The effect of drama-supported, patient role-play experience on empathy and altruism levels in nursing students: A randomized controlled study.

AIM: This study aims to determine the effect of drama-supported, patient role-play experiences on the empathy and altruism levels of nursing students. BACKGROUND: Empathy, one of the most important skills of the nursing profession, has an important place in the patient-nurse relationship. To be empathetic, which is acknowledged as the most basic motivation of altruistic behavior, requires recognizing emotional states and understanding the needs of others. DESIGN: The format of this study was a pre-test-post-test, regular parallel-group, randomized, controlled experiment. METHODS: The study data were collected between October 2021 and February 2022. The research was carried out with second-year students at Necmettin Erbakan University, Faculty of Nursing, who did not have any history of hospitalization or any chronic diseases. All subjects agreed to participate in the study (n = 52, intervention group=26, control group 26). Data were collected using a Descriptive Characteristics Form, the Altruism Scale and the Jefferson Scale of Empathy for Nursing Students (JSENS). After a three-hour drama workshop, participants in the intervention group acted out the role of a bed-bound patient in the laboratory environment and no intervention was applied to the control group. A series of Mixed ANOVAs were conducted for the analysis of the data. RESULTS: The mean age of participants was 19.94 years (SD = ± 1.31) and 83.7 % of the participants were women. The intervention group showed a significant increase in altruism compared with the control group, as evidenced by higher scores in the Altruism Scale Total Score and a significant group*time interaction effect. However, in the JSENS Total Score, including the perspective taking and standing in patient's shoes sub-dimensions, no differences were observed based on group, time and group * time interactions. CONCLUSION: The patient role-play experience increased the empathy and altruism levels of nursing students, but the effect was not evident at the three-month follow-up.

From Individuals to Systems and Contributions to Creations: Novel Framework for Mapping the Efforts of Individuals by Convening The Center of Health and Health Care.

BACKGROUND: People with lived health care experiences (often referred to as "patients") are increasingly contributing to health care and are most effective when they are involved as partners who can contribute complementary knowledge alongside other stakeholders in health care. OBJECTIVE: Convening The Center aimed to bring together "people known as patients"-the center of health care-to address priorities as they defined them. METHODS: According to the original project design, an in-person gathering was to be conducted; however, as a result of the COVID-19 pandemic, the in-person gathering was transformed into a series of digital gatherings, including an in-depth interview phase, small-group gatherings, and a collective convening of 25 participants (22 women and 3 men from the United States, India, Costa Rica, Sweden, and Pakistan). Each participant was interviewed on Zoom (Zoom Video Communications Inc), and the interview data were thematically analyzed to design a subsequent small group and then full cohort Zoom sessions. Visual note-taking was used to reinforce a shared understanding of each individual- and group-level conversation. RESULTS: The interviews and gatherings for Convening The Center offered unique perspectives on patient activities in research, health innovation, and problem-solving. This project further developed a novel, two-spectrum framework for assessing different experiences that patients may have or seek to gain, based on what patients actually do, and different levels of patients' involvement, ranging from individual to community to systemic involvement. CONCLUSIONS: The descriptors of patients in academic literature typically focus on what health care providers think patients "are" rather than on what patients "do." The primary result of this project is a framework for mapping what patients "do" and "where" they do their work along two spectra: from creating their own projects to contributing to work initiated by others and from working at levels ranging from individual to community to systems. A better understanding of these spectra may enable researchers to more effectively engage and leverage patient expertise in health care research and innovation.

Mutual Role Expectations by Patients and General Practitioners-A Mixed Methods Study on Complementarity.

Background: Changes in public attitudes toward "authorities" in general, as well as shifts in medical practice toward participative models of diagnosis and treatment, imply fundamental transformations in the patient−doctor relationship. However, consistency in reciprocal role expectations cannot be assumed, and this study reveals significant discrepancies in attitudes and behaviors in primary health consultations. Methods: We conducted a study in the tri-lingual northeastern Italian region of South Tyrol to determine whether perceptions of the patient's role were congruent or differed. In a mixed method approach, the quantitative research part consisted of a survey with 34 identical questions for general practitioners (n = 109) and adult primary care patients (n = 506) on verbal communication, self-initiative and health literacy, interpersonal and social qualities of the patient−physician relationship, and formal aspects of the consultation. Patients were interviewed via telephone, and general practitioners responded online. In the qualitative part, 26 semi-structured in-depth interviews were conducted with the patients and analyzed. Results: General practitioners considered patients' communicative efforts (p < 0.001), self-initiative (p < 0.001), compliance (p = 0.0026), and openness regarding psychosocial issues (p < 0.001) to be significantly more important, whereas patients showed a tendency to give increased importance to formal aspects such as politeness and hygiene (p < 0.001). Perception of the patient's role differed significantly between the Italian and German linguistic groups. Conclusions: Patients and general practitioners differ in their understanding of patients' roles. These data suggest that a considerable proportion of the population lacks a clear and tangible idea of the active role they could play in consultations. Targeted information on the identified aspects of patient−provider communication may facilitate participatory behavior and positively impact the longitudinal quality of the patient−general practitioner relationship.

Current Status of Phlebotomy Training Among Novice Nurses in Japan: A Survey Analysis.

Introduction Phlebotomy is an invasive technique that requires technical competence, which often makes novice nurses nervous. We created a phlebotomy training program with roleplaying scenarios in which the learners played the role of a nurse and a patient. Methods The study included 84 novice nurses. They played the role of a patient and a nurse and were administered a survey at the end of the training. Data were analyzed using text mining and natural language processing. Results By playing the role of a patient, novice nurses were able to increase awareness of patients' feelings and understand the principles of nursing techniques. Conclusions Phlebotomy training involving roleplay enabled learners to understand the importance of communication and how to make their patients feel comfortable.

Convalescents' Reports on COVID-19 Experience-A Qualitative Study.

BACKGROUND: The dynamic character of the COVID-19 pandemic and its social consequences caused several medical and societal issues and dilemmas. The aim of our qualitative research was to capture and analyze attitudes and beliefs of convalescents who experienced mild symptoms of COVID-19 in the first wave of the pandemic and decided to donate their plasma for therapeutic purposes. MATERIAL AND METHODS: The article presents results of qualitative research conducted on the basis of grounded theory (GT) methodology. Empirical material includes 10 in-depth interviews conducted with respondents who had mild or asymptomatic disease and, after recovery, voluntarily donated their plasma to the Regional Centre for Blood Donation and Blood Treatment (RCKiK). Data were collected in May and June 2020 in Poland. Qualitative analysis was focused on the experience of convalescents who entered the social role of a sick person in individual, social, and organizational dimensions. RESULTS: The social role of the patient in the narratives of convalescents was related to three stages: (1) initiation to the role, (2) staying in the COVID-19 patient role, and (3) leaving the role. Research results enabled the distinction of three basic descriptive categories ("ontological uncertainty", "the global and individual dimension", and "being sick in the disease-infected environment"), which became epistemological framework for a detailed description of the roles played by an individual COVID-19 patient during the pandemic. CONCLUSIONS: The disease, despite its mild course, generated a number of non-medical issues, and the entire process of being ill was burdened with institutional and emotional struggles. The experience of mild COVID-19 is significantly modified by disease institutionalization. These results may contribute to a better understanding of the psychosocial dimension of COVID-19 and convalescents' motivations for plasma donation.

"I'm not the doctor; I'm just the patient": Patient agency and shared decision-making in naturally occurring primary care consultations.

OBJECTIVES: To explore interactional processes in which clinical decisions are made in situ during medical consultations, particularly the ways in which patients show agency in decision-making processes by proposing and opposing actions, and which normative dimensions and role-expectations their engagement entail. METHODS: Narrative analysis of verbatim transcripts of 22 naturally occurring consultations, sourced from a corpus of 212 consultations between general practitioners and patients in England. After thematically coding the whole dataset, we selected 22 consultations with particularly engaged patients for in-depth analysis. RESULTS: Patients oppose further actions more often than they propose actions, and they oppose more directly than they propose. When they explain why they propose and oppose something, they reveal their values. Patients' role-performance changes throughout the consultations. CONCLUSION: Assertive patients claim - and probably also achieve - most influence when they oppose actions directly and elaborate why. Patients display ambiguous role-expectations. In final concluding stages of decision-making processes, patients usually defer to GPs' authority. PRACTICE IMPLICATIONS: Clinicians should be attentive to the ways in which patients want to engage in decision-making throughout the whole consultation, with awareness of normative dimensions of both process and content, and the ways in which patient's actions are constrained by their institutional position.

Provider perspectives on the role of the patient as an active participant in HIV care.

The World Health Organization (WHO) advocates for patients to play an active role in their healthcare in order to improve the quality of care delivery. However, there is limited research on provider perceptions of the role of the patient during a medical encounter in an HIV setting in Sub-Saharan Africa. This qualitative study was conducted between September 2014 and August 2015. Sixty healthcare providers were recruited using convenience sampling methods from three sites (Moi Teaching and Referral Hospital, Webuye and Busia) within the Academic Model Providing Access to Healthcare (AMPATH) HIV care and treatment program. In-depth interviews were conducted in either Swahili or English, transcribed and translated if necessary into English. Data was analysed thematically. Provider expectations were mainly influenced by their professional role. Despite this variance, providers expect patients to communicate openly during their clinical encounters. Overall, there was a shift in provider expectations of the patient from a traditional paternalistic role to a more active role. This study provides valuable insight into provider expectations of patients during medical encounters in HIV settings. Findings from this study may contribute to developing appropriate interventions for providers as well as to design patient empowerment initiatives.

Elderly patients' decision-making embedded in the social context: a mixed-method analysis of subjective norms and social support.

BACKGROUND: Older patients are increasingly encouraged to be actively involved but how they perceive their role in the decision-making process varies according to their health care providers and their health situation. Their role could be influenced by their social context but more specifically by subjective norms (i.e. patients' view of the role that significant others expect them to play in the decision-making process) and perceived social support. We explore how social context (i.e. subjective norms and social support) relates to how the patient perceives their role in the decision-making process. Also, we explore the level of alignment on subjective norms between patients and their informal caregivers and nurses. METHODS: Mixed-method study among older patients, informal caregivers and nurses. For the quantitative questionnaire, a home care organisation randomly selected patients. The patients were asked to identify their informal caregiver and the home care organisation was asked to identify the nurse who was most involved in their care. In total 133 patients, 64 informal caregivers and 72 nurses were questioned. Participants for the qualitative interviews were selected using convenience sampling, resulting in the inclusion of ten patients, five informal caregivers and six nurses. Subjective norms were based on a previous study. Social support was measured with the 'social support for health scale' of the Health Literacy Questionnaire. The Control Preference Scale was used as outcome variable. The interviews focused on subjective norms, social support and how the patient perceived their role. Quantitative analysis included the calculation of subjective norm difference scores between respondent groups, one-way analysis of variance and multinomial logistic regression analysis. Directed content analysis was applied to the interviews using Atlas TI. RESULTS: Lower difference scores were found for patient-informal caregiver dyads (mean = 0.95), implying more alignment than in patient-nurse dyads (mean = 2.12). Patients perceiving themselves to have a shared or passive role tend to believe that they are expected to leave decision-making to the health care provider. Higher social support scores related more to a shared role. Alignment relates to: familiarity with the patient's preferences, overprotectiveness or valuing the care provider's opinion and the severity of the patient's medical history. CONCLUSION: Patients and informal caregivers align on whether the patient should make decisions. The more patients believe that they are expected to leave decision-making to the health care provider, the more they perceive themselves as having a passive role. The more patients who feel they have support, the more they perceive themselves as having a shared role. Patients and caregivers could be facilitated to make role expectations explicit. Examining support resources in the social network is desirable.

The Patient's Role in Patient Safety.

Keeping patients safe while they receive medical care is essential. Yet current systems designed to ensure patient safety are not enough, because medical error is the third leading cause of preventable deaths in the United States. Clinicians can partner with the patient to enhance patient safety. Pulse Center for Patient Safety proposes patient- and family-driven processes designed to improve a patient's chances of avoiding harm. This article discusses highlights of the role of patient safety through a grassroots lens, summarizes the factors that influence the patient's role in patient safety and reviews recommendations on how clinicians can partner with patients.

Taking patient virtue seriously.

Virtue theory in philosophical bioethics has influenced clinical ethics with depictions of the virtuous doctor or nurse. Comparatively little has been done with the concept of the virtuous patient, however. Bioethicists should correct the asymmetry in virtue theory between physician virtues and patient virtues in a way that provides a practical theory for the new patient-centered medicine-something clinicians and administrators can take seriously.

Maintenance therapy for teeth and implants.

Maintenance care is mandatory for the long-term success of periodontal and implant treatment. As it is frequently necessary to treat recurrent or persisting disease, maintenance therapy goes beyond a true prophylaxis. During this lifelong therapy, both the patient and the dental team need to be working closely together. It is imperative to combine efforts to have the build-up of biofilm under control during maintenance and to reduce, as much as possible, the influence that risk factors may play in plaque accumulation as well as in the tissue inflammatory response. Guidelines to evaluate periodontal tissue response are described, and a maintenance protocol is outlined. The management of residual pockets is stressed, and a variety of treatment approaches are considered and evaluated. How to evaluate peri-implant tissues during maintenance is discussed, as is the protocol of the cumulative interceptive supportive therapy.

Invaded by Cancer, and the Patient is Me.

A cancer diagnosis is life-altering. Each patient situation is unique, including response to the news, approach to available treatment options, and insight into every aspect of life. As a pharmacist, the author shares personal insights into living with a cancer diagnosis, her new role as a patient, her perspective as a pharmacist, processing the reactions of those surrounding her, and what she's learning about herself through all of this.

Patients' knowledge about pharmacists, technicians, and physicians.

PURPOSE: Including pharmacists within care teams can lead to positive health benefits, yet pharmacists remain underused. Misperceptions about pharmacists' duties and expertise compared to physicians' may contribute. This study sought to determine how well patients know the differences between pharmacists, technicians, and physicians regarding their duties and levels of education about medications. It also investigated how patients' perceptions affect their likelihood to initiate interactions with pharmacists, as well as reasons why they choose not to speak with pharmacists. METHODS: An online survey of 477 U.S. adults was administered via Amazon's Mechanical Turk. Participants' knowledge of pharmacists', pharmacy technicians', and medical doctors' education and expertise were measured. Logistic regression determined whether patients' attitudes toward pharmacists predicted patient-pharmacist interactions. Participants' reasons for choosing to not talk to pharmacists about their medications were assessed via an open-ended response. RESULTS: Patients generally know the duties pharmacists can perform compared to duties of technicians, but they incorrectly believe that physicians have more years of drug education than do pharmacists. Patients who have more positive attitudes toward pharmacists versus doctors are more likely to initiate interactions with pharmacists. Not seeing a need to interact, believing their doctors told them everything, or their ability to find information elsewhere (e.g., the Internet) were the 3 most cited reasons for not interacting with a pharmacist. CONCLUSION: Reaching across disciplinary lines to colleagues in health communication may assist the pharmacy profession in finding ways to increase patients' knowledge and perceptions about the important role pharmacists can play, thereby increasing the likelihood of patients wanting to interact with pharmacists.

Primary health care nurses' views on patients' abilities and resources to make choices and take decisions on health care.

Recent health reforms in many European countries have emphasised patient choice as a tool for patient participation, and for the improved efficiency of services. Little attention has been paid to experiences of the nurses in these reforms, even though the reforms directly concern all health care personnel and cannot be implemented without their contribution. This study looks at patient choice from the perspective of the nurses working in primary health care clinics in Finland. In Finnish primary care, nurses have a central role in coordinating patient care and advising patients. The data come from 31 interviews conducted in 17 health care clinics. The approach adopted in the analysis is data-driven and brings forth nurses' experiences in their daily work with patients. A detailed analysis of the nurses' responses and views was conducted with discourse analysis. While nurses positioned some patients as knowledgeable, able to search for information and make use of different services without nurses' help, some of the patients were positioned as those needing nurses' advice and guidance through the complex system of health and social care services. Nurses' positions varied from co-actors and gate-keepers to advocates and spokespersons. In order to succeed future health care reforms need to take better into account the realities of health clinics and the grassroots-level knowledge that primary care nurses have on patients and clinical practices.

Challenges in the nurse's role in rehabilitation contexts.

AIM AND OBJECTIVE: To shed light on how nurses perceive particular challenges that they experience in encounters with patients in rehabilitation wards. BACKGROUND: Rehabilitation is a tailor-made process that allows someone with impairment to live well. Many rehabilitation institutions embrace strong beliefs in patient participation as well as awareness of and listening to the needs and wishes of patients. To our knowledge, few studies have investigated the challenges encountered by nurses from patients in rehabilitation contexts and how these challenges might influence their roles as nurses. DESIGN AND METHODS: This study has a qualitative design that is based on three focus group interviews with nurses working in three rehabilitation wards. A convenience sample of 15 nurses, five from each ward, was recruited to participate in focus group interviews. The participants worked in wards for patients suffering mainly from stroke and head injuries. The analysis is inspired by hermeneutic principles to explore the participants' challenges in their role in rehabilitation contexts. RESULTS: Data analyses identified three main themes surrounding the challenges experienced by nurses: (1) Adjusting patients' and next of kin's expectations, (2) Tailoring support and information, (3) Recognising patients' knowledge. CONCLUSION: Our results from the three rehabilitation wards indicate that nurses display various educative strategies. There is, however, a need for further empirical work into how knowledgeable patients and next of kin create new challenges with implications for the nurse's role within rehabilitation contexts. RELEVANCE TO CLINICAL PRACTICE: The study highlights the educative aspects of the nurse's role in relation to patients and next of kin on rehabilitation wards as significant contributors to recovery processes.

Exploring eHealth Ethics and Multi-Morbidity: Protocol for an Interview and Focus Group Study of Patient and Health Care Provider Views and Experiences of Using Digital Media for Health Purposes.

BACKGROUND: eHealth is a broad term referring to the application of information and communication technologies in the health sector, ranging from health records to medical consultations (telemedicine) and multiple forms of health education, support, and tools. By providing increased and anytime access to information, opportunities to exchange experiences with others, and self-management support, eHealth has been heralded as transformational. It has the potential to accelerate the shift from traditional "passive patient" to an informed, engaged, and empowered "patient as partner," equipped to take part in shared decision-making, and take personal responsibility for self-managing their illness. OBJECTIVE: The objective of our study is to examine how people with chronic illness use eHealth in their daily lives, how it affects patient-provider relationships, and the ethical and practical ramifications for patients, providers, and service delivery. METHODS: This two-phase qualitative study is ongoing. We will purposively sample 60-70 participants in British Columbia, Canada. To be eligible, patient participants have to have arthritis and at least one other chronic health condition; health care providers (HCPs) need a caseload of patients with multi-morbidity (>25%). To date we have recruited 36 participants (18 patients, 18 HCPs). The participants attended 7 focus groups (FGs), 4 with patients and 3 with rehabilitation professionals and physicians. We interviewed 4 HCPs who were unable to attend a FG. In phase 2, we will build on FG findings and conduct 20-24 interviews with equal numbers of patients and HCPs (rehabilitation professionals and physicians). As in the FGs conducted in phase I, the interviews will use a semistructured, but flexible, discussion guide. All discussions are being audiotaped and transcribed verbatim. Constant comparisons and a narrative approach guides the analyses. A relational ethics conceptual lens is being applied to the data to identify emergent ethical issues. RESULTS: This study explores ethical issues in eHealth. Our goal is to identify the role of eHealth in the lives of people with multiple chronic health conditions and to explore how eHealth impacts the patient role, self-managing, and the patient-HCP relationship. The ethical lens facilitates a systematic critical analysis of emergent ethical issues for further investigation and pinpoints areas of practice that require interventions as eHealth develops and use increases both within and outside of the clinical setting. CONCLUSIONS: The potential benefits and burdens of eHealth need to be identified before an ethical framework can be devised.

Cancer patients' experiences of using an Interactive Health Communication Application (IHCA).

Interactive Health Communication Applications (IHCAs) are increasingly used in health care. Studies document that IHCAs provide patients with knowledge and social support, enhance self- efficacy and can improve behavioural and clinical outcomes. However, research exploring patients' experiences of using IHCAs has been scarce. The aim of this study was to explore cancer patients' perspectives and experiences related to the use of an IHCA called WebChoice in their homes. Qualitative interviews were conducted with infrequent, medium and frequent IHCA users-six women and four men with breast and prostate cancer. The interviews were transcribed and analyzed inspired by interactionistic perspectives. We found that some patients' perceived WebChoice as a "friend," others as a "stranger." Access to WebChoice stimulated particularly high frequency users to position themselves as "information seeking agents," assuming an active patient role. However, to position oneself as an "active patient" was ambiguous and emotional. Feelings of "calmness", "normalization of symptoms", feelings of "being part of a community", feeling "upset" and "vulnerable", as well as "feeling supported" were identified. Interaction with WebChoice implied for some users an increased focus on illness. Our findings indicate that the interaction between patients and an IHCA such as WebChoice occurs in a variety of ways, some of which are ambivalent or conflicting. Particularly for frequent and medium frequency users, it offers support, but may at the same time reinforce an element of uncertainty in their life. Such insights should be taken into consideration in the future development of IHCAs in healthcare in general and in particular for implementation into patients' private sphere.

Informal work and formal plans: articulating the active role of patients in cancer trajectories.

INTRODUCTION: Formal pathways models outline that patients should receive information in order to experience a coherent journey but do not describe an active role for patients or their relatives. The aim of this is paper is to articulate and discuss the active role of patients during their cancer trajectories. METHODS AND THEORY: An in-depth case study of patient trajectories at a Danish hospital and surrounding municipality using individual interviews with patients. Theory about trajectory and work by Strauss was included. RESULTS: Patients continuously took initiatives to organize their treatment and care. They initiated processes in the trajectories, and acquired information, which they used to form their trajectories. Patients presented problems to the healthcare professionals in order to get proper help when needed. DISCUSSION: Work done by patients was invisible and not perceived as work. The patients' requests were not sufficiently supported in the professional organisation of work or formal planning. Patients' insertion and use of information in their trajectories challenged professional views and working processes. And the design of the formal pathway models limits the patients' active participation. When looking at integrated care from the perspective of patients, the development of a more holistic and personalized approach is needed.