Examining the relationship between patient-centred care and outcomes.

PURPOSE: to examine the extent to which staff nurses provided patient-centred care (PCC), as perceived by staff nurses and patients, and to explore the relationships between implementation of PCC and patient outcomes. DESIGN: A descriptive correlational design with repeated measures was used. Descriptive statistics, correlations and t-tests were calculated. METHODS: Data were collected from 63 nurses and 44 patients admitted to cardiology, neurology/neurosurgery and orthopedic units. Nurses' and patients' perception of implementation of dimensions of PCC, and patient outcomes were measured with validated instruments. FINDINGS: Overall, nurses and patients reported implementation of PCC to a moderate extent. Provision of different aspects of PCC was associated with high levels of patient self-care. CONCLUSIONS: Implementation of PCC is expected to improve patient outcome by increasing patient self-care ability and improving satisfaction with care and quality of life. CLINICAL RELEVANCE: The findings will guide further improvement in the implementation of PCC to continuously enhance quality of nursing care, the patients' hospital experience and readiness for discharge.

Patient awareness of seizures as documented in the epilepsy monitoring unit.

Treatment for epilepsy depends largely on seizure frequency reported by patients through their seizure diaries. However, patients may be unaware of some of their seizures, which may lead to incomplete diary data, impacting on appropriate treatment plans. The purpose of this study was to quantify awareness of seizures in patients admitted to an epilepsy monitoring unit through post event assessments by registered nurses. Results indicated that only 44.5% of complex partial and secondarily generalized tonic-clonic seizures were recognized by patients with epilepsy. Incomplete data in seizure diaries are likely a widespread problem, which may have an important impact on treatment and, thereby, on the safety and quality of life of individuals with epilepsy.

Developing an innovative care delivery model: interprofessional practice teams.

An interprofessional project team at the University Health Network (UHN) completed a project to develop an Interprofessional Patient-Centred Practice (IPCP) Framework, explore enablers and barriers to collaborative practice and recommend a model of care delivery and interprofessional practice. The following recommendations were made: adopt proposed IPCP Framework as the basis for developing interprofessional teams, implement an IPCP tool kit as a resource, develop evidence-based interventions across health care teams, and educate health professionals on IPCP.

Seizure freedom reduces illness intrusiveness and improves quality of life in epilepsy.

BACKGROUND: Chronic illnesses are associated with multiple stressors that compromise quality of life (QOL). Implicit in many of these stressors is the concept of illness intrusiveness: the disruption of lifestyles, activities, and interests due to the constraints imposed by chronic disease and its treatment. The purpose of this study was to examine illness intrusiveness and QOL in epilepsy in patients with different levels of seizure control. METHODS: Cross-sectional data were obtained and compared between two groups of patients categorized by presence of seizures: seizure freedom or continued seizures (N = 145). Standard instruments measured the following variables: illness intrusiveness, perceived personal control, subjective well-being, and disease specific QOL. RESULTS: Illness intrusiveness varied inversely and significantly with seizure control. Complete seizure freedom, whether achieved by pharmacological or surgical treatment, was associated with the lowest levels of illness intrusiveness. Seizure freedom was also associated with increased perceived control, positive affect, self-esteem and QOL in epilepsy. CONCLUSIONS: The most robust benefits of decreased illness intrusiveness in epilepsy occur when treatment leads to complete seizure control. Therefore every effort should be made by health care providers to achieve seizure freedom to reduce illness intrusiveness and improve QOL in epilepsy.

Examining the relationship between patient-centred care and outcomes on a neuroscience unit: a pilot project.

Patient-centred care (PCC) has been adopted as the approach to care in various health care institutions. The extent to which PCC is actually implemented by nurses and the extent to which PCC is associated with positive patient outcomes are not clear. The purpose of this pilot study is twofold: to examine the extent to which staff nurses provided PCC to patients admitted to a neuroscience unit, as perceived by the nurses and patients assigned to their care, and to examine the relationships between implementation of PCC and patient outcomes. A descriptive correlational design with repeated measures was used. Data were collected from 21 nurses and 14 patients from a neuroscience unit where PCC staff development initiatives had been implemented. PCC is operationalized as provision of individualized care, patient participation in care, patient education and counselling, and coordination of care. Patient outcome data related to symptom experience, functional status, self-care, and sense of personal control were gathered upon admission and one week after discharge. Results indicated that nurses reported the implementation of PCC to a slightly higher extent than did patients. Significant relationships were found between aspects of PCC and patient outcomes in terms of sense of personal control and satisfaction with care. Findings from this pilot study will guide further improvement in the implementation of PCC to continuously enhance quality of nursing care, the neuroscience patient's hospital experience and readiness for discharge.

Psychological impact of illness intrusiveness in epilepsy - comparison of treatments.

Chronic illnesses are associated with multiple stressors that compromise quality of life (QOL). Implicit in many of these is the concept of illness intrusiveness, the disruption of lifestyles and activities attributable to constraints imposed by chronic disease and its treatment. This study tested the illness intrusiveness theoretical framework in epilepsy and compared the impact of pharmacological and surgical treatments on illness intrusiveness and QOL. Cross-sectional data compared three epilepsy groups (N = 145): (a) 40 patients admitted for presurgical evaluation to an Epilepsy Monitoring Unit; (b) 52 patients treated pharmacologically; and (c) 53 post-surgical patients. Illness intrusiveness differed significantly across epilepsy patients with the differences primarily related to seizure control. Illness intrusiveness varied inversely with seizure control (p < .05). Seizure freedom, whether achieved by surgical or pharmacological treatments, was associated with maximal reduction of illness intrusiveness. Increased illness intrusiveness correlated significantly with decreased QOL and increased depressive symptoms. Perceived control over diverse life domains correlated positively with QOL and psychosocial outcomes. Path analysis supported the validity of the illness intrusiveness theoretical framework in epilepsy. Illness intrusiveness is an important determinant of the psychosocial impact of epilepsy and its treatment. Effective pharmacological or surgical treatment may reduce illness intrusiveness in epilepsy. Findings also offer encouragement that QOL in epilepsy, as in other chronic conditions, may be enhanced by multidisciplinary bio-psychosocial efforts. Health care providers should consider multifaceted interventions to reduce illness intrusiveness and, thereby, improve QOL.

Quality of life in epilepsy.

This article will review the various stressors in epilepsy and disease, treatment and psychosocial factors that may contribute to disrupting daily activities and interfering with lifestyles and interests, that impact on overall well-being or quality of life (QOL). We will introduce the concept of illness intrusiveness in epilepsy that reflects disease- and treatment-induced lifestyle disruptions that compromise QOL.