention. The research was conducted in two phases. First, a descriptive study was carried out to identify the candidates sociodemographic and clinical characteristics and information needs. In the second phase, a pilot study was performed to analyze the candidates knowledge before and after the educative intervention, as well as to assess their satisfaction with the information they received. The sample comprised 55 candidates: a majority were men; the average age was 50.25 years and average education 8.49 years; 70.91% of subjects were on leave from their job and the predominant income was between two and six minimum wages. Most candidates were CHILD B, the mean MELD score was 14.91 points, 72.72% were overweight and the average evolution of the chronic liver diseases was 101.21 months. Most patients in the sample presented cirrhosis caused by virus and alcoholism. The mean waiting time for a transplant was 1199.58 days. The main clinical manifestations included ascites (58.18%), esophageal varices (81.82%), hepatic encephalopathy (50.91%) and previous digestive hemorrhage (47.27%). Information needs related to the preoperative period obtained the highest mean scores. Candidates also indicated information needs related to post-transplant complications and necessary care. In a sample of 15 patients for the second phase, significant cognitive gain was observed after the intervention, with an almost 20% improvement in candidates performance (p<0,05). Candidates satisfaction with the information they received was assessed positively. Higher satisfaction levels were found for information related to the postoperative period and care needed across the lifetime. Significant correlation was found (p<0.05) between knowledge after the intervention and satisfaction level. This research evidences that providing quality information can increase liver transplant candidates knowledge and give them satisfaction.

ABSTRACT:Healthcare management is a field that is related to management, leadership, and service of anorganization. Due to high competition and change in the environment of healthcare organizations,managers need to embrace the innovation to respond to those changes and make the organizationsuccessful by improving the process, structure, and culture of the organization as well as to provideefficient and effective care that will lead to achieve patient satisfaction. Service quality is one ofthe key factor among the service innovations that contribute to business development and leadingposition in the business world with high competition. Patient satisfaction is important for anyhealthcare organization. Patient satisfaction improves hospital/clinic image, which changes into anincrease in the use of services provided by the healthcare systems and increases market share.Patient satisfaction is dependent on the service quality which is the main factor in healthcareinnovations.Purpose: The purpose of this study is to understand experience levels of the patient satisfaction ofservice quality in Swedish dental clinics, based on the factors affecting dental service quality.Data Sources: Interviews with staff from six clinics in Sweden, 240 patient surveys from twopublic and two private Swedish dental clinic, group interviews with three Swedish dental clinics,Science-Direct, Research Gate, ABI Inform, Google Scholar, Academia.edu.Method: This study is based on the quantitative and qualitative analysis (i.e., mixed methodapproach) and abductive approaches to measure patient satisfaction in Swedish dental clinicsthrough service quality. The problem is analyzed through interviews with the staff in private andpublic dental clinics. The factors affecting the dental service quality are analyzed throughtheoretical and empirical analysis. The patient’s satisfaction was measured by SERVQUAL toolthrough using patients’ survey that consists of 12 questions based on the four factors (tangibility,empathy, responsiveness, and Assurance). Patient survey is conducted in four dental clinics. SPSSwas used to calculate mean and standard deviation for the survey’s result. After analyzing the result,group interviews with clinic 1, clinic 3 and clinic 5 was conducted to understand different valuesin the tool i.e., the value created, value destroyed, and value missed based on the customerperception to analyze the service quality of the dental clinics.Findings: The result from the surveys showed that the factor empathy has highest positive affectand responsiveness has the lowest effect in four dental clinics. The lowest effect in the factorresponsiveness is based on the waiting time to meet a dentist. The group interviews gave us thedifferent values which are based on the idea of the value mapping tool in customer perspective.The value that the clinics gained trust from their patients. The value missed\destroyed is the waitingtime to meet a dentist. The new opportunities are to improve the services by installing newtechnology products and changing the appearance of the clinic.

Este estudo teve como objetivo investigar a adesão ao tratamento medicamentoso em pacientes com depressão unipolar atendidos em um Núcleo de Saúde Mental, localizado em um município do interior paulista. Trata-se de um estudo retrospectivo, transversal, descritivo e com abordagem quantitativa. No entanto, dados qualitativos também foram utilizados para complementar os resultados. A população foi constituída por 168 pacientes com depressão unipolar que atenderam aos critérios de inclusão e exclusão do estudo. Para a coleta dos dados quantitativos foi empregada a técnica de entrevista estruturada, com a utilização de um questionário para os dados referentes ao perfil demográfico, socioeconômico, clínico e farmacoterapêutico, do teste de Medida de Adesão ao Tratamento - MAT e do Inventário de Depressão de Beck. Já para a coleta dos dados qualitativos foi aplicada a técnica de entrevista semi-estruturada gravada, realizada apenas em uma parcela dos pacientes do estudo (N=27). Para análise dos dados quantitativos foi utilizado o aplicativo Stata (versão 10.2) e para os dados qualitativos a Análise Temática, conforme proposta por Minayo. Os resultados revelaram que a maioria dos pacientes era do sexo feminino (84,5%), com idade acima de 50 anos (75%), com a cor da pele branca (76,8%), casada (57,1%) e com renda familiar menor que dois salários mínimos e meio (60,1%). Verificou-se, ainda, que a maioria dos pacientes (71%) foi considerada aderente ao tratamento medicamentoso. Identificou-se maior frequência de adesão aos medicamentos em pacientes sem depressão ou com depressão leve/moderada (p = 0,031), viúvos (p = 0,029), com cor da pele branca (p = 0,020), que realizavam apenas tratamento medicamentoso (p = 0,034), que receberam informação sobre o tratamento para depressão (p = 0,030) e que compravam o medicamento quando o mesmo estava em falta na rede pública (p = 0,016). Observou-se importante déficit de conhecimento dos pacientes em relação ao nome, dose e frequência de administração dos medicamentos, havendo maior porcentagem de adesão entre os pacientes que apresentaram de 51 a 100% de conhecimento em relação à frequência de administração dos medicamentos prescritos (p = 0,001). Os depoimentos dos sujeitos da pesquisa resultaram na elaboração de quatro categorias que revelam as principais dificuldades por eles vivenciadas no seguimento da terapêutica medicamentosa: \"os sintomas da depressão\", \"efeitos limitados e desgastantes da medicação e a polifarmacoterpia\", \"a necessidade de apoio\" e \"pouco conhecimento sobre a depressão e o tratamento\". Constatou-se que, embora a maioria dos pacientes estivesse satisfeita com a equipe de saúde e tratamento, seus depoimentos revelavam déficit de conhecimento sobre os medicamentos, dúvidas e queixas relacionadas ao atendimento. Espera-se que os resultados desta pesquisa forneçam subsídios para se repensar as estratégias de intervenção utilizadas nos serviços de saúde direcionadas à adesão ao tratamento medicamentoso por pessoas com depressão unipolar, visando o seu sucesso terapêutico. / The objective of this study was to investigate adherence to drug treatment in patients with unipolar depression followed at a Mental Health Center of a city in Upstate São Paulo. This retrospective, cross-sectional, descriptive study was performed using a quantitative approach. Nevertheless, qualitative data were also used to complement the results. The study population consisted of 168 patients with unipolar depression, who complied with the established inclusion and exclusion criteria. The quantitative data were collected by means of structured interviews, using a questionnaire for demographic, socioeconomic, clinical and pharmacotherapeutic data, the Measurement of Adherence to Treatment - MAT and the Beck\'s Depression Inventory. The qualitative data, on the other hand, were collected using recorded semi-structured interviews, which were performed with only part of the sample (N=27). The quantitative data analysis was performed using the Sata application (version 10.2), while qualitative data were submitted to Thematic Analysis, as proposed by Minayo. The results revealed that most patients were women (84.5%), older than 50 years of age (75%), of white skin (76.8%), married (57.1%) and with a family income of less than 2.5 minimum salaries (60.1%). It was also observed that most patients (71%) adhered to the drug treatment. Patients with the best treatment adherence, were those with mild/moderate or no depression (p = 0.031), widowed (p = 0.029), of white skin (p = 0.020), whose treatment was only drug-based (p = 0.034), who had been instructed regarding the depression treatment (p = 0.030) and who bought the medication even when the public health service was unable to supply (p = 0.016). An important knowledge deficit was observed among the patients regarding the name, dose and administration frequency of the drugs, with better adherence among patients who presented 51 to 100% knowledge regarding the administration frequency of the prescribed drugs (p = 0.001). Based on the study subjects\' reports, four categories were obtained to describe the main difficulties they faced in following the drug treatment: \"the symptoms of depression\", \"limited and wearing effects of the drugs and polypharmacotherapy\", \"the need for support\" and \"little knowledge about depression and its treatment\". It was found that, regardless of most patients being satisfied with the health team and the treatment, their reports revealed knowledge deficit regarding the drugs, as well as questions and complaints related to the service. It is expected that the present study results serve as the basis to reconsider the intervention strategies used by health services aiming at achieving drug treatment adherence in people with unipolar depression, with a view to a successful treatment outcome.

A esquizofrenia é um transtorno mental que provoca a desorganização de diversos processos mentais. Trata-se de uma condição crônica com expressivo impacto em termos de sobrecarga pessoal e social. O tratamento medicamentoso contínuo é necessário para evitar recaídas e manter o paciente no melhor nível de funcionamento possível. Este estudo teve como objetivo compreender o significado da terapêutica medicamentosa para a pessoa com esquizofrenia, em sua perspectiva e na de seu familiar, e formular um modelo teórico sobre o fenômeno estudado. Para tanto, foi adotado como referencial teórico o Interacionismo Simbólico e, como referencial metodológico, a Teoria Fundamentada nos Dados. A pesquisa foi desenvolvida em um Serviço Ambulatorial de Clínica Psiquiátrica de um hospital universitário, um Núcleo de Saúde Mental e um CAPS II, localizados no interior do estado de São Paulo - Brasil. Pelo processo de amostragem teórica, foram selecionados para o estudo 36 pessoas com esquizofrenia e 36 familiares. A entrevista e a observação foram as principais estratégias utilizadas para a obtenção dos dados que foram coletados no período de 2008 a 2010. Os dados coletados foram transcritos e, posteriormente, analisados em três etapas: codificação aberta, axial e seletiva. Verificou-se que, ao ser acometido pela esquizofrenia, o paciente percebe-se \"vivendo dias difíceis\" e identifica no medicamento uma possibilidade de melhora. \"Pesando o custo-benefício do medicamento\" e \"identificando obstáculos e incentivos para o tratamento\" o paciente implementa estratégias \"agindo em busca de alívio\" para o sofrimento causado pela esquizofrenia ou pelo tratamento medicamentoso. Entretanto, esse indivíduo se julga \"permanecendo em um labirinto\", pois não encontra uma saída para livrar-se do transtorno e da necessidade da farmacoterapia. A experiência descrita se centraliza no fenômeno \"CONVIVENDO COM UMA AJUDA QUE ATRAPALHA\" que representa o significado da terapêutica medicamentosa para a pessoa com esquizofrenia. A teoria aqui apresentada fornece uma compreensão abrangente, contextualizada, motivacional e empática da realidade vivenciada pelo paciente. Desse modo, o presente estudo oferece subsídios para o planejamento da assistência a essa clientela e aponta elementos a serem investigados. / Schizophrenia is a mental disorder that provokes the disorganization of several mental processes. It is a chronic condition with considerable impact in terms of personal and social burden. Continuous medication treatment is needed to avoid relapses and maintain the patient at the best possible functioning level. This study aimed to understand the meaning of medication therapy for schizophrenia patients, from their own perspective and that of their relative, and to formulate a theoretical model for the study phenomenon. Therefore, Symbolic Interactionism was adopted as the theoretical framework, and Grounded Theory as the methodological framework. The research was developed at a Psychiatric Clinical Outpatient Service of a teaching hospital, a Mental Health Center and a CAPS II located in the interior of São Paulo State - Brazil. Through a theoretical sampling process, 36 schizophrenia patients and 36 relatives were selected for the study. Interview and observation were the main strategies used for data collection, between 2008 and 2010. The collected data were transcribed and later analyzed in three phases: open, axial and selective coding. It was verified that, when the schizophrenia affects them, the patients perceive that they are \"going through difficult times\" and identify the medication as a possibility for improvement. \"Weighing the cost-benefit of the medication\" and \"identifying treatment obstacles and incentives\", the patients put in practice strategies \"acting in search of relief\" for the suffering the schizophrenia or medication treatment causes. These patients, however, consider that they \"continue in a labyrinth\", as they do not find a way out to get rid of the disorder and the need for the drug therapy. The described experience centers on the phenomenon \"LIVING WITH HELP THAT BOTHERS\", which represents the meaning of the medication therapy for schizophrenia patients. The theory presented here provides a broad, contextualized, motivational and empathetic understanding of the reality these patients experience. Thus, this study offers support to plan care for these clients and appoints elements for further research.

Orientador: José Eduardo Corrente / Coorientador: Márcia Galan Perroca / Resumo: Introdução: A Satisfação é determinada pela reação do paciente ao serviço recebido, portanto um indicador sensível de qualidade em atendimentos. Na Fisioterapia, os atendimentos têm características distintas de outras profissões, portanto o instrumento de avaliação de satisfação deve ser adequado a essa população e ao serviço investigado. Objetivo: Comparar a satisfação dos usuários que realizam tratamento fisioterapêutico ambulatorial em clínicas públicas (CP), clínicas privadas de convênio (CC), clínica escola (CE) e avaliar a adequação do instrumento utilizado à população estudada. Métodos: Foram avaliados 382 pacientes, no período de um ano, com idade mínima de 18 anos, que haviam realizado no mínimo cinco sessões de atendimento em cinco municípios da região noroeste do estado de São Paulo, divididos em três grupos. Foi utilizado um questionário com perguntas sociodemográficas sobre idade, sexo, renda, escolaridade e satisfação nos domínios interação paciente-terapeuta; acesso e atendimento da recepção; conveniência; ambiente e satisfação geral. Resultados: Os pacientes entrevistados foram em maioria do sexo feminino (68,60%), tinham idade média de 51,96 anos, na CC apresentaram maior renda e escolaridade, 51,71% conheceram o serviço por indicação médica e 64,03% já haviam realizado fisioterapia anteriormente. Na comparação entre os serviços, a CE apresentou maior satisfação que a CP em equipe de apoio, conveniência e ambiente físico e que a CC em relação terapeuta-pacien... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Satisfaction is determined by the patient's reaction to the service received, therefore a sensitive indicator of quality care. In physical therapy, attendances have distinct characteristics from other professions, so the satisfaction assessment tool should be suited to this population and investigation service. Objective: To compare the satisfaction of users who perform outpatient physical therapy treatment in public clinics (CP), private clinics agreement (CC) and clinical school (EC) and assess the suitability of the instrument used for the studied population. Methods: We evaluated 382 patients within one year, with a minimum age of 18, who had attended at least five sessions of care in five municipalities in the northwestern region of São Paulo State. They were divided into three groups. It was used a questionnaire with sociodemographic questions about age, gender, income, education and satisfaction in the areas patient-therapist interaction; reception access and service; convenience; environment and overall satisfaction. Results: The interviewed patients were mostly female (68,60%), had a mean age of 51.96 years, in the CC they showed higher income and education, 51,71% knew the service through medical indication and 64,03% had performed physical therapy previously. Comparing the services, the EC showed higher satisfaction than the CP in support staff, convenience and physical environment and than CC in therapist-patient relationship and overall satisfaction... (Complete abstract click electronic access below) / Doutor

As part of healthcare reform through the Affordable Care Act of 2010, hospitals across the United States are being held accountable for providing a positive patient experience and will lose up to 2% of their reimbursement by 2017 if they fail to reach targeted scores. The purpose of this quality improvement project was to review the process used by a Georgia hospital to educate newly-hired nurses about customer service expectations and to provide recommendations for process improvement. Theoretical foundations supporting customer service included the caring philosophy of Mayeroff; the caring theories of Watson, Leininger, Boykin, and Nyberg; and Roy's adaptation theory. Using the plan-do-study-act model, the project began with a literature review to discover evidence-based customer service strategies. A qualitative evaluation was then conducted of the organizational documents (job description, annual review form, orientation checklists, clinical orientation record, the Standards of Behavior Form) and the educational slide presentations to determine how customer service was presented to new employees. The customer service strategies introduced during orientation and reinforced by the organization in employee evaluations were compared with evidence-based strategies. Improvement recommendations were developed and presented to the 13 nursing leaders of the organization. Materials developed to improve customer service included a poster for display, a tool for examining customer service strategies in hourly rounding, and a performance competency tool to assess nurses' customer service delivery. The project promotes social change by enhancing nurse-patient interactions, improving patients' perceptions of care, and increasing trust between the patients and the healthcare team to improve patient outcomes.

The value-based purchase requirement of the Patient Protection and Affordable Care Act puts pressure on hospital leaders to control cost while improving quality of care. The resource dependency theory was the theoretical framework for this correlational study. Archival data from the Centers for Medicare and Medicaid Services collected from 166 acute care urban hospitals for the Fiscal Year 2016. Multiple linear regression analysis was used to determine the relationship between nursing salaries per patient day, cost of uncompensated care as a percentage of net patient revenue, percentage of net income from patient services, and overall patient satisfaction for quality of care received. The multiple regression analysis results indicated the model as a whole to significantly predict overall patient satisfaction for quality of care for the Fiscal Year 2016, F (3,162) = 13.788, p = .000, and R2 = .203. In the final model, all 3 independent variables significantly predicted overall patient satisfaction for quality of care. Nursing salaries per patient day and percentage of net income from patient services were significant positive predictors of overall patient satisfaction for quality of care. Nursing salaries per patient day (� = .366, t = 5.120, p = .000) accounted for a higher contribution to the model than percentage of net income from patient services (� = .169, t = 2.374, p = .019). The cost of uncompensated care as a percentage of net patient revenue displayed a significant negative relationship with overall patient satisfaction for quality of care (� = .176, t = €2.458, p = .015). The implications of this study for positive social change include the potential to enhance the quality of care for patients while maintaining local hospitals' financial viability.

There is a lack of quality communication among health care professionals and patients in the hospital setting, which can negatively impact patient satisfaction and increase hospital readmission rates. Interdisciplinary bedside rounding (IBR) is a method of rounding that uses direct communication and discussion of the patient at the bedside, and the use of IRB may improve the quality communication among health care professionals and patients. The purpose of this program outcomes evaluation project was to evaluate whether IBR increased patient satisfaction with nursing communication and if IBR decreased hospital readmission rates. The Iowa model of evidence-based practice provided a framework that was used for this project. This program outcomes evaluation used a retrospective pre-post design to collect data 3 months prior to and 3 months following IBR on 1 medical surgical hospital unit. A convenience sample of 42 IBR patient participants was used. HCAHPS scores were used to evaluate patient satisfaction with nursing communication, with a percent of change comparison evaluated. Thirty day readmission rates were evaluated using a hospital based data set and a direct comparison of data was performed. Findings revealed that IBR did not improve patient satisfaction with nursing communication overall. In regards to hospital readmissions, 1% of the hospital readmissions were from the IRB group versus 10% hospital wide. Those who experienced IBR were less likely to return within 30 days. The use of the IBR program and resultant reduced readmission rates show promise for positive social change by improved patient outcomes and decreased health care costs for all.