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Patient Participation (patient + participation)
Selected AbstractsPatient Participation in Palliative Care: A Voice for the VoicelessEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2005DEBRA P. OLIVER msw No abstract is available for this article. [source] Patient Participation in Health Care Consultations: Qualitative PerspectivesJOURNAL OF CLINICAL NURSING, Issue 14 2008Bodil Wilde-Larsson [source] An Analysis of the Concept of Patient ParticipationNURSING FORUM, Issue 1 2008BSc Health Service Adm., MSc Nursing, Monika J. M. Sahlsten PhD The concept of patient participation has an array of interpretations and lacks clarity. The purpose of this article is to explore the concept of patient participation within the context of nursing practice. The method described by Walker and Avant (1995) is used. The critical attributes of the concept are identified. Formation of model, borderline, and contrary cases exemplifies key characteristics. Antecedents, consequences, and empirical referents presented allow for further refinement of the key attributes defining the concept. Patient participation in nursing practice can be defined as an established relationship between nurse and patient, a surrendering of some power or control by the nurse, shared information and knowledge, and active engagement together in intellectual and/or physical activities. [source] Patient participation in collective healthcare decision making: the Dutch modelHEALTH EXPECTATIONS, Issue 1 2010Hester M. Van De Bovenkamp MA Abstract Objective, To study whether the Dutch participation model is a good model of participation. Background, Patient participation is on the agenda, both on the individual and the collective level. In this study, we focus on the latter by looking at the Dutch model in which patient organizations are involved in many formal decision-making processes. This model can be described as neo-corporatist. Design, We did 52 interviews with actors in the healthcare field, 35 of which were interviews with representatives of patient organizations and 17 with actors that involved patient organizations in their decision making. Results, Dutch patient organizations have many opportunities to participate in formal healthcare decision making and, as a result, have become institutionalized. Although there were several examples identified in which patient organizations were able to influence decision making, patient organizations remain in a dependent position, which they try to overcome through professionalization. Discussion, Although this model of participation gives patient organizations many opportunities to participate, it also causes important tensions. Many organizations cannot cope with all the participation possibilities attributed to them. This participation abundance can therefore cause redistribution effects. Furthermore, their dependent position leads to the danger of being put to instrumental use. Moreover, professionalization causes tensions concerning empowerment possibilities and representativeness. Conclusion, Although the Dutch model tries to make patient organizations an equal party in healthcare decision making, this goal is not reached in practice. It is therefore important to study more closely which subjects patients can and should contribute to, and in what way. [source] The Combined Effects of Participatory Styles of Elderly Patients and Their Physicians on SatisfactionHEALTH SERVICES RESEARCH, Issue 2 2004K. Tom Xu Objectives. To test whether concordance or discordance of patient participation between patients and physicians is associated with higher satisfaction, and to examine the effects of patients' and physicians' participatory styles on patients' satisfaction with their physicians. Data. Data collected in the Texas Tech 5000 Survey of elderly patients in West Texas were used. Patient satisfaction with their physicians was measured by a single item from the Consumer Assessment of Health Plans (CAHPS), representing patients' ratings of their physicians. Patient participation was measured by an index derived from a three-item instrument and physicians' participatory decision-making (PDM) style was measured by a three-item instrument developed by the Medical Outcomes Study. Methods. An ordered logit multivariate regression was used to investigate the effects of patients' and physicians' participatory styles on satisfaction with physicians. The interaction between patients' participation and physicians' participatory styles was also included to examine the dependency of the two variables. Results. Controlling for confounding factors, a higher PDM score was associated with a higher rating of patient satisfaction with physicians. A higher patient participation score was related to a lower physician satisfaction rating. The combined effect of patients' and physicians' participation styles indicated that for a low patient participation score, a high PDM score was not needed to produce high satisfaction. The greater the discordance in this direction, the higher the satisfaction. However, with a high patient participation score, only an extremely high PDM score would produce relatively high satisfaction. Conclusions. The current study supports the discordance hypothesis. Participatory physicians and patient,physician communications concerning patient participation can promote higher satisfaction. [source] An Analysis of the Concept of Patient ParticipationNURSING FORUM, Issue 1 2008BSc Health Service Adm., MSc Nursing, Monika J. M. Sahlsten PhD The concept of patient participation has an array of interpretations and lacks clarity. The purpose of this article is to explore the concept of patient participation within the context of nursing practice. The method described by Walker and Avant (1995) is used. The critical attributes of the concept are identified. Formation of model, borderline, and contrary cases exemplifies key characteristics. Antecedents, consequences, and empirical referents presented allow for further refinement of the key attributes defining the concept. Patient participation in nursing practice can be defined as an established relationship between nurse and patient, a surrendering of some power or control by the nurse, shared information and knowledge, and active engagement together in intellectual and/or physical activities. [source] Patient participation in surgical pauseANAESTHESIA, Issue 2 2010A. Jeffrey No abstract is available for this article. [source] Patient involvement in health-related decisions during prolonged critical illness,RESEARCH IN NURSING & HEALTH, Issue 4 2007Mary Beth Happ Abstract We describe patterns of communication of patients involved in health-related decision making during prolonged mechanical ventilation (PMV). Data were collected using observation, interview, and record review. Twelve of 30 patients participated in decisions about initiating, withdrawing, and withholding life-sustaining treatment, surgery, artificial feeding, financial/legal issues, discharge care, and daily care procedures. Patient involvement was largely validation or confirmation of what clinicians and families had already decided. Patients' participation was enlisted by clinicians and family members even when the patients did not exhibit full decisional capacity. Patient involvement in health-related decisions during prolonged critical illness is a shared and negotiated process that requires continued empirical study and ethical analysis. © 2007 Wiley Periodicals, Inc. Res Nurs Health 30:361,372, 2007. [source] Validation of Serbian version of the disease-specific myasthenia gravis questionnaireACTA NEUROLOGICA SCANDINAVICA, Issue 2 2010I. Basta Basta I, Pekmezovi, T, Padua L, Stojanovi, V, Stevi, Z, Nikoli, A, Peri, S, Lavrni, D. Validation of Serbian version of the disease-specific myasthenia gravis questionnaire. Acta Neurol Scand: 2010: 122: 110,114. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Aim,,, The aim of this study was to validate translated and cross-cultural adapted Italian version of myasthenia gravis-specific questionnaire (MGQ) in Serbian MG patients. Materials and Methods,,, The questionnaire was validated in 140 consecutive MG patients from Belgrade. In each patient association between the total MGQ score and form and severity of the disease was determined. Also, correlation between regional domain scores of MGQ and main clinical findings according to Besinger's clinical score was analyzed. Results,,, Patients' participation in the assessment was satisfactory with excellent internal consistency and reproducibility. Total MGQ score, as well as domain scores, correlated with highly significant inverse relationship with the disease severity and clinical status of patients at the moment of completing the questionnaire. Furthermore, the bulbar domain of the questionnaire appeared more specific and sensitive than clinical history and examination. Conclusion,,, We concluded that the Serbian version of the MGQ may be useful as a measure of clinical outcome in patients with MG. [source] Issues with recruitment to randomised controlled trials in the drug and alcohol field: a literature review and Australian case studyDRUG AND ALCOHOL REVIEW, Issue 2 2008CLARE L. THOMSON Abstract Issues. The randomised control trial (RCT) is a widely used tool for measuring the effectiveness of health treatments and services. However, subject recruitment is an ongoing challenge for those conducting RCTs and may have a serious impact on the success of the study and the reliability of the outcomes. Approach. In this review we present an examination of the problems and strategies associated with recruitment to RCTs, with particular reference to studies conducted in the drug and alcohol field. A case study of recruitment to an RCT for the treatment of alcohol dependence is presented, supplemented by PubMed, Current Contents and Medline searches to identify relevant publications. Key Findings. The literature suggests that the most common barriers to patient participation involve fears of assignment to placebo treatment, insufficient compensation and poor attendance at initial appointments. Moreover, subject referrals from staff may be a greater problem than reluctance of patients. Referrals are inhibited by complicated entry criteria, time constraints due to busy work schedules or a limited research culture. Implications. Subject recruitment may be promoted by financial reimbursement, close partnerships between research and referral staff; increasing the treatment group ratio in multi-drug trials to minimise randomisation to placebo; addressing negative staff attitudes; and simplifying the referral process. Conclusion. The need for multi-centre sites in Australian drug and alcohol treatment studies is highlighted. [source] Development of the web-based type 2diabetes education programme: DIEPEUROPEAN DIABETES NURSING, Issue 2 2009E Heinrich MSc PhD student Abstract Background: Education is an essential part of diabetes care. However, in The Netherlands, no education programme was available for everyone at any time and adaptive to users' specific needs. Aim: To describe the structured development and final content of a type 2 diabetes web-based education programme. Methods: A web-based education programme,the Diabetes Interactive Education Programme (DIEP),was developed using intervention mapping and involved collaboration between programme planners, Dutch diabetes organisations and potential users (patients and healthcare providers). DIEP incorporates information, multimedia and tools to support self-reflection, goal setting, problem solving and active patient participation. Results:www.diep.info consists of seven chapters with basic and additional information, a dictionary, self-management checklists and a workbook for goal setting and preparation for consultations. The information included is mostly spoken text supported by headlines, images, video and patient experiences. Adoption, implementation and evaluation plans have been made. Outcomes of the process and effect evaluation will be reported in the future. Conclusions: DIEP is a unique education programme, based on theory and planned development, which is supported by diabetes organisations. By using multimedia and incorporating different functionalities, DIEP attempts to meet the current practice requirements. DIEP aims to meet the needs of multiple, specific patient groups in the future, and has already been adapted for use in different countries (eg Belgium). Copyright © 2009 FEND [source] Telling stories from everyday practice, an opportunity to see a bigger picture: a participatory action research project about developing discharge planningHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2009Pia Petersson RN Abstract In spite of laws, rules and routines, findings from Swedish as well as international research show that discharge planning is not a simple matter. There is considerable knowledge about discharge planning, but the quality of the actual process in practice remains poor. With this in mind, a research and developmental health and social care network decided to use participation action research to explore the discharge planning situation in order to generate new ideas for development. This paper reports on the research process and the findings about our enhanced understanding about the discharge planning situation. Story dialogue method was used. The method is based on stories from everyday practice. The stories are used as ,triggers' to ask probing questions in a dialogical and structured form. Local theory is developed to help the participants to find solutions for action in the practice. Our findings were that the discharge planning situation could be seen as a system including three interconnected areas: patient participation, practitioners' competence and organizational support. To reach good quality in discharge planning, all these three issues need to be developed, but not only as routines and forms. Rather, when developing a discharge planning situation, a system where relational aspects such as confidence and continuity are essential and thus needs to be considered. To achieve a change, the core problem needs to be clarified. When the issue is complex, the solution needs to consider the bigger picture and not just the parts. Telling stories from everyday practice, and to systematically reflect and analyse those in interprofessional groups can create opportunities for enhanced understanding, as well as be a vehicle for future change of practice. [source] Organisation and features of hospital, intermediate care and social services in English sites with low rates of delayed dischargeHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2007Matt Baumann MSc Abstract In recent years, there has been significant concern, and policy activity, in relation to the problem of delayed discharges from hospital. Key elements of policy to tackle delays include new investment, the establishment of the Health and Social Care Change Agent Team, and the implementation of the Community Care (Delayed Discharge) Act 2003. Whilst the problem of delays has been widespread, some authorities have managed to tackle delays successfully. The aim of the qualitative study reported here was to investigate discharge practice and the organisation of services at sites with consistently low rates of delay, in order to identify factors supporting such good performance. Six ,high performing' English sites (each including a hospital trust, a local authority, and a primary care trust) were identified using a statistical model, and 42 interviews were undertaken with health and social services staff involved in discharge arrangements. Additionally, the authors set out to investigate the experiences of patients in the sites to examine whether there was a cost to patient care and outcomes of discharge arrangements in these sites, but unfortunately, it was not possible to secure sufficient patient participation. Whilst acknowledging the lack of patient experience and outcome data, a range of service elements was identified at the sites that contribute to the avoidance of delays, either through supporting efficiency within individual agencies or enabling more efficient joint working. Sites still struggling with delays should benefit from knowledge of this range. The government's reimbursement scheme appears to have been largely helpful in the study sites, prompting efficiency-driven changes to the organisation of services and discharge systems, but further focused research is required to provide clear evidence of its impact nationally, and in particular, how it impacts on staff, and patients and their families. [source] From rhetoric to reality: including patient voices in supportive cancer care planningHEALTH EXPECTATIONS, Issue 3 2005Sara K. Tedford Gold PhD Abstract Objective, To explore the extent and manner of patient participation in the planning of regional supportive care networks throughout the province of Ontario. We consider the disconnect between the rhetoric and reality of patient involvement in network planning and co-ordination. Context, In 1997, the Province of Ontario, Canada, established a new, regionalized cancer care system. By transferring responsibility to the regional level and to networks, the architects of the new provincial system hoped to broaden participation in decision making and to enhance the responsiveness of decisions to communities. Research approach, Through a qualitative, multiple case study approach we evaluated the processes of involving patients in network development. In-depth, semi-structured interviews and document analysis were complemented by observations of provincial meetings, regional council and network meetings. Results, The network development processes in the three case study regions reveal a significant gap between intentions to involve patients in health planning and their actual involvement. This gap can be explained by: (i) a lack of clear direction regarding networks and patient participation in these networks; (ii) the dominance of regional cancer centres in network planning activities; and, (iii) the emergence of competing provincial priorities. Discussion, These three trends expose the complexity of the notion of public participation and how it is embedded in social and political contexts. The failed attempt at involving patients in health planning efforts is the result of benign neglect of public participation intents and the social and political contexts in which public and patient participation is meant to occur. [source] Developing an assessment tool for evaluating community involvementHEALTH EXPECTATIONS, Issue 1 2005Jane South BA RGN MA Abstract Background, Current UK policy has resulted in greater requirements for public and patient participation in health service planning and decision making. Organizations and services need to be able to monitor and evaluate the effectiveness and quality of their community involvement processes, but there are few appropriate evaluation tools or sets of indicators available. This paper reports on work within Bradford Health Action Zone to develop a self-assessment tool for organizations on community involvement. Methods, A multi-agency working group developed the tool. A literature search was undertaken and evaluation resources were reviewed. A set of benchmarks for community involvement in regeneration was utilized in developing the assessment areas. A range of individuals with expertise on community involvement practice and performance management was consulted. The tool was then piloted in two primary care trusts prior to final modifications. Results, The process resulted in the production of Well Connected , a self-assessment tool on community involvement designed for organizations to assess their progress and identify areas for improvement. A scoring system assesses evidence of a strategic approach to community involvement, good practice throughout the organization, and a range of opportunities and support. Feedback from the pilots revealed that the tool had facilitated assessment of the strengths and weaknesses of organizational practices. Conclusion, The paper discusses some of the methodological challenges pertaining to the measurement of community involvement. Notwithstanding those challenges, it is argued that Well Connected provides a robust and practical framework that health organizations and their partners can use to assess practice. [source] Conversation analysis: a method for research into interactions between patients and health-care professionalsHEALTH EXPECTATIONS, Issue 1 2001Paul Drew Background,It is clear that much of the success of health-care provision depends on the quality of interactions between health professionals and patients. For instance, it is widely recognized that patients are more likely to take medication effectively if they have been involved in discussions about treatment options, and understand and support the decision about what is prescribed (patient concordance). Hence, patient participation is important for the success of medical outcomes. The key is to explore how communicative choices made by health professionals impact on the quality of interactions in general, and of patient participation in particular. However, to date there has not been an appropriate method for investigating this connection or impact. Objective,To outline the perspective and method of Conversation Analysis (CA). Developed within sociology and linguistics, CA offers a rigorous method (applicable to large data sets) to the study of interaction in health settings. Strategy,The method of CA is illustrated through a review of CA studies of doctor,patient interactions. Two such studies, one from the US and the other from Finland, are reviewed, in order to show how CA can be applied to identifying both forms of patient participation, and the interactional conditions which provide opportunities for patient participation. These studies focus principally on the medical examination and diagnostic stages of the consultation. Further research will examine the forms and conditions of patient participation in decision-making. [source] The medical visit context of treatment decision-making and the therapeutic relationshipHEALTH EXPECTATIONS, Issue 1 2000Debra Roter Dr (Phil) The ascendance of the autonomy paradigm in treatment decision-making has evolved over the past several decades to the point where few bioethicists would question that it is the guiding value driving health-care provider behaviour. In achieving quasi-legal status, decision-making has come to be regarded as a formality largely removed from the broader context of medical communication and the therapeutic relationship within which care is delivered. Moreover, disregard for individual patient preference, resistance, reluctance, or incompetence has at times produced pro forma and useless autonomy rituals. Failures of this kind, have been largely attributed to the psychological dynamics of the patients, physicians, illnesses, and contexts that characterize the medical decision. There has been little attempt to provide a framework for accommodating or understanding the larger social context and social influences that contribute to this variation. Applying Paulo Freire's participatory social orientation model to the context of the medical visit suggests a framework for viewing the impact of physicians' communication behaviours on patients' capacity for treatment decision-making. Physicians' use of communication strategies can act to reinforce an experience of patient dependence or self-reliance in regard to the patient-physician relationship generally and treatment decision-making, in particular. Certain communications enhance patient participation in the medical visit's dialogue, contribute to patient engagement in problem posing and problem-solving, and finally, facilitate patient confidence and competence to undertake autonomous action. The purpose of this essay is to place treatment decision-making within the broader context of the therapeutic relationship, and to describe ways in which routine medical visit communication can accommodate individual patient preferences and help develop and further patient capacity for autonomous decision-making. [source] The Combined Effects of Participatory Styles of Elderly Patients and Their Physicians on SatisfactionHEALTH SERVICES RESEARCH, Issue 2 2004K. Tom Xu Objectives. To test whether concordance or discordance of patient participation between patients and physicians is associated with higher satisfaction, and to examine the effects of patients' and physicians' participatory styles on patients' satisfaction with their physicians. Data. Data collected in the Texas Tech 5000 Survey of elderly patients in West Texas were used. Patient satisfaction with their physicians was measured by a single item from the Consumer Assessment of Health Plans (CAHPS), representing patients' ratings of their physicians. Patient participation was measured by an index derived from a three-item instrument and physicians' participatory decision-making (PDM) style was measured by a three-item instrument developed by the Medical Outcomes Study. Methods. An ordered logit multivariate regression was used to investigate the effects of patients' and physicians' participatory styles on satisfaction with physicians. The interaction between patients' participation and physicians' participatory styles was also included to examine the dependency of the two variables. Results. Controlling for confounding factors, a higher PDM score was associated with a higher rating of patient satisfaction with physicians. A higher patient participation score was related to a lower physician satisfaction rating. The combined effect of patients' and physicians' participation styles indicated that for a low patient participation score, a high PDM score was not needed to produce high satisfaction. The greater the discordance in this direction, the higher the satisfaction. However, with a high patient participation score, only an extremely high PDM score would produce relatively high satisfaction. Conclusions. The current study supports the discordance hypothesis. Participatory physicians and patient,physician communications concerning patient participation can promote higher satisfaction. [source] Standardized Care Planning: Evaluation of ICNP Beta in the Areas of Nutrition and Skin Care in a Practice SettingINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Jan Florin PURPOSE To evaluate completeness, granularity, multiple axial content, and clinical utility of the beta version of the International Classification of Nursing Practice (ICNP®). METHODS Standardized care plans were developed based on research in the areas of nutrition and skin care and clinically tested in a 35-bed infectious disease unit at a Swedish university hospital. A convenience sample of 56 computerized and manual patient records were content analyzed and mapped to the terms in ICNP® beta. FINDINGS A total of 1,771 phrases were identified. Approximately 60% of the record content describing nursing phenomena and about one third of the nursing interventions in the areas of nutrition and skin care could be expressed satisfactorily using the terminology of ICNP® beta. For about 25% of the content describing both nursing phenomena and interventions, no corresponding term was found. The most common deficiencies were focus terms for stating patient perspective or collaboration, nonhuman focus, normal findings, more qualitative judgments, and different expressions for stating duration. Some terms are available in the ICNP beta as a whole, but the organization of axes impedes or restricts the use of terms beyond the ICNP categories. Terms needed to express nursing phenomena could sometimes be found in nursing actions axes. CONCLUSIONS The ICNP® beta needs to be further developed to capture relevant data in nursing care. The axial structure needs to be evaluated, and completeness and granularity of terms need to be addressed further before ICNP beta can be used on a daily basis in the clinical setting. Terms need to be developed to express patient participation and preferences, normal conditions, qualitative dimensions and characteristics, nonhuman focuses as well as duration. Empirical studies covering the complexity of information in nursing care are needed. [source] Applicability of the International Classification of Nursing Practice (ICNP®) in the Areas of Nutrition and Skin CareINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 1 2003Margareta Ehnfors PhD PURPOSE. To evaluate completeness, granularity, multiple axial content, and clinical utility of the beta version of the ICNP® in the context of standardized nursing care planning in a clinical setting. METHODS. An 35-bed acute care ward for infectious diseases at a Swedish university hospital was selected for clinical testing. A convenience sample of 56 patient records with data on nutrition and skin care was analyzed and mapped to the ICNP. FINDINGS. Using the ICNP terminology, 59%-62% of the record content describing nursing phenomena and 30%-44% of the nursing interventions in the areas of nutrition and skin care could be expressed satisfactorily. For about a quarter of the content describing nursing phenomena and interventions, no corresponding ICNP term was found. CONCLUSIONS. The ICNP needs to be further developed to allow representation of the entire range of nursing care. Terms need to be developed to express patient participation and preferences, normal conditions, qualitative dimensions and characteristics, nonhuman focus, and duration. PRACTICE IMPLICATIONS. The practical usefulness of the ICNP needs further testing before conclusions about its clinical benefits can be determined. Search terms: ICNP®, nursing classification, standardized terminology, VIPS [source] Activating Seniors to Improve Chronic Disease Care: Results from a Pilot Intervention StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2010Dominick L. Frosch PhD OBJECTIVES: To evaluate the effect of an activation intervention delivered in community senior centers to improve health outcomes for chronic diseases that disproportionately affect older adults. DESIGN: Two-group quasi-experimental study. SETTING: Two Los Angeles community senior centers. PARTICIPANTS: One hundred sixteen senior participants. INTERVENTION: Participants were invited to attend group screenings of video programs intended to inform about and motivate self-management of chronic conditions common in seniors. Moderated discussions reinforcing active patient participation in chronic disease management followed screenings. Screenings were scheduled over the course of 12 weeks. MEASUREMENTS: One center was assigned by coin toss to an encouragement condition in which participants received a $50 gift card if they attended at least three group screenings. Participants in the nonencouraged center received no incentive for attendance. Validated study measures for patient activation, physical activity, and health-related quality of life were completed at baseline and 12 weeks and 6 months after enrollment. RESULTS: Participants attending the encouraged senior center were more likely to attend three or more group screenings (77.8% vs 47.2%, P=.001). At 6-month follow-up, participants from either center who attended three or more group screenings (n=74, 64%) reported significantly greater activation (P<.001), more minutes walking (P<.001) and engaging in vigorous physical activity (P=.006), and better health-related quality of life (Medical Outcomes Study 12-item Short-Form Survey (SF-12) mental component summary, P<.001; SF-12 physical component summary, P=.002). CONCLUSION: Delivering this pilot intervention in community senior centers is a potentially promising approach to activating seniors that warrants further investigation for improving chronic disease outcomes. [source] Self-evaluation and peer review , an example of action research in promoting self-determination of patients with rheumatoid arthritisJOURNAL OF CLINICAL NURSING, Issue 3a 2007LicNSc, Päivi Löfman RN Aims and objectives., The aim of this paper was to describe the areas that have been performed well and the areas in need of further development of rheumatoid arthritis patients. Background., Nurses' self-evaluation and peer review are important methods for ascertaining the changes and success in the development of nursing practice. To date, there has been minimal research regarding the use of those evaluation methods in nursing practice. Design., The findings of self-evaluation and peer review of nurses are described in a participatory action research study aimed at promotion of self-determination for patients with rheumatoid arthritis. Methods., In self-evaluation, the collection of data was accomplished using a self-evaluation instrument with the permanent nursing staff (n = 18), then analysed through quantitative methods. For peer review, the data were gathered through focus groups (n = 21) using a tool similar to the one used for self-evaluation. The participants included many of the same nurses as in self-evaluation. The data were analysed using qualitative content analysis. Results., Well-performed areas in nursing of rheumatoid arthritis patients were found to be promoting patient participation, supporting self-determination, performing patient-centred nursing and raising patient self-respect. The areas in need of development were connected to the nursing staff themselves: increasing collaboration of nursing staff, decreasing authoritarianism in nursing care and developing nursing practice with colleagues. Conclusions., Self-evaluation and peer review are complementary and support one another, especially since nurses were found to be more critical in their self-evaluations than in peer review. Relevance to clinical practice., Both evaluation tools proved to be useful methods in the evaluation phase of the action research process as a means of professional development. Also assisting in the development of clinical nursing practice. [source] Research Article: Participation of patients with chronic illness in nursing care: An Iranian perspectiveNURSING & HEALTH SCIENCES, Issue 3 2010Mohsen Soleimani rn, phd (Cand.) Abstract The increasing number of chronically ill people has served as an impetus for the promotion of patient participation in nursing care. However, little is known about patient participation in Iran. The aim of this study was to identify the factors that are relevant to patient participation and the nature of that participation, as experienced by chronically ill patients and registered nurses in Iran. Grounded theory was used as the method. Twenty-two participants were recruited by using purposeful and theoretical sampling. The data were generated by semistructured interviews and participant observations. Constant comparison was used for the data analysis. This study indicated that participation is an interactive process between nurses, patients, and family members in the caregiving context. Participation occurred when the caring agents worked together. The core category of "convergence of the caring agents" emerged. The subcategories emerged as the levels of participation and included "adhering", "involving", "sharing", and "true participation". The factors related to the caring agents and caregiving context could be considered as predictors of the level of participation when caring for these patients. [source] An Analysis of the Concept of Patient ParticipationNURSING FORUM, Issue 1 2008BSc Health Service Adm., MSc Nursing, Monika J. M. Sahlsten PhD The concept of patient participation has an array of interpretations and lacks clarity. The purpose of this article is to explore the concept of patient participation within the context of nursing practice. The method described by Walker and Avant (1995) is used. The critical attributes of the concept are identified. Formation of model, borderline, and contrary cases exemplifies key characteristics. Antecedents, consequences, and empirical referents presented allow for further refinement of the key attributes defining the concept. Patient participation in nursing practice can be defined as an established relationship between nurse and patient, a surrendering of some power or control by the nurse, shared information and knowledge, and active engagement together in intellectual and/or physical activities. [source] Constructing a patient education system: A performance technology projectPERFORMANCE IMPROVEMENT, Issue 4 2009Edith E. Bell The purpose of the patient education system described here was to distribute patient education material to and within medical practices managed by a small medical practice management company. The belief was that patient education opportunities improved health care outcomes and increased patient participation in health care decisions and compliance with health care plans. This tool reinforced medical practices' commitment to having patients participate actively in their treatment, differentiated them from other practices, and contributed to the generation of new patients. [source] Treating late-life depression with interpersonal psychotherapy in the primary care sectorINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2007Herbert C. Schulberg Abstract Background Interpersonal psychotherapy (IPT) is an empirically-validated intervention for treating late-life depression. Objective To determine the manner in which IPT is utilized by primary care physicians in relation to antidepressant medications. Methods The authors reviewed treatment logs prepared by care managers during the first 12 months of a patient's participation in the PROSPECT clinical trial to determine initial and longitudinal treatment patterns utilized by physicians, and clinical outcomes associated with initial treatment assignment. Results Primary care physicians in practices randomized to PROSPECT's intervention arm initially prescribed an antidepressant medication for 58% of eligible patients and referred only 11% of them to IPT. Over time, however, 27% of patients participated in IPT as monotherapy or augmentation therapy. Initial treatment assignment was not associated with depressive status at 4 and 12 months nor with suicidal ideation at 4, 8, and 12 months. Conclusion IPT is an effective treatment for late-life depression whose greater use by primary care physicians should be encouraged. Copyright © 2006 John Wiley & Sons, Ltd. [source] Non-antibiotic treatment for bacterial infections: how to validate chance findingsCLINICAL MICROBIOLOGY AND INFECTION, Issue 4 2009L. Leibovici Abstract Researchers have examined in observational studies a possible influence of statins, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and ,-blockers on the prevention of infections or on their outcomes. A priori, we can suspect that biases will work in favour of chance findings, because of the motivation to publish, to publish piquant findings, and to find new niches for lucrative drugs. We should distinguish between three phases. Publication of a novel finding should raise the possibility that an intervention will work in situations other than those expected, and justify, as a second phase, the performance of rigorous, prospective, observational studies. If the results of these studies substantiate the claims for benefit, randomized controlled trials may be performed in the third phase. For all the questions examined here, we have not yet passed the threshold of evidence needed to offer patients participation in randomized controlled trials. [source] The Combined Effects of Participatory Styles of Elderly Patients and Their Physicians on SatisfactionHEALTH SERVICES RESEARCH, Issue 2 2004K. Tom Xu Objectives. To test whether concordance or discordance of patient participation between patients and physicians is associated with higher satisfaction, and to examine the effects of patients' and physicians' participatory styles on patients' satisfaction with their physicians. Data. Data collected in the Texas Tech 5000 Survey of elderly patients in West Texas were used. Patient satisfaction with their physicians was measured by a single item from the Consumer Assessment of Health Plans (CAHPS), representing patients' ratings of their physicians. Patient participation was measured by an index derived from a three-item instrument and physicians' participatory decision-making (PDM) style was measured by a three-item instrument developed by the Medical Outcomes Study. Methods. An ordered logit multivariate regression was used to investigate the effects of patients' and physicians' participatory styles on satisfaction with physicians. The interaction between patients' participation and physicians' participatory styles was also included to examine the dependency of the two variables. Results. Controlling for confounding factors, a higher PDM score was associated with a higher rating of patient satisfaction with physicians. A higher patient participation score was related to a lower physician satisfaction rating. The combined effect of patients' and physicians' participation styles indicated that for a low patient participation score, a high PDM score was not needed to produce high satisfaction. The greater the discordance in this direction, the higher the satisfaction. However, with a high patient participation score, only an extremely high PDM score would produce relatively high satisfaction. Conclusions. The current study supports the discordance hypothesis. Participatory physicians and patient,physician communications concerning patient participation can promote higher satisfaction. [source] Cardiac rehabilitation programme for coronary heart disease patients: An integrative literature reviewINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2009Nidal F Eshah RN, PhD(c) Previous Western cardiac rehabilitation (CR) purported to improve patients' quality of life and health-related parameters for cardiovascular diseases (CVD). Nursing's role in CR was minimally identified. The purpose of this integrative literature review was to determine the effectiveness of current CR programmes and to determine if nurses are included in multidisciplinary CR teams. An online search of databases for the National Institutes of Health Library, Medline, CINAHL, Blackwell Synergy and PsychINFO electronic databases, with keywords,cardiac rehabilitation, lifestyle modification, secondary prevention, quality of life, effects of rehabilitation,identified 13 articles published 2001,2006 for inclusion. Cardiac rehabilitation programmes provided significant improvement in participants' quality of life, exercise capacity, lipid profile, body mass index, body weight, blood pressure, resting heart rate, survival rate, mortality rate and decreased myocardial infarction (MI) risk factors, although there was limited participation. They also decreased depression and anxiety. Eight studies included Nurses as CR providers, but without clear descriptions of their role. Nurses in developing countries need to participate in CR programmes to improve patients' participation, and to focus on modalities with lower overhead costs, such as home-based CR, and to clearly articulate their unique contributions. [source] Coping with type-2 diabetes: the role of sense of coherence compared with active managementJOURNAL OF ADVANCED NURSING, Issue 6 2000Birgitta Sandén-Eriksson PhD Coping with type-2 diabetes: the role of sense of coherence compared with active management Changes in lifestyle, particularly in dietary and exercise habits, are necessary for the majority of patients with type-2 diabetes but are difficult to carry out. However, Antonovsky describes a salutogenic health perspective grounded in patients' developing what he terms ,a sense of coherence' (SOC). Can a strong SOC help diabetes patients to control the disease? The aim of this study was to analyse the relationship between SOC and treatment results measured as glucolysed haemoglobine (HbA1c) in patients with type-2 diabetes. The aim was further to test the relationship between treatment results and an index of patients' participation in active management and emotional state. Eighty-eight patients answered a questionnaire containing 13 statements about sense of coherence (SOC-13), questions about self-assessed health, diabetes activity such as self-management of diet, exercise and self-control of blood sugar and emotional acceptance. There was no direct relationship between SOC-13 and treatment results measured as HbA1c but there was a positive correlation between SOC-13, self-assessed health and HbA1c (P < 0·02). Self-assessed health was seen as a mediating factor. The better patients' estimation of their own health, the higher were SOC-13 scores and the lower HbA1c. There was also a strong positive correlation between low levels of HbA1c and high levels of an index of active management and emotional acceptance of diabetes (P < 0·001). [source] | ||||||||||||||||||||||||||||