Expectations Of Health Care Providers Research Articles

Family participation during intensive care unit rounds

In an earlier study, published in The Journal, Stickney et al from Boston Children’s Hospital evaluated the level of parental satisfaction with family attendance during pediatric intensive care unit rounds (J Pediatr 2014;164:404-6.e4). They found a high degree of parental satisfaction but a lower degree of healthcare provider satisfaction. In the current issue of The Journal, they report a new study of the goals and expectations of parents and healthcare providers in this setting. This was performed using qualitative methods; the parents were interviewed at bedside, and the healthcare providers participated in focus group discussions.The results show many important areas of agreement between providers and parents regarding goals for rounds when parents are present, including helping parents achieve an understanding of the child’s status and plan of care. However, providers and parents disagreed about the nature of opportunities to ask questions. Parents additionally reported that they wanted to provide important information about their children to the healthcare team and that they expected transparency from the team. In contrast, providers stated that parental presence sometimes inhibited frank discussion and education. The authors conclude that even though there is some agreement in goals for parent participation in morning rounds in the pediatric intensive care unit, there are opportunities to adjust the expectations of both parents and healthcare providers. They suggest several possible solutions that could help address this problem.Article page 1245▶ In an earlier study, published in The Journal, Stickney et al from Boston Children’s Hospital evaluated the level of parental satisfaction with family attendance during pediatric intensive care unit rounds (J Pediatr 2014;164:404-6.e4). They found a high degree of parental satisfaction but a lower degree of healthcare provider satisfaction. In the current issue of The Journal, they report a new study of the goals and expectations of parents and healthcare providers in this setting. This was performed using qualitative methods; the parents were interviewed at bedside, and the healthcare providers participated in focus group discussions. The results show many important areas of agreement between providers and parents regarding goals for rounds when parents are present, including helping parents achieve an understanding of the child’s status and plan of care. However, providers and parents disagreed about the nature of opportunities to ask questions. Parents additionally reported that they wanted to provide important information about their children to the healthcare team and that they expected transparency from the team. In contrast, providers stated that parental presence sometimes inhibited frank discussion and education. The authors conclude that even though there is some agreement in goals for parent participation in morning rounds in the pediatric intensive care unit, there are opportunities to adjust the expectations of both parents and healthcare providers. They suggest several possible solutions that could help address this problem. Article page 1245▶ Family Participation during Intensive Care Unit Rounds: Goals and Expectations of Parents and Health Care Providers in a Tertiary Pediatric Intensive Care UnitThe Journal of PediatricsVol. 165Issue 6PreviewTo compare perceptions, goals, and expectations of health care providers and parents regarding parental participation in morning rounds and target specific areas of opportunity for educational interventions. Full-Text PDF

Family Participation during Intensive Care Unit Rounds: Goals and Expectations of Parents and Health Care Providers in a Tertiary Pediatric Intensive Care Unit

To compare perceptions, goals, and expectations of health care providers and parents regarding parental participation in morning rounds and target specific areas of opportunity for educational interventions. Semistructured interviews of parents and focus groups of health care providers to learn about their experiences in, goals for, and perceived barriers to successful parental participation in morning rounds. Qualitative methods were used to analyze interview and focus group transcripts. Parents (n = 21) and health care providers (n = 24) participated in interviews and focus groups, respectively. Analyses revealed key areas of agreement between providers and parents regarding goals for rounds when parents are present, including helping parents achieve an understanding of the child's current status and plan of care. Providers and parents disagreed, however, about the nature of opportunities to ask questions. Parents additionally reported a strong desire to provide expert advice about their children and expected transparency from their care team, while providers stated that parental presence sometimes hindered frank discussions and education. Some agreement in goals for parent participation in morning rounds exists, although there are opportunities to calibrate expectations for both parents and health care providers. Solutions may involve a protocol for orienting parents to morning rounds, focusing on improving communication with parents outside of morning rounds, and the preservation of a forum for providers to have private discussions as a team.

A core syllabus for post-graduate training in respiratory physiotherapy

Physiotherapy contributes significantly to improving quality of life for patients with respiratory disease [1, 2]. Physiotherapists specialised in dealing with respiratory pathology and its associated problems are not only central in the delivery of pulmonary rehabilitation but also provide strategies and techniques for exercise testing, airway clearance, breathlessness management, mobility and function improvement and pain management [2]. Published evidence-based recommendations have paved the way for standardised practice [1–6] while also unravelling the extended scope of responsibilities of the respiratory physiotherapist [7]. The breakdown of traditional roles and allocation of new responsibilities is not confined to the respiratory physiotherapist within healthcare systems. Team-based healthcare and interprofessional treatment of patients is prevalent in the provision of care across the globe. New methods of healthcare delivery indicate that tasks are entrusted to those deemed competent to perform them [8]. It has therefore been necessary to train allied health professionals to take over parts of clinical care [9]. Mobility of the healthcare workforce has been at the forefront of discussion among healthcare providers and policy makers [10]. We now live in a “global village” [11], the consequence of which has seen a marked increase in health professionals completing part of their training and work experience abroad [10]. In this transition to international healthcare, more and more institutions, countries and regions will need standards to meet public, patient and healthcare provider expectations. This reform in medical practice is thus motivated by the breakdown of traditional roles and responsibilities within the healthcare system [12], increasing trends towards mobility [13] and more complex patient needs. These motivators for change have emphasised a new reality for healthcare systems bounded by a skilled healthcare …

An ethnographic study of barriers to cancer pain management and opioid availability in India.

The world's global cancer burden disproportionally affects lower income countries, where 80% of patients present with late-stage disease and have limited access to palliative care and effective pain-relieving medications, such as morphine. Consequently, millions die each year with unrelieved pain. Objective. The objective of this study was to examine barriers to opioid availability and cancer pain management in India, with an emphasis on the experiences of nurses, who are often the front-line providers of palliative care. Methods. Fifty-nine participants were recruited using a purposive, snowball sampling strategy. Ethnographic data collection included in-depth, semistructured interviews (n = 54), 400+ hours of participant observation, and review of documents over 9 months at a government cancer hospital in South India. Systematic qualitative analysis led to identification of key barriers that are exemplified by representative quotes. Results. Morphine is more available at this study site than in most of India, but access is limited to patients seen by the palliative care service, and significant gaps in supply still occur. Systems to measure and improve pain outcomes are largely absent. Key barriers related to pain management include the role of nursing, opioid misperceptions, bureaucratic hurdles, and sociocultural/infrastructure challenges. Implications. Interventions must streamline process details of morphine procurement, work within the existing sociocultural infrastructure to ensure opioids reach patients most in need, target unexpected audiences for symptom management education, and account for role expectations of health care providers. Conclusion. Macro- and micro-level policy and practice changes are needed to improve opioid availability and cancer pain management in India.

Electronic health information and long-term conditions

This article discusses the increasing availability of health-related information, and the impact that this can have for people with long-term conditions' expectations of healthcare providers. The article suggests a framework for decision making about the role that healthcare staff should play in the information searching, retrieval, and synthesis activities which people with long-term conditions engage in. The framework is based on a series of decisions related to: perceptions of ownership of long-term conditions; whether intermediatory or apomediatory approaches to information management are deemed to be most appropriate; and, as a result of these considerations, what, if any, place healthcare staff should take in the process of patients searching or and interpreting information about long-term health needs. These decisions will enable healthcare providers to plan services based on clear decision pathways, and to clarify to all concerned what are deemed to be reasonable expectations of health service provision.

Establishment of outcome-related analytic performance goals

Accrediting organizations require laboratories to establish analytic performance criteria that ensure their tests provide results of the high quality required for patient care. However, the procedures for instituting performance criteria that are directly linked to the needs of medical practice are not well established, and therefore alternative strategies often are used to create and implement surrogate performance standards. We reviewed six approaches for establishing outcome-related analytic performance goals: (a) limits defined by regulations and external assessment programs, (b) limits based on biologic variation, (c) limits based on surveys of clinicians about their needs, (d) limits based on effects on guideline driven medical decisions, (e) limits based on analysis of patterns for ordering follow-up clinical tests, and (f) limits based on formal medical decision models. Performance criteria were tabulated for 12 common chemistry analytes and four routine hematology tests. There is no consensus currently about the preferred methods for establishing medically necessary analytic performance limits. The various methods reviewed give considerably different performance limits. The analytic performance limits claimed by a laboratory should correspond to those limits that can be reliably maintained based on validated QC monitoring systems. These limits generally are larger than the observed CVs and bias parameters collected for assay validation. There is a major need for increased communication among laboratorians and clinicians on this topic, especially when the analytic performance limits that can be consistently maintained by a laboratory are inconsistent with the expectations of health care providers.

To Ask or Not to Ask?

To formatively evaluate the Hand Hygiene Saves Lives video and explore the perceptions and expectations of health care providers and laypersons regarding hand hygiene (HH), health care-associated infections, and patient empowerment using the Health Belief Model as a framework. Four focus groups were conducted in February 2008 among laypersons (n = 18) and health care providers (n = 17). Qualitative data were coded for themes, and quantitative Likert scales ranging from 1 (not at all) to 5 (very) were analyzed using SPSS. Health care-associated infections were perceived to be somewhat common (mean, 3.4) and HH as very important (mean, 4.9). Laypersons reported being significantly more likely to ask their nurses (2.5 versus 4.3; P = 0.001) and physicians (3.3 versus 4.3; P = 0.010) to perform HH after viewing the video. The video's target audience was perceived to be families (42.0%) or patients (39.1%) and the message to be the importance of HH (45.5%) or creating comfort about asking (24.2%). Empowering patients using tools such as a video may be an important patient safety advance to improve HH in health care settings and prevent health care-associated infections.

Establishment of Outcome-Related Analytic Performance Goals

Accrediting organizations require laboratories to establish analytic performance criteria that ensure their tests provide results of the high quality required for patient care. However, the procedures for instituting performance criteria that are directly linked to the needs of medical practice are not well established, and therefore alternative strategies often are used to create and implement surrogate performance standards. We reviewed 6 approaches for establishing outcome-related analytic performance goals: (a) limits defined by regulations and external assessment programs, (b) limits based on biologic variation, (c) limits based on surveys of clinicians about their needs, (d) limits based on effects on guideline driven medical decisions, (e) limits based on analysis of patterns for ordering follow-up clinical tests, and (f) limits based on formal medical decision models. Performance criteria were tabulated for 12 common chemistry analytes and 4 routine hematology tests. There is no consensus currently about the preferred methods for establishing medically necessary analytic performance limits. The various methods reviewed give considerably different performance limits. The analytic performance limits claimed by a laboratory should correspond to those limits that can be reliably maintained based on validated QC monitoring systems. These limits generally are larger than the observed CVs and bias parameters collected for assay validation. There is a major need for increased communication among laboratorians and clinicians on this topic, especially when the analytic performance limits that can be consistently maintained by a laboratory are inconsistent with the expectations of health care providers.

EMF-3: Internet Usage and Aptitude in Utilizers of Urban and Suburban Emergency Departments

Research indicates that many hospitals are developing computer systems that allow patients to access digital health information. However, only 60% of Americans regularly use the Internet, and only veteran Internet users will likely be able to navigate to obtain health information successfully. There may be a divide between healthcare provider expectations and patients’ ability to access electronic health information.

Consultant Pharmacists and the Survey Process

The State Operations Manual (SOM), published by the Centers for Medicare and Medicaid Services (CMS), describes the nursing facility survey process that is the primary regulatory focus for facilities. CMS is now revising several sections in Appendix PP of the SOM that contains the Interpretive Guidelines for Long-Term Care Facilities; some of these guidelines have already been released. The pharmacy-related sections of these guidelines are due out later this year. Because these revisions will affect the survey process, expectations of health care providers, and possibly the care process within nursing facilities, consultant pharmacists and all members of the interdisciplinary care team need to start preparing for these revisions. The information provided here is meant to be a refresher of the components of the survey process as a preliminary step in the preparation for the release of new guidelines.

The dilemma of “to-be or not-to-be”: needs and expectations of the Taiwanese cadaveric organ donor families during the pre-donation transition

There has been little study of the Chinese cadaveric donor family's decisions to donate organs within the Chinese cultural framework. A convenience sample of 25 cadaveric donor family members (12 men, 13 women) who gave their consent to donation at National Taiwan University Hospital agreed to participate in this study and completed in-depth interviews. Data were analyzed by a three-steps within-method qualitative triangulation method. The factors influencing the donor family's decisions to donate organs, the needs of donor families, and their expectations of health care providers during the pre-donation transition — the critical period of time between signing a donation and consent to organ harvesting — were examined. The background context and a conceptual framework were further developed to discuss and depict this phenomenon. This project aims to broaden the horizon on organ donation and contribute to the understanding of some of the psychodynamic issues in the Chinese family in Taiwan.

Parents call for concerned and collaborative care.

Parents' perceptions and expectations of health care providers within the context of the pediatric lung transplant experience were investigated using a phenomenological approach. Fifteen parents of 12 children were interviewed. Two theme clusters, concerned care and collaborative care, were formulated. Themes that reflected parents' perceptions of concerned care included: being treated as an individual, seeing familiar faces, feeling that their children really mattered, and conversely, experiencing a feeling of abandonment. Parents' perceptions of collaborative care included: being part of the team, and conversely, feeling caught in the middle. The theme cluster, concerned care, reflected the value parents place on continuity of care. Humanistic nursing theory provided the link between study results and nursing practice.

Provider Expectations and Alcoholism Treatment

Alcoholism treatment and substance abuse treatment in general have been known to produce unfavorable outcomes. Success rates reported by researchers and health care professionals alike are generally very low. Methodological difficulties in assessing outcome rates withstanding, the consensus regarding substance abuse treatment efficacy is pessimistic. The present article addresses the effect of health care provider expectations on the behavior of the service recipient and treatment outcome. Alternatives to difficulties encountered by these expectations are discussed.

Health Care Leaders—It Is Time to Step Forward

Bruce Vladeck's timely and interesting article clearly makes the point that it is indeed time for health care leaders to step forward as they consider the relationship between health care organizations and the communities they serve. I must acknowledge that my review of this work is influenced by my own personal experience and background in hospital administration and, for the most part, I tend to translate health care organization into hospital. In my view, the author captures well the sense of complexity in health care management today. He makes a number of points about this, but one is particularly significant, and that is the matter of public expectations of health care providers. These expectations are increasingly more difficult to match with performance. Institutions are asked to have the best of technology and medicine available but at prices low enough to quiet critics. Vladeck says these expectations become the boundaries in which health care organizations must function. My own view is that these limits are tightening and the freedom to plot our own course is being reduced, largely because we have not been able to deal with the cost issue as a part of our freedom to shift plans, change programs, implement new technology, etc. As we in health care wrestle with problems of meeting community needs we are troubled by the question of who defines or determines these needs. Indeed, hospitals may well see their core technology or services in the decade of the 1990s begin to shift from acute care, medical-surgical services, to more of emergency and primary care, clinics, prevention, education. Research and development, especially in the area of genetics, increasingly seems to indicate that we may move from centralizing major technology in large centers such as hospitals into smaller operating units with machines that will fit quite well in these new or different facilities. I agree with the author that health care leaders will have to know what their institutions' core activities are or should be and they will have to focus on them in order to build up and outward from them. Vladeck writes about the characteristics of successful leaders and suggests that leadership is not readily visible at the superficial level. While this may appear rather obvious in general terms, I am often reminded that leaders do have a certain air about them, a certain look. This may be affected by posture, attitude, demeanor, intellect, etc. My thought is that the self-confidence and strong sense of purpose that routinely accompanies leadership does show up in people's appearance, and it can be detected. Styles of management certainly change over time, but the basic qualities of leadership seem to be very consistent. As I reflected on the article and health institutions' responsibilities to their communities, I was reminded that some time ago I read that hospitals' roots do lie in societal issues. We began as almshouses and have grown into technological palaces. In our own country as we have moved forward from the eighteenth century to the beginnings of the twenty-first, we find that hospitals are still the recipients of society's failures and that there still remains the serious debate as to whose responsibility it is to pay for the health care of those who suffer as a result of chemical addiction, improper diet, inadequate housing, and other less-than-healthy lifestyles. The article places heavy emphasis on institutional mission, goals, objectives--and appropriately so. Increasingly we hear today that hospitals, for example, must get back to basics, that the days of diversification are gone. We see complex corporate organizations being reduced and simplified. Also, the quality factor is emerging as well as a renewed awareness of our customers. Indeed, in some ways hospitals are following patterns being set by American business and industry. Vladeck underlines the issue of goals and mission when he talks about the specific attributes of leaders. …

Personality disorders: Treatment of the nonpsychotic chronic patient

Nonpsychotic chronic patients are troublesome not only because of their psychosocial dysfunction, cognitive and affective impairments, and behavioral problems but also because they fail to meet the expectations of health care providers. All of these conditions can cause problems of interactive fit between these patients and their clinicians.