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The Patient–Health-professional Interaction in a Hospital Setting
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the thesis was to describe patient−health-professional interactions in a hospital setting, with a specific focus on the surgical care unit. The thesis consists of four studies and includes both qualitative and quantitative studies. Content analysis and phenomenography were used in the qualitative studies; the quantitative study was an intervention study with a three-phase quasi-experimental design.

The findings of study I showed that patient complaints to a local Patients’ Advisory Committee about negative interactions with health professionals most often concerned the perceived insufficiencies of information, respect, and empathy. The findings of study II showed that experiences of negative interactions with health professionals caused long-term consequences for individual patients and reduced patients’ confidence in upcoming consultations. The findings of the phenomenographic study (III) showed that surgical nurses understand an important part of their work in qualitatively different ways, which can be presented as a hierarchy of increasing complexity and comprehensiveness. In the most restricted understanding, surgical nurses focus on the work task, whereas in the others surgical nurses demonstrate increasing degrees of patient-centeredness. Finally, the results of study IV showed that an uncomplicated intervention that invited patients to express their daily questions and concerns in writing (using the ‘Tell-us card’) improved the patients’ perceptions of participation in their care in a surgical care unit. For further implementation of the Tell-us card to succeed, it needs to be prioritized and supported by leaders in ongoing quality improvement work.

The value of a patient-focused interaction needs to be the subject of ongoing discussions in surgical care units. Patients’ stories of negative interactions could be used as a starting point for discussions in professional reflection sessions. It is important to discuss and become aware of different ways of understanding professional interactions and relationships with patients; these discussions could open up new areas of professional development. Providing patients an opportunity to ask their questions and express their concerns in writing, and using this information in the patient−health-professional interaction, could be an important step towards improved patient participation.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2011. , 77 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 673
Keyword [en]
The patient–health-professional interaction, relationship, complaints, patient participation, hospital setting, quality of care, content analysis, phenomenography, intervention
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-151420ISBN: 978-91-554-8077-6OAI: oai:DiVA.org:uu-151420DiVA: diva2:410127
Public defence
2011-05-30, Grönwallsalen, Akademiska Sjukhuset, Ing 70, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-05-09 Created: 2011-04-11 Last updated: 2011-07-01Bibliographically approved
List of papers
1. Patients' and relatives' complaints about encounters and communication in health care: evidence for quality improvement
Open this publication in new window or tab >>Patients' and relatives' complaints about encounters and communication in health care: evidence for quality improvement
2009 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 75, no 2, 199-204 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to describe patients' and relatives' complaints to the local Patients' Advisory Committee about their encounters and communication in health care. METHODS: Complaints (n=105) regarding patients' and relatives' dissatisfaction with communication and encounters in health care, registered at a local Patients' Advisory Committee between 2002 and 2004, were included. The texts were analysed using content analysis. RESULTS: Three categories were identified: "Not receiving information or being given the option to participate", "Not being met in a professional manner" and "Not receiving nursing or practical support". Insufficient information, insufficient respect and insufficient empathy were described as the most common reasons for a negative professional encounter. CONCLUSION: Patients and relatives experienced unnecessary anxiety and reduced confidence in health care after negative professional encounters. PRACTICE IMPLICATIONS: The complaints reported to the Patients' Advisory Committee could be used more effectively in health care and be regarded as important evidence when working with quality improvement. To systematically use patient stories, such as those obtained in this report, as a reflective tool in education and supervision could be one way to improve communication and bring new understanding about the patient's perspective in health care.

Keyword
Complaints, Communication, Professional encounter and content analysis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-101332 (URN)10.1016/j.pec.2008.10.007 (DOI)000265471500010 ()19038522 (PubMedID)
Available from: 2009-04-24 Created: 2009-04-23 Last updated: 2011-07-01Bibliographically approved
2. Patients' complaints about negative interactions with health professionals in a surgical setting
Open this publication in new window or tab >>Patients' complaints about negative interactions with health professionals in a surgical setting
2011 (English)In: International Journal of Person Centered Medicine, ISSN 2043 7749, Vol. 1, no 4, 756-765 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe the experiences of patients who complain about negative interactions with health professionals in a surgical setting. The study was based on interviews with patients (n = 15) who had contacted their local Patients’ Advisory Committee to report their negative interaction with health professionals in a large university hospital in Sweden. Exploring the experiences of patients who report negative interactions may be a starting point for learning about the patients’ views of the health care organisation, and this information may contribute to quality improvement. The interviews were analysed using qualitative content analysis. Patients’ experiences of negative interactions are described under three main themes: ‘having lost confidence’, ‘feeling like a nuisance’ and ‘feeling abandoned and lonely’. Negative interactions with health professionals caused long-term consequences for patients, including suffering, insecurity, and worry. It also reduced their confidence in upcoming consultations. From the patients’ perspective a caring relationship with health professionals and reliable, appropriate, and timely information are vital to high quality care. Patient access to information and positive interactions with health professionals should be routine quality indicators in the surgical care unit. In the process of quality improvement, all health professionals need to be involved in setting goals, making small tests of changes, and evaluating outcomes. Patients’ stories of negative interactions could provide the impetus for professional reflection sessions in the surgical care unit and for education for all health professionals to develop new competence in patient relations

Place, publisher, year, edition, pages
Buckingham: The University of Buckingham Press, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-151410 (URN)
Available from: 2011-04-11 Created: 2011-04-11 Last updated: 2013-08-12Bibliographically approved
3. Surgical nurses' different understandings of their interactions with patients: a phenomenographic study
Open this publication in new window or tab >>Surgical nurses' different understandings of their interactions with patients: a phenomenographic study
2011 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 3, 533-541 p.Article in journal (Refereed) Published
Abstract [en]

Surgical nurses' different understandings of their interactions with patients: a phenomenographic study The aim of this study was to identify and describe different ways surgical nurses understand their roles and interactions with patients and their families in a surgical care setting. The surgical nurse has an important role in supporting and encouraging the patient during the hospital stay. It can be a challenge for the nurse to quickly establish a trustful relationship with the patient. The assumption is that nurses' interactions with patients are affected by their understanding and expectations of the roles in the nurse-patient relationship. A qualitative interview approach was used and the interviews were analysed using the phenomenographic method. A strategic sample of 17 registered nurses in two hospitals in Sweden was interviewed. In the analysis four ways of understanding the nurse's role in interactions with the patient were identified: (A) Focusing on medical treatment, following prescribed instructions, and maintaining routines; (B) Providing information, giving service, and coordinating care and treatment; (C) Seeing patients as vulnerable people and helping and supporting them as individuals; and (D) Inviting patients to participate in the caring process and encouraging them to take responsibility in their own care. Seeing each patient as a person with individual needs and personal resources. The first way of understanding, A, focuses on the work task; the other three understandings focus on the patients, but differ in how the nurses see them as people. Understanding A represents a restricted and task-oriented approach, whereas the others are more patient-focused, but also more complex. To realise patient-centred care, nurses should pay attention to all aspects of the interaction. Nurses need to have time at ward meetings or in supervision to discuss and become aware of different ways of understanding their interactions and relationships with patients. In this way new areas of professional development may be opened up.

Keyword
phenomenography, qualitative approaches, nurse-patient interaction, nurse-patient relationships, surgical nursing, professional development, patient participation
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-138701 (URN)10.1111/j.1471-6712.2010.00860.x (DOI)000293756500016 ()21158890 (PubMedID)
Available from: 2010-12-28 Created: 2010-12-17 Last updated: 2015-07-22Bibliographically approved
4. The impact of an intervention to improve patient participation in a surgical care unit: a quasi-experimental study
Open this publication in new window or tab >>The impact of an intervention to improve patient participation in a surgical care unit: a quasi-experimental study
2012 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, no 5, 528-538 p.Article in journal (Refereed) Published
Abstract [en]

Background: Organizational changes in surgical care are requiring patients to become more responsible for their own care, both before and after surgery, and also during recovery. Involving patients in their care is vital to improving quality of care and patient safety.

Objective: The aim of this study was to investigate the impact of the ‘Tell-us’ card on patients’ perceptions of quality of care, with a specific focus on patient participation. Another aim was to evaluate the use of the Tell-us card from the patients’ perspective.

Design: A quasi-experimental design with an intervention group and control groups was used. The patient's self-written Tell-us card was introduced as the intervention.

Setting: The study was conducted in two surgical care units at a Swedish university hospital.

Participants: A consecutive sample of patients admitted from the waiting list and from the emergency department was included (n = 310). The inclusion criteria were surgical patients with a hospital stay of at least one day. Patients who were younger than 18 years, not able to speak or write in Swedish, or unable or unwilling to give informed consent to participate were excluded.

Methods: Quality of care was assessed using the questionnaire ‘Quality from the Patient's Perspective’. The patients included in the intervention group were asked to write what was most important for them during the day or just before discharge on patient-written Tell-us cards.

Results: The use of the Tell-us card resulted in significant improvements (5 out of 17 items) in patients’ abilities to participate in decisions about their nursing and medical care. The patients found the Tell-us card more useful in their interaction with registered nurses and assistant nurses than with physicians.

Conclusions: The use of the Tell-us card improved patients’ participation in some areas of nursing and medical care in the surgical care units. The Tell-us card is an uncomplicated and inexpensive tool that could be an important step towards improved patient participation in the surgical care unit. More research is needed to evaluate the use of the Tell-us card in different hospital units and over a longer period of time.

Keyword
Intervention study, Patient-centred care, Patient participation, Surgical care unit, Quality of care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-150699 (URN)10.1016/j.ijnurstu.2011.10.024 (DOI)000303960600004 ()
Available from: 2011-04-11 Created: 2011-04-04 Last updated: 2012-06-05Bibliographically approved

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