Dying, death and bereavement: developing a national survey of bereaved relatives.

BACKGROUND: Assessing and measuring the experience and quality of care provided is central to the improvement of care delivery of all healthcare systems. This paper reports on the development of a survey instrument to capture the experiences of care at end of life from the perspective of bereaved relatives in the Republic of Ireland. METHODS: A multi-method, multi-stakeholder, sequential approach was adopted for this study. Items for inclusion in the survey instrument bank were identified through (1) a feasibility study and scoping literature review, (2) expert panel programme board review, (3) focus groups and (4) gap analysis. The following steps were undertaken to prioritise the items for inclusion in the final survey instrument: (1) a Delphi study (2) technical expert panel review (3) cognitive interviews with bereaved relatives and an (4) expert panel programme board review. RESULTS: Following an iterative process with key stakeholders, a survey instrument was developed with sections focusing on the provision of care at home, in the last nursing home / residential care facility, hospice and hospital, as well as care experience in the last 2 days of life, the relative's experiences of care and support, the circumstances of care surrounding death and demographic information. In total, a bank of 123 questions were prioritised to be included in the National End of Life Survey instrument. CONCLUSION: The survey will provide a standardised national approach to capturing the experience of care of those who have died, from the perspective of bereaved relatives in the Republic of Ireland. This will allow health service providers, policy makers and regulators to gather important insights into the experiences of care at end of life and will help fulfil the requirement of healthcare services to ensure they are providing high-quality care.

Preparing for Electronic Medical Record Implementation: Carolina Care Communication in an Electronic Environment.

This article describes 1 organization's successful approach to mitigating the potential negative effects of a new electronic medical record on patient experience. The Carolina Care model, developed at the University of North Carolina Hospitals to actualize caring theory in practice, helped to structure and greatly facilitate this work. Seven focus areas were integrated to create the "Communication in an Electronic Environment" program with a strong emphasis on nurse-patient communication.

Reducing liver transplant length of stay: a Lean Six Sigma approach.

CONTEXT: Organ transplant centers are under increasing scrutiny to maintain outcomes while controlling cost in a challenging population of patients. Throughout health care and transplant specifically, length of stay is used as a benchmark for both quality and resource utilization. OBJECTIVE: To decrease our length of stay for liver transplant by using Lean Six Sigma methods. DESIGN: The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) method was used to systematically analyze our process from transplant listing to hospital discharge after transplant, identifying many factors affecting length of stay. PATIENTS OR OTHER PARTICIPANTS: Adult, single-organ, primary liver transplant recipients between July 2008 and June 2012 were included in the study. Recipients with living donors or fulminant liver failure were excluded. INTERVENTION(S): Multiple interventions, including a clinical pathway and enhanced communication, were implemented. MAIN OUTCOME MEASURE(S): Length of stay after liver transplant and readmission after liver transplant.R ESULTS: Median length of stay decreased significantly from 11 days before the intervention to 8 days after the intervention. Readmission rate did not change throughout the study. The improved length of stay was maintained for 24 months after the study. CONCLUSION: Using a Lean Six Sigma approach, we were able to significantly decrease the length of stay of liver transplant patients. These results brought our center's outcomes in accordance with our goal and industry benchmark of 8 days. Clear expectations, improved teamwork, and a multidisciplinary clinical pathway were key elements in achieving and maintaining these gains.

Experiences of shared decision making in acute hospitals: A mixed methods secondary analysis of the Irish National Inpatient Experience Survey.

INTRODUCTION: This study explored patient experiences of shared decision making (SDM) in public acute hospitals in Ireland. METHODS: Quantitative and qualitative data from three years of the Irish National Inpatient Experience Survey were analysed. Survey questions were mapped to definitions of SDM and subjected to principal components analysis. Three SDM subscales (care on the ward; treatments; discharge) and one overall SDM scale were created. Differences in experiences of SDM by aspects of care and patient group were assessed. Thematic analysis of qualitative responses was undertaken. RESULTS: 39,453 patients participated in the survey. The mean SDM experience score was 7.60 ± 2.43. Experience scores were highest on the treatments sub-scale, and lowest during discharge. Patients who had a non-emergency admission, those aged 51-80 years and men had more positive experiences than other groups. Patient comments highlighted that opportunities to clarify information and facilitation of families/caregivers in SDM were found to be lacking. CONCLUSION: There were differences in experiences of SDM by aspects of care and patient group. PRACTICE IMPLICATIONS: Efforts to improve SDM in acute hospitals are required, particularly at the time of discharge. SDM may be improved by facilitation of more time for discussion between clinicians and patients and/or their families/caregivers.

Women's experiences of initiating feeding shortly after birth in Ireland: A secondary analysis of quantitative and qualitative data from the National Maternity Experience Survey.

OBJECTIVE: To explore women's experiences of initiating and continuing breast or formula feeding shortly after birth in Ireland's maternity hospitals and units, as well as at home after birth. DESIGN: Mixed methods secondary analysis of qualitative and quantitative data from the Irish National Maternity Experience Survey 2020. SETTING: All 19 maternity hospitals and units in the Republic of Ireland and the national home births service. Women were asked about their maternity care experiences, including antenatal care, care during labour and birth, feeding, and care at home after birth. PARTICIPANTS: A total of 3,205 women who gave birth in October or November 2019 participated in the study (50% response rate). MEASUREMENTS: Free-text comments related to women's experiences of initiating and continuing breast or formula feeding were analysed using thematic analysis. Quantitative data were described using means (SD) and frequencies and percentages. FINDINGS: In the first few days after birth, 41.9% of women breastfed exclusively, 29.0% used formula and breast milk, and 29.1% bottle-fed only. Seven-hundred and twenty women (22.5%) made 824 comments related to feeding. Four themes were identified: (1) support and encouragement from healthcare professionals, (2) information and advice regarding feeding, (3) Pressure to feed in a particular way and (lack of) respect for personal preferences, and (4) hospital environment and resources. KEY CONCLUSIONS: Some women experienced a lack of support with feeding their babies, regardless of feeding method. Clear and concise information on feeding practices and home supports could help to support mothers with breast or formula feeding. IMPLICATIONS FOR PRACTICE: It is important that healthcare professionals provide evidence-based information and support, while respecting women's choices. Lactation consultants could offer training and consistent information to healthcare professionals as well as providing specialist support to mothers who experience problems with breastfeeding during their hospital stay and in the postnatal period.

Care Experiences of Older People in the Emergency Department: A Concurrent Mixed-Methods Study.

The growing population of older people has increased demand to meet their complex healthcare needs, including in emergency departments (EDs). This study explored the experiences of people aged 65+ in Irish EDs, involving secondary analysis of quantitative and qualitative data from the 2019 National Inpatient Experience Survey (NIES). Experiences in the ED and overall hospital experiences were dichotomized as poor to fair or good to very good. Logistic regression was used to model quantitative data. Free text comments relating to EDs were thematically analyzed. Of 12,343 survey participants, 4,442 (39.9%) were aged 65+ years and used the ED. Longer waiting times, completion of the questionnaire by another person either with or on behalf of the patient, and having both a medical card and private health insurance were predictors of poor to fair ED experiences. Patients aged 85+ years were more likely to report good to very good ED experiences. Poor experiences in the ED were associated with poorer overall hospital experiences (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.76 to 2.73, p < .001). Thematic analysis revealed that long waiting times and unpleasant waiting conditions, including lack of communication, privacy, and personal care were important challenges encountered in the ED, with some older patients noting their preference for separate ED services. There is a need to reduce waiting times and integrate user perspectives in the planning, organization, and delivery of ED care to improve experiences and quality of care for a growing older population.

Recognition: a key retention strategy for the mature nurse.

Recognition of staff can be one of the easiest, cost-effective strategies to retain experienced mature nursing staff. The authors discuss the Senior and Generational Excellence initiative that identifies strategies and brings attention to the unique skills and needs of mature professional nurses.