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1.
Am J Nurs ; 121(3): 40-46, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33625010

RESUMO

ABSTRACT: Quality and Safety Education for Nurses (QSEN) was launched in 2005 as a national nursing initiative aimed at preparing nurses with the competencies needed to continuously improve the quality and safety of the health care they provide. The six QSEN competencies-and the knowledge, skills, and attitudes that each entails-have served as a basis for significant curricular revision, more enlightened professional practice, relevant research, and health care system improvements. Since the launch of QSEN, new technologies have emerged, the range of care sites has broadened, new practice roles have emerged, and patients and families have become more active health care consumers. This article highlights these changes, considers Amazon as a powerful contemporary social force, examines the company's core values, and considers their relevancy to the six QSEN competencies. Essential new literacies and cognitive capacities are also identified. Lastly, the authors outline steps nurses can take to incorporate the QSEN competencies, along with the literacies and capacities, into their practice and organizations. Doing so is vital to delivering safe, high-quality care in this rapidly changing health care climate, and will enable nurses to claim their leadership and thrive professionally in an Amazon world.


Assuntos
Competência Clínica/normas , Educação em Enfermagem/normas , Conhecimentos, Atitudes e Prática em Saúde , Papel do Profissional de Enfermagem , Segurança do Paciente , Assistência Centrada no Paciente/normas , Qualidade da Assistência à Saúde , Prática Clínica Baseada em Evidências , Humanos , Garantia da Qualidade dos Cuidados de Saúde
2.
Prof Case Manag ; 26(2): 62-69, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33507016

RESUMO

PURPOSE: Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease known as COVID-19, case management has emerged as a critical intervention in the treatment of cases, particularly for patients with severe symptoms and medical complications. In addition, case managers have been on the front lines of the response across the health care spectrum to reduce risks of contagion, including among health care workers. The purpose of this article is to discuss the case management response, highlighting the importance of individual care plans to provide access to the right care and treatment at the right time to address both the consequences of the disease and patient comorbidities. PRIMARY PRACTICE SETTINGS: The COVID-19 response spans the full continuum of health and human services, including acute care, subacute care, workers' compensation (especially catastrophic case management), home health, primary care, and community-based care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: From the earliest days of the pandemic, case managers have assumed an important role on the front lines of the medical response to COVID-19, ensuring that procedures are in place for managing a range of patients: those who were symptomatic but able to self-isolate and care for themselves at home; those who had serious symptoms and needed to be hospitalized; and those who were asymptomatic and needed to be educated about the importance of self-isolating. Across the care spectrum, individualized responses to the clinical and psychosocial needs of patients with COVID-19 in acute care, subacute care, home health, and other outpatient settings have been guided by the well-established case management process of screening, assessing, planning, implementing, following up, transitioning, and evaluating. In addition, professional case managers are guided by values such as advocacy, ensuring access to the right care and treatment at the right time; autonomy, respecting the right to self-determination; and justice, promoting fairness and equity in access to resources and treatment. The value of justice also addresses the sobering reality that people from racial and ethnic minority groups are at an increased risk of getting sick and dying from COVID-19. Going forward, case management will continue to play a major role in supporting patients with COVID-19, in both inpatient and outpatient settings, with telephonic follow-up and greater use of telehealth.


Assuntos
/enfermagem , Administração de Caso/normas , Enfermagem de Cuidados Críticos/educação , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Planejamento de Assistência ao Paciente/normas , Assistência Centrada no Paciente/normas , Adulto , Administração de Caso/estatística & dados numéricos , Currículo , Educação Continuada em Enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto
4.
Educ. med. (Ed. impr.) ; 21(6): 403-409, nov.-dic. 2020.
Artigo em Espanhol | IBECS | ID: ibc-198379

RESUMO

Exponemos a continuación 12 casos en los que la realización de una historia clínica y una exploración física detalladas son clave para obtener una planificación diagnóstico-terapéutica óptima que permita una asistencia de calidad. Por otro lado, consideramos la educación en valores centrada en el paciente como otro de los objetivos primordiales a transmitir en facultades y hospitales universitarios. Este artículo, basado en casos reales debidamente anonimizados, pretende aportar pequeñas pinceladas al respecto, esperando resulten de utilidad


A presentation is made of 12 cases that have a full and detailed clinical history and physical examination, which are essential for obtaining optimal diagnostic-therapeutic planning for quality care. Furthermoe, education in values focused on the patient is considered as another of the essential objectives to be transmitted in university faculties and hospitals. This article, based on anonymised real cases, aims to provide small brushstrokes in this regard, hoping that they will be useful


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Ficha Clínica , Exame Físico/métodos , Qualidade da Assistência à Saúde/normas , Educação Médica/normas , Modelos Educacionais , Assistência Centrada no Paciente/normas , Competência Clínica
6.
Methodist Debakey Cardiovasc J ; 16(3): 220-224, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133358

RESUMO

Improving patient experience is a fundamental component of patient-centered care and one of the key strategies for improving health care quality, delivery, and outcomes. Several studies have described the association between improved patient experience and better health outcomes among individuals with cardiovascular disease. These findings are important given that cardiovascular disease is a leading cause of morbidity and mortality in the United States and globally. This review summarizes the findings on patient-reported health care experiences and discusses how optimizing these experiences may be a tool to improve health outcomes among individuals with cardiovascular disease.


Assuntos
Doenças Cardiovasculares/terapia , Participação do Paciente , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Assistência Centrada no Paciente , Doenças Cardiovasculares/diagnóstico , Tomada de Decisão Compartilhada , Humanos , Assistência Centrada no Paciente/normas , Relações Médico-Paciente , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde
7.
Obstet Gynecol ; 136(5): 1001-1005, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030869

RESUMO

Patient-centered care is one of the six aims for improvement in health care quality outlined by the National Academy of Medicine (previously known as the Institute of Medicine). We propose an algorithm for patients who are presenting with a pregnancy of unknown location that emphasizes pregnancy desiredness to improve patient-centered care. Health care professionals should assess pregnancy desiredness at a patient's initial consultation for evaluation of pregnancy of unknown location; desiredness, along with other clinical criteria, should guide management. For women with an undesired pregnancy, health care professionals should offer expedient active management. Uterine aspiration will allow for quick clinical diagnosis and resolution of the pregnancy. Alternatively, for women with a desired pregnancy or for those who are ambivalent, we recommend careful conservative management. Adopting this algorithm will recenter the patient in the complex management of pregnancy of unknown location.


Assuntos
Assistência Centrada no Paciente/normas , Gravidez Ectópica/diagnóstico , Gravidez não Desejada/psicologia , Cuidado Pré-Natal/normas , Qualidade da Assistência à Saúde/normas , Algoritmos , Feminino , Humanos , Gravidez , Gravidez Ectópica/psicologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia
8.
Obstet Gynecol ; 136(4): 859-867, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32976375

RESUMO

Prenatal testing for chromosomal abnormalities is designed to provide an accurate assessment of a patient's risk of carrying a fetus with a chromosomal disorder. A wide variety of prenatal screening and diagnostic tests are available; each offers varying levels of information and performance, and each has relative advantages and limitations. When considering screening test characteristics, no one test is superior in all circumstances, which results in the need for nuanced, patient-centered counseling from the obstetric care professional and complex decision making by the patient. Each patient should be counseled in each pregnancy about options for testing for fetal chromosomal abnormalities. It is important that obstetric care professionals be prepared to discuss not only the risk of fetal chromosomal abnormalities but also the relative benefits and limitations of the available screening and diagnostic tests. Testing for chromosomal abnormalities should be an informed patient choice based on provision of adequate and accurate information, the patient's clinical context, accessible health care resources, values, interests, and goals. All patients should be offered both screening and diagnostic tests, and all patients have the right to accept or decline testing after counseling.The purpose of this Practice Bulletin is to provide current information regarding the available screening test options available for fetal chromosomal abnormalities and to review their benefits, performance characteristics, and limitations. For information regarding prenatal diagnostic testing for genetic disorders, refer to Practice Bulletin No. 162, Prenatal Diagnostic Testing for Genetic Disorders. For additional information regarding counseling about genetic testing and communicating test results, refer to Committee Opinion No. 693, Counseling About Genetic Testing and Communication of Genetic Test Results. For information regarding carrier screening for genetic conditions, refer to Committee Opinion No. 690, Carrier Screening in the Age of Genomic Medicine, and Committee Opinion No. 691, Carrier Screening for Genetic Conditions. This Practice Bulletin has been revised to further clarify methods of screening for fetal chromosomal abnormalities, including expanded information regarding the use of cell-free DNA in all patients regardless of maternal age or baseline risk, and to add guidance related to patient counseling.


Assuntos
Aberrações Cromossômicas , Transtornos Cromossômicos , Aconselhamento , Doenças Fetais , Testes Genéticos/métodos , Diagnóstico Pré-Natal/métodos , Transtornos Cromossômicos/diagnóstico , Transtornos Cromossômicos/genética , Aconselhamento/métodos , Aconselhamento/normas , Aconselhamento/provisão & distribução , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/genética , Acesso aos Serviços de Saúde/normas , Humanos , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Gravidez , Estados Unidos
9.
PLoS One ; 15(9): e0238356, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991624

RESUMO

BACKGROUND: A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample. METHODS: We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men's mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health. RESULTS: Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency. IMPLICATIONS: Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.


Assuntos
Afro-Americanos/estatística & dados numéricos , Doença Crônica/terapia , Comunicação , Disparidades em Assistência à Saúde , Hispano-Americanos/estatística & dados numéricos , Assistência Centrada no Paciente/normas , Relações Médico-Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Seguimentos , Humanos , Cobertura do Seguro , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Prognóstico , Racismo/estatística & dados numéricos
10.
Lancet Diabetes Endocrinol ; 8(10): 855-867, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32946822

RESUMO

Older adults with diabetes are heterogeneous in their medical, functional, and cognitive status, and require careful individualisation of their treatment regimens. However, in the absence of detailed information from clinical trials involving older people with varying characteristics, there is little evidence-based guidance, which is a notable limitation of current approaches to care. It is important to recognise that older people with diabetes might vary in their profiles according to age category, functional health, presence of frailty, and comorbidity profiles. In addition, all older adults with diabetes require an individualised approach to care, ranging from robust individuals to those residing in care homes with a short life expectancy, those requiring palliative care, or those requiring end-of-life management. In this Review, our multidisciplinary team of experts describes the current evidence in several important areas in geriatric diabetes, and outlines key research gaps and research questions in each of these areas with the aim to develop evidence-based recommendations to improve the outcomes of interest in older adults.


Assuntos
Envelhecimento , Diabetes Mellitus/terapia , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto/normas , Idoso , Idoso de 80 Anos ou mais , Humanos
11.
Obstet Gynecol ; 136(4): e48-e69, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32804883

RESUMO

Prenatal testing for chromosomal abnormalities is designed to provide an accurate assessment of a patient's risk of carrying a fetus with a chromosomal disorder. A wide variety of prenatal screening and diagnostic tests are available; each offers varying levels of information and performance, and each has relative advantages and limitations. When considering screening test characteristics, no one test is superior in all circumstances, which results in the need for nuanced, patient-centered counseling from the obstetric care professional and complex decision making by the patient. Each patient should be counseled in each pregnancy about options for testing for fetal chromosomal abnormalities. It is important that obstetric care professionals be prepared to discuss not only the risk of fetal chromosomal abnormalities but also the relative benefits and limitations of the available screening and diagnostic tests. Testing for chromosomal abnormalities should be an informed patient choice based on provision of adequate and accurate information, the patient's clinical context, accessible health care resources, values, interests, and goals. All patients should be offered both screening and diagnostic tests, and all patients have the right to accept or decline testing after counseling.The purpose of this Practice Bulletin is to provide current information regarding the available screening test options available for fetal chromosomal abnormalities and to review their benefits, performance characteristics, and limitations. For information regarding prenatal diagnostic testing for genetic disorders, refer to Practice Bulletin No. 162, Prenatal Diagnostic Testing for Genetic Disorders. For additional information regarding counseling about genetic testing and communicating test results, refer to Committee Opinion No. 693, Counseling About Genetic Testing and Communication of Genetic Test Results. For information regarding carrier screening for genetic conditions, refer to Committee Opinion No. 690, Carrier Screening in the Age of Genomic Medicine and Committee Opinion No. 691, Carrier Screening for Genetic Conditions. This Practice Bulletin has been revised to further clarify methods of screening for fetal chromosomal abnormalities, including expanded information regarding the use of cell-free DNA in all patients regardless of maternal age or baseline risk, and to add guidance related to patient counseling.


Assuntos
Aberrações Cromossômicas , Transtornos Cromossômicos , Aconselhamento , Doenças Fetais , Testes Genéticos/métodos , Diagnóstico Pré-Natal/métodos , Transtornos Cromossômicos/diagnóstico , Transtornos Cromossômicos/genética , Aconselhamento/métodos , Aconselhamento/normas , Aconselhamento/provisão & distribução , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/genética , Acesso aos Serviços de Saúde/normas , Humanos , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Gravidez , Estados Unidos
12.
Health Qual Life Outcomes ; 18(1): 288, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32831086

RESUMO

PURPOSE: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called 'WellNet'. METHODS: This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol five dimensions five levels (EQ-5D-5L) instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. RESULTS: Out of 616 patients, 417 (68%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID. CONCLUSION: Patient-tailored chronic disease management (CDM) plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.


Assuntos
Assistência Centrada no Paciente/normas , Qualidade de Vida , Idoso , Austrália , Doença Crônica/psicologia , Doença Crônica/terapia , Estudos Controlados Antes e Depois , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Reprodutibilidade dos Testes , Inquéritos e Questionários
13.
PLoS One ; 15(7): e0236019, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667953

RESUMO

BACKGROUND: Delivery of preventive care and chronic disease management are key components of a high functioning primary care practice. Health Centers (HCs) funded by the Health Resources and Services Administration (HRSA) have been delivering affordable and accessible primary health care to patients in underserved communities for over fifty years. This study examines the association between health center organization's health information technology (IT) optimization and clinical quality performance. METHODS AND FINDINGS: Using 2016 Uniform Data System (UDS) data, we performed bivariate and multivariate analyses to study the association of Meaningful Use (MU) attestation as a proxy for health IT optimization, patient centered medical home (PCMH) recognition status, and practice size on performance of twelve electronically specified clinical quality measures (eCQMs). Bivariate analysis demonstrated performance of eleven out of the twelve preventive and chronic care eCQMs was higher among HCs attesting to MU Stage 2 or above. Multivariate analysis demonstrated that Stage 2 MU or above, PCMH status, and larger practice size were positively associated with performance on cancer screening, smoking cessation counseling and pediatric weight assessment and counseling eCQMs. CONCLUSIONS: Organizational advancement in MU stages has led to improved quality of care that augments HCs patient care capacity for disease prevention, health promotion, and chronic care management. However, rapid technological advancement in health care acts as a potential source of disparity, as considerable resources needed to optimize the electronic health record (EHR) and to undertake PCMH transformation are found more commonly among larger HCs practices. Smaller practices may lack the financial, human and educational assets to implement and to maintain EHR technology. Accordingly, targeted approaches to support small HCs practices in leveraging economies of scale for health IT optimization, clinical decision support, and clinical workflow enhancements are critical for practices to thrive in the dynamic value-based payment environment.


Assuntos
Promoção da Saúde/normas , Informática Médica/normas , Assistência Centrada no Paciente/normas , Atenção Primária à Saúde/normas , Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Health Qual Life Outcomes ; 18(1): 241, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32690091

RESUMO

BACKGROUND: With a shift in the healthcare paradigm towards a more patient-centered approach, data on inflammatory bowel disease (IBD) needs to be further explored. This study aimed to determine patient perspectives on the effect of IBD and features of patients with lower satisfaction level and compare patient and physician perception of IBD-related Quality of Care (QoC). METHODS: A previously developed pre-standardised set of questions regarding patient-centered outcome (PRO) measures for IBD, comprising 36 items, was administered in five centers, and a concomitant questionnaire for specialised physicians was adapted and administered. RESULTS: Overall, 1005 patients with IBD met the inclusion criteria. Sixty-five questionnaires were administered to specialised physicians. Both patients and physicians perceived the IBD-related QoC as being satisfactory. Furthermore, this study revealed areas of shortcomings where it comes to patient perceptions. Female sex and the presence of negatively impacting disease characteristics (presence of significant pain or discomfort, lack of energy, feeling fatigued most of the time, experiencing anxiety or depression in the last 2 weeks) were associated with lower satisfaction levels. CONCLUSIONS: Our findings can be used in establishing strategies aimed at improving patient QoC and defining strategic priorities. These data can aid in improving the communication of the pressing needs of IBD patients, to both the public payers and health authorities.


Assuntos
Doenças Inflamatórias Intestinais/psicologia , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Adulto , Idoso , Consenso , Estudos Transversais , Feminino , Humanos , Doenças Inflamatórias Intestinais/terapia , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/normas , Qualidade da Assistência à Saúde/normas , Qualidade de Vida , Adulto Jovem
15.
Curr Oncol ; 27(2): 90-99, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32489251

RESUMO

Background: Patient-reported outcomes (pros) are essential to capture the patient's perspective and to influence care. Although pros and pro measures are known to have many important benefits, they are not consistently being used and there is there no Canadian pros oversight. The Position Statement presented here is the first step toward supporting the implementation of pros in the Canadian health care setting. Methods: The Canadian pros National Steering Committee drafted position statements, which were submitted for stakeholder feedback before, during, and after the first National Canadian Patient Reported Outcomes (canpros) scientific conference, 14-15 November 2019 in Calgary, Alberta. In addition to the stakeholder feedback cycle, a patient advocate group submitted a section to capture the patient voice. Results: The canpros Position Statement is an outcome of the 2019 canpros scientific conference, with an oncology focus. The Position Statement is categorized into 6 sections covering 4 theme areas: Patient and Families, Health Policy, Clinical Implementation, and Research. The patient voice perfectly mirrors the recommendations that the experts reached by consensus and provides an overriding impetus for the use of pros in health care. Conclusions: Although our vision of pros transforming the health care system to be more patient-centred is still aspirational, the Position Statement presented here takes a first step toward providing recommendations in key areas to align Canadian efforts. The Position Statement is directed toward a health policy audience; future iterations will target other audiences, including researchers, clinicians, and patients. Our intent is that future versions will broaden the focus to include chronic diseases beyond cancer.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Oncologia/estatística & dados numéricos , Neoplasias/terapia , Medidas de Resultados Relatados pelo Paciente , Assistência Centrada no Paciente/estatística & dados numéricos , Canadá , Assistência à Saúde/métodos , Assistência à Saúde/normas , Humanos , Oncologia/métodos , Oncologia/normas , Neoplasias/diagnóstico , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Qualidade de Vida
16.
Rev Lat Am Enfermagem ; 28: e3272, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32491126

RESUMO

OBJECTIVE: to analyze the experience of the patient during hospitalization, focusing on the co-production of care related to patient safety protocols. METHOD: qualitative study, whose data were collected through the triangulation of multiple sources: document analysis, observation of 10 professionals in the provision of care and 24 interviews with patient-families from 12 clinical and surgical inpatient units of a hospital. Thematic analysis was carried out, based on the concept of co-production. RESULTS: safety protocols according to the experience of the patient portrayed the role of patient-families as co-producers of safe care. It was found an alignment between perceptions of the patients, institutional definitions and basic national and international patient safety protocols. However, these protocols are not always followed by professionals. CONCLUSION: co-production was perceived in the protocols for safe surgery and prevention of injuries resulting from falls. In patient identification, hand hygiene and medication process, it was found that co-production depends on the proactive behavior of patient-families, as it is not encouraged by professionals. The research contributes with subsidies to leverage the participation of the patient as an agent of their safety, highlighting the co-production of health care as a valuable resource for advancing patient safety.


Assuntos
Família , Hospitalização/estatística & dados numéricos , Segurança do Paciente/normas , Assistência Centrada no Paciente/normas , Acidentes por Quedas/prevenção & controle , Adulto , Idoso , Brasil , Protocolos Clínicos , Feminino , Higiene das Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
17.
Top Magn Reson Imaging ; 29(3): 131-134, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32568975

RESUMO

Patients undergoing MRI may experience fear, claustrophobia, or other anxiety manifestations due to the typically lengthy, spatially constrictive, and noisy MRI acquisition process and in some cases are not able to tolerate completion of the study. This article discusses several patient-centered aspects of radiology practice that emphasize interpersonal interactions. Patient education and prescan communication represent 1 way to increase patients' awareness of what to expect during MRI and therefore mitigate anticipatory anxiety. Some patient interaction strategies to promote relaxation or calming effects are also discussed. Staff teamwork and staff training in communication and interpersonal skills are also described, along with literature evidence of effectiveness with respect to patient satisfaction and productivity endpoints. Attention to how radiologists, nurses, technologists, and other members of the radiology team interact with patients before or during the MRI scan could improve patients' motivation and ability to cooperate with the MRI scanning process as well as their subjective perceptions of the quality of their care. The topics discussed in this article are relevant not only to MRI operations but also to other clinical settings in which patient anxiety or motion represent impediments to optimal workflow.


Assuntos
Comunicação , Imagem por Ressonância Magnética/métodos , Satisfação do Paciente , Assistência Centrada no Paciente/métodos , Humanos , Imagem por Ressonância Magnética/normas , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto , Assistência Centrada no Paciente/normas , Relações Profissional-Paciente , Qualidade da Assistência à Saúde , Radiologia/educação , Radiologia/métodos
18.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32430441

RESUMO

To control the spread of severe acute respiratory syndrome coronavirus 2, the virus responsible for coronavirus disease 2019, many hospitals have strict visitor restriction policies. These policies often prohibit both parents from visiting at the same time or having grandparents or other family members visit at all. We discuss cases in which such policies created ethical dilemmas and possibly called for compassionate exceptions from the general rules.


Assuntos
Betacoronavirus , Criança Hospitalizada/psicologia , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Pandemias/prevenção & controle , Assistência Centrada no Paciente/ética , Pneumonia Viral/prevenção & controle , Visitas a Pacientes/psicologia , Adolescente , Criança , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/transmissão , Análise Custo-Benefício , Família , Feminino , Política de Saúde , Humanos , Recém-Nascido , Controle de Infecções/normas , Masculino , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Pneumonia Viral/psicologia , Pneumonia Viral/transmissão
19.
Int J Med Inform ; 139: 104132, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32416522

RESUMO

BACKGROUND: In institutional dementia care, person-centered care improves care processes and the quality of life of residents. However, communication gaps impede the implementation of person-centered care in favor of routinized care. OBJECTIVE: We evaluated whether self-organizing knowledge management reduces communication gaps and improves the quality of person-centered dementia care. METHOD: We implemented a self-organizing knowledge management system. Eight significant others of residents with severe dementia and six professional caregivers used a mobile application for six months. We conducted qualitative interviews and focus groups afterward. MAIN FINDINGS: Participants reported that the system increased the quality of person-centered care, reduced communication gaps, increased the task satisfaction of caregivers and the wellbeing of significant others. CONCLUSIONS: Based on our findings, we develop the following hypotheses: self-organizing knowledge management might provide a promising tool to improve the quality of person-centered care. It might reduce communication barriers that impede person-centered care. It might allow transferring content-maintaining tasks from caregivers to significant others. Such distribution of tasks, in turn, might be beneficial for both parties. Furthermore, shared knowledge about situational features might guide person-centered interventions.


Assuntos
Cuidadores/normas , Comunicação , Demência/terapia , Gestão do Conhecimento/normas , Assistência Centrada no Paciente/normas , Autocuidado , Grupos Focais , Humanos , Satisfação do Paciente , Pesquisa Qualitativa , Qualidade de Vida
20.
J Clin Nurs ; 29(15-16): 2967-2978, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32453484

RESUMO

AIM AND OBJECTIVES: This study aimed to explore the effects of person-centred care on their job productivity, job satisfaction and organisational commitment among employees in long-term care facilities. BACKGROUND: Person-centred care has been regarded as the best caregiving model for long-term care facilities. Few studies tested the impact of person-centred care on employee performance. DESIGN: A cross-sectional study was employed. METHODS: This study sent 373 samples with self-report questionnaires to the employees of sixteen long-term care facilities in Taiwan. A total of 366 valid samples were collected. A 33-item person-centred care questionnaire with Likert-scale responses was developed to assess the extent of person-centred care. We adopted hierarchical multiple regression analysis to test the impact of person-centred care on employee performance. We adopted the STROBE guidelines. RESULTS: Friendly environment level and personalised care, respectively, scored the highest with a mean of 4.19 among five dimensions of person-centred care. Personalised care, residents' self-realisation and relationships, and organisational support had significant positive correlations with job productivity. Friendly environment level and organisational support had significant correlations with job satisfaction. Friendly environment level, residents' self-realisation and relationships, and organisational support had significant correlations with organisational commitment. CONCLUSION: Person-centred care has beneficial impact on job satisfaction, job productivity and organisational commitment of employees in long-term care facilities. RELEVANCE TO CLINICAL PRACTICE: Person-centred care appears to be a crucial factor of employee performance in long-term care facilities. The five-dimensional person-centred care questionnaire in this study can serve as an important management tool for improving the effectiveness of person-centred care.


Assuntos
Satisfação no Emprego , Assistência de Longa Duração/normas , Assistência Centrada no Paciente/normas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Inquéritos e Questionários , Taiwan
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