Higher Care Satisfaction Research Articles

Prevalence of Hoarseness in Primary Health Care and Hospitals—Associations With Different Work Tasks and Environmental Factors Among Nurses

The voice is one of the most essential tools necessary for nurses achieve high care satisfaction and safety. Research on hoarseness has mainly focused on professional speakers, like teachers. The aim of this study was to determine the current prevalence of hoarseness among six subgroups of nurses (registered nurses, primary care nurses, pediatric nurses, laboratory nurses, dental nurses, and midwives) and also to identify potential environmental risk factors in their working environment. The health data was collected in collaboration with two health care professional trade unions. The findings are based on 15,553 returned health questionnaires which were statistically analyzed. The 1-year prevalence of hoarseness among all participating nurses was 30.2 % in this data, but the variation between different occupational subgroups was significant; ranging from 25 % for laboratory nurses to 38 % for midwives. These findings were in line with perceived environmental problems and the differences between the sub-groups were not explained by the participants suffering from asthma, sinusitis, rhinitis, or common respiratory infections; there were no explanatory differences in the prevalence's of the above-mentioned diseases. The variation in prevalence of hoarseness between the different occupational subgroups was significant and the prevalence was found to be in line with perceived environmental problems. The most common problems were stuffiness, dry air, and inadequate ventilation. In addition, both a perceived "sewer odor" and "smell of mold or cellar" in one's own working environment were also found to be significant risk factors for hoarseness. Based on this study, the current indoor air problems in Finnish health care facilities can be verified and are a source of risk to nurses' voices.

Experiences of care coordination among older adults in the United States: Evidence from the Health and Retirement Study

IntroductionThe goal of this study was to examine variation in patient experiences and perceptions of care coordination across sociodemographic and health factors. MethodsData come from the 2016 Health and Retirement Study (N = 1, 216). Three domains of coordination were assessed: 1) Perceptions (e.g., patient impressions of provider-provider communication), 2) Tangible supports (e.g., meeting with a care coordinator, being accompanied to appointments), and 3) Technical supports (e.g., use of a “patient portal”). Logistic regression was used to quantify the frequency of each domain and examine variation by racial minority status, socioeconomic status, and health status. ResultsApproximately 42% of older adults perceived poor care coordination, including 14.8% who reported receiving seemingly conflicting advice from different providers. Only one-third had ever met with a formal care coordinator, and 40% were occasionally accompanied to appointments. Although racial minorities were less likely to have access to technical supports, they were more likely to use them. Better perceived coordination was associated with higher care satisfaction (Odds Ratio: 1.43, 95% CI: 1.27–1.61). ConclusionsImportant gaps in care coordination remain for older adults. Practice implicationsProviders should consider assessing patient perceptions of care coordination to address these gaps in an equitable manner.

Associations of patient-reported care satisfaction with symptom burden and healthcare use in hospitalized patients with cancer.

Hospitalized patients with cancer often experience a high symptom burden, which may impact care satisfaction and healthcare utilization. We prospectively enrolled patients with cancer and unplanned hospitalizations from September 2014 to April 2017. Upon admission, we assessed patients' care satisfaction (FAMCARE items: satisfaction with care coordination and speed with which symptoms are treated) and physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms. We used regression models to identify factors associated with care satisfaction and associations of satisfaction with symptom burden and hospital length of stay (LOS). Among 1,576 participants, most reported being "satisfied"/ "very satisfied" with care coordination (90%) and speed with which symptoms are treated (89%). Older age (coordination: B < 0.01, P = 0.02, speed: B = 0.01, P < 0.01) and admission to a dedicated oncology service (B = 0.20, P < 0.01 for each) were associated with higher satisfaction. Higher satisfaction with care coordination was associated with lower ESAS-physical (B = - 1.28, P < 0.01), ESAS-total (B = - 2.73, P < 0.01), PHQ4-depression (B = - 0.14, P = 0.02), and PHQ4-anxiety (B = - 0.16, P < 0.01) symptoms. Higher satisfaction with speed with which symptoms are treated was associated with lower ESAS-physical (B = - 1.32, P < 0.01), ESAS-total (B = - 2.46, P < 0.01), PHQ4-depression (B = - 0.14, P = 0.01), and PHQ4-anxiety (B = - 0.17, P < 0.01) symptoms. Satisfaction with care coordination (B = - 0.48, P = 0.04) and speed with which symptoms are treated (B = - 0.44, P = 0.04) correlated with shorter LOS. Hospitalized patients with cancer report high care satisfaction, which correlates with older age and admission to a dedicated oncology service. Significant associations among higher care satisfaction, lower symptom burden, and shorter hospital LOS highlight the importance of improving symptom management and care coordination in this population.

Patient-reported care satisfaction and symptom burden in hospitalized patients with cancer.

180 Background: Hospitalized patients with cancer often experience a high symptom burden, which may impact care satisfaction and healthcare utilization. However, research describing these patients’ care satisfaction, symptom burden, and health care use is lacking. We sought to investigate relationships among care satisfaction, physical and psychological symptom burden, and hospital length of stay (LOS) in hospitalized patients with cancer. Methods: We prospectively enrolled patients with cancer and unplanned hospitalizations from 9/2014 to 4/2017. Upon admission, we assessed patients’ care satisfaction (FAMCARE items: satisfaction with care coordination and the speed with which symptoms are treated) as well as their physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms. We used regression models to identify factors associated with care satisfaction, and we also examined associations of care satisfaction with patients’ symptom burden and hospital length of stay (LOS). Results: Among 1,576 participants (median age = 65.0 years [range:19-96], 46.3% female, 70.9% with incurable cancer, 58.4% admitted to a dedicated oncology service), most reported being “satisfied” or “very satisfied” with care coordination (90.1%) and the speed with which symptoms are treated (89.0%). Older age (care coordination: B &lt; 0.01, P = 0.022, speed with which symptoms are treated: B = 0.01, P = 0.001) and admission to a dedicated oncology service (B = 0.20, P &lt; 0.001 for each) were associated with higher care satisfaction. Higher satisfaction with care coordination was associated with lower ESAS-physical (B = -1.28, P = 0.007), ESAS-total (B = -2.73, P &lt; 0.001), PHQ4-depression (B = -0.14, P = 0.022), and PHQ4-anxiety (B = -0.16, P = 0.008) symptoms. Higher satisfaction with the speed with which symptoms are treated was associated with lower ESAS-physical (B = -1.32, P = 0.003), ESAS-total (B = -2.46, P &lt; 0.001), PHQ4-depression (B = -0.14, P = 0.014), and PHQ4-anxiety (B = -0.17, P = 0.004) symptoms. Greater satisfaction with care coordination (B = -0.48, P = 0.040) and the speed with which symptoms are treated (B = -0.44, P = 0.041) were both associated with shorter LOS. Conclusions: Hospitalized patients with cancer report high care satisfaction, which correlates with older age and admission to a dedicated oncology service. Significant associations among higher care satisfaction, lower symptom burden, and shorter hospital LOS highlight the importance of improving symptom management and care coordination in this population.

Delivering Bad News: Should Physicians Express their Emotions?

The traditionally assumed medical dictum is that a physician who expresses his or her emotions in font of patients or their families is almost deemed unprofessional. This feeling may be common place, particularly among traditional physicians who still hold the belief that professionalism is endangered if physicians deliver bad news laced with their true emotions. Discussion of this important topic surfaces now and then and are then hidden away without definite answers possibly due to lack of attention by physician's fraternity to dispense with this out-of-date dictum. Though we understand the protection of professionalism is the basis for this practice, the topic is rarely revisited because the community of physicians remains distant from this sensitive issue, in spite of its importance in achieving high care satisfaction from patients and their families. In view of the increased emphasis on enhancing patients’ hospital experiences and satisfaction, the demonstration of sensitivity on the part of physicians in some form as a component of their compassionate care may require renewed attention.

Patient-reported care satisfaction and symptom burden in hospitalized patients with cancer.

2013 Background: Hospitalized patients with cancer often experience high symptom burden, which may impact their care satisfaction and use of health care services. Yet, studies describing these patients’ care satisfaction, symptom burden, and health care utilization are lacking. Methods: We prospectively enrolled patients with cancer and unplanned hospitalizations from 9/2014-4/2017. Upon admission, patients self-reported their care satisfaction (FAMCARE items asking about satisfaction regarding speed with which symptoms are treated and coordination of care) and physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire 4 [PHQ4]) symptom burden. We used regression models to identify patient factors associated with care satisfaction. We also explored associations between patients’ care satisfaction, symptom burden, and hospital length of stay (LOS) in models adjusted for age, sex, marital status, comorbidity score, cancer type, cancer documented as curable/incurable, time since cancer diagnosis, and admission to a dedicated oncology service. Results: We enrolled 1,576 of 1,749 (90.1%) consecutive patients (mean age = 63.19±13.39 years, 46.3% female). Most reported being very satisfied/satisfied with the speed with which symptoms are treated (89.0%) and coordination of care (90.1%). Older age (B = 0.01, P &lt; .02 for both) and admission to a dedicated oncology service (B = 0.20, P &lt; .01 for both) were each independently associated with higher satisfaction with the speed with which symptoms are treated and coordination of care. Higher satisfaction with the speed with which symptoms are treated was associated with lower PHQ4 depression (B = -0.14, P = .01), PHQ4 anxiety (B = -0.11, P &lt; .01), ESAS physical (B = -1.30, P &lt; .01), and ESAS total (B = -2.44, P &lt; .01) symptoms. Higher satisfaction with coordination of care was associated with lower PHQ4 depression (B = -0.14, P = .02), PHQ4 anxiety (B = -0.16, P &lt; .01), ESAS physical (B = -1.30, P &lt; .01), and ESAS total (B = -2.75, P &lt; .01) symptoms. Satisfaction with the speed with which symptoms are treated (B = -0.47, P = .03) and coordination of care (B = -0.50, P = .03) were both associated with shorter hospital LOS. Conclusions: Most hospitalized patients with cancer reported high care satisfaction, which was associated with older age and admission to a dedicated oncology service. We found relationships among higher care satisfaction, lower symptom burden, and shorter hospital LOS, underscoring the importance of efforts to enhance symptom management and care coordination in this population.

Implementing continuity of midwife carer \u2013 just a friendly face? A realist evaluation

BackgroundGood quality midwifery care saves the lives of women and babies. Continuity of midwife carer (CMC), a key component of good quality midwifery care, results in better clinical outcomes, higher care satisfaction and enhanced caregiver experience. However, CMC uptake has tended to be small scale or transient. We used realist evaluation in one Scottish health board to explore implementation of CMC as part of the Scottish Government 2017 maternity plan.MethodsParticipatory research, quality improvement and iterative data collection methods were used to collect data from a range of sources including facilitated team meetings, local and national meetings, quality improvement and service evaluation surveys, audits, interviews and published literature. Data analysis developed context-mechanism-outcome configurations to explore and inform three initial programme theories, which were refined into an overarching theory of what works for whom and in what context.ResultsTrusting relationships across all organisational levels are the context in which CMC works. However, building these relationships during implementation requires good leadership and effective change management to drive whole system change and foster trust across all practice and organisational boundaries. Trusting relationships between midwives and women were valued and triggered a commitment to provide high quality care; CMC team relationships supported improvements in ways of working and sustained practice, and relationships between midwives and providers in different care models either sustained or constrained implementation. Continuity enabled midwives to work to full skillset and across women’s care journey, which in turn changed their perspective of how they provided care and of women’s care needs. In addition to building positive relationships, visible and supportive leadership encourages engagement by ensuring midwives feel safe, valued and informed.ConclusionLeadership that builds trusting relationships across all practice and organisational boundaries develops the context for successful implementation of CMC. These relationships then become the context that enables CMC to grow and flourish. Trusting relationships, working to full skill set and across women’s care journey trigger changes in midwifery practice. Implementing and sustaining CMC within NHS organisational settings requires significant reconfiguration of services at all levels, which requires effective leadership and cannot rely solely on ground-up change.

Reconstructive utilisation and outcomes following mastectomy surgery in women with breast cancer treated in England.

Breast cancer usually necessitates breast-conserving surgery or mastectomy, which adversely affect appearance and wellbeing. Immediate reconstruction restores the breast mound but its availability and efficacy are uncertain. Two discrete datasets were used to evaluate mastectomies in England: Hospital Episode Statistics to measure overall activity and variation over time and by region and a national prospective audit to evaluate immediate reconstruction decision making, complication rates and patient-reported satisfaction with information, choice and outcomes. The 2005-08 Hospital Episode Statistics analyses identified 20% breast-conserving surgery reoperation rates nationally, frequently involving mastectomy. Rates were higher with in-situ disease present (30% vs 18%) and varied across NHS trusts (10th-90th centiles 12-30%). The 2008-09 national audit examined 18,216 women. The 19% immediate reconstruction rate varied regionally (9-43%), as did 2006-09 Hospital Episode Statistics data (8-32%). A total of 48% of women were offered immediate reconstruction, again varying regionally (24-75%). Offer likelihood fell with increasing age. National immediate reconstruction rates increased from 10% to 23% from 2000 to 2014, but regional variation persisted. Despite high care satisfaction, just 65% of mastectomy patients received the right amount of reconstructive information (90% for immediate reconstruction). Women from deprived areas experienced higher complication rates. Flap-based immediate reconstruction led to greater satisfaction with breast area appearance, emotional and sexual wellbeing and overall outcome than mastectomy; implant-only immediate reconstruction scored no better. Reconstruction is central to improving breast cancer outcomes. The differential outcomes and persistent regional inequalities identified should facilitate decision making, support improved access to all reconstructive options and inform the development of an optimal patient pathway.

Effect of clinical care pathway combined with whole-course psychological intervention on gastrointestinal function in patients undergoing radical gastrectomy for gastric cancer

Objective To observe the effect of clinical care pathway combined with whole-course psychological nursing intervention on the gastrointestinal function of patients undergoing radical gastrectomy for gastric cancer. Methods A total of 90 patients who had been seeking radical gastrectomy for gastric cancer in the hospital from January 2015 to January 2017 were selected, and then according to the random number table method, these patients were divided into a control group and an observation group, 45 cases of each group.The control group received routine care, while the observation group was given clinical care pathway combined with whole-course psychological nursing intervention based on the care for the control group.The gastrointestinal function, negative psychological emotions, postoperative complications and satisfaction in the two groups were observed and compared. Results The total incidence of postoperative gastrointestinal symptoms, infections and other complications of the observation group were significantly lower than those of the control group, and the differences were statistically significant (P<0.05). The postoperative anal discharge time, recuperation time and defecation time in the observation group were less than those in the control group, and the differences were statistically significant(P<0.05). After intervention, the scores of anxiety self-rating scale (SAS) and depression self-rating scale (SDS) in the control group were higher than those in the observation group, and the differences were statistically significant(P<0.05). Conclusions For patients undergoing radical gastrectomy for gastric cancer, clinical care pathway combined with whole-course psychological nursing intervention is with significant clinical care effect, which can significantly help to alleviate their negative emotions and boost the recovery of their gastrointestinal function.Moreover, it incurs less postoperative complications and yet brings higher care satisfaction of the patients. Key words: Radical gastrectomy for gastric cancer; Clinical care pathway; Whole-course psychological care; Gastrointestinal function

Reviewing roles: nurses vs physician assistants.

Primary care is under tremendous pressure because of the ageing population, resource constraints, and technological changes that make care at home possible. Finding ways to extend the capacity of the GP service are needed if care is to be refocused in the community. A variety of solutions have been proposed, including the introduction of physician assistants (PA) to the primary care workforce. Physician assistants have a 2-year training working to the medical model, which builds upon a science degree. Physician assistants have existed for 40 years in the US, and early studies (Woodin et al, 2005; Farmer et al, 2011) of their employment in the UK were favourable in terms of their competency and greater diagnostic skills compared with nurses in extended roles. Drennan et al (2011) found that PAs were a helpful addition to the general practice team enabling the meeting of patient care demand within budgetary constraints. In more recent years, a larger evaluation (Drennan et al, 2014) reported that PAs were a flexible resource to general practice and increased clinician time for same-day appointments within their practices. Although their appointment times were slightly longer than those of the GPs and they saw younger and fewer patients with chronic diseases, there were no differences in procedures undertaken or prescriptions issued. Moreover, the patients were equally satisfied with the PA and GP consultations, and 90% said they would would be satisfied to consult a PA again. The costs of PAs was also cheaper than that of a GP. Why haven’t nurse practitioners (NPs) been championed as a potential solution to increasing the capacity of the GP service? Unlike the US where ‘nurse practitioner’ is the registered title of more than 200 000 advanced practice nurses, mostly working in primary care with Medicare and Medicaid patients (American Association of Nurse Practitioners, 2015), NP is not a recognised title in the UK. One is left to wonder whether the recent debates about whether nurses are now ‘too posh to wash’ has spilled over to create a reputational legacy that nurses cannot be both clever and capable of advanced clinical decision making, as well as simultaneously compassionate—not a charge that is levelled at GPs. While clarity about the purpose and expectations of RNs is clearly important, the ongoing debate is a distraction if we wish to see RNs as key contributors to solutions to general practice workforce capacity issues. After all, nurses work within a regulatory framework, can prescribe unlike PAs, and patients have similar health outcomes if treated by NPs compared with GPs and report higher care satisfaction (Horrocks et al, 2002). It would be good to see the potential contribution of nurses highlighted alongside the emergent role of pharmacists within GP surgeries (Royal Pharmaceutical Society, 2014; Royal College of General Practitioners, 2015). BJCN

Care satisfaction among older people receiving public care and service at home or in special accommodation

To explore care satisfaction in relation to place of living, health-related quality of life, functional dependency and health complaints among people 65years or older, receiving public care and service. The concept public care and service concerns formal care from the municipality, including home help, home nursing care, rehabilitation and a special accommodation. To be able to provide care and service of high quality to older people, knowledge about factors influencing their experience of satisfaction with the care is essential. Cross-sectional, including comparison and correlation. One-hundred sixty-six people receiving public care and service from the municipality were interviewed regarding demography, functional ability, perceived health complaints and care. Health-related quality of life was measured with SF-12, and self-rated care satisfaction was measured with a questionnaire. Low self-rated care satisfaction was associated with dependency in Instrumental Activities of Daily Living, blindness, faeces incontinence and anxiety, while high self-rated care satisfaction was associated with dependency in Personal Activities of Daily Living. Those at home rated an overall higher care satisfaction and were more satisfied with care continuity and personal relations; they thought that the staff had more time and were more respectful and quiet, than the ratings by those in a special accommodation (equivalent to a nursing home). Care satisfaction and health-related quality of life among older people was more associated with functional impairment and health complaints than to whether care and service was received at home or in a special accommodation. An approach using intervention focused on functional ability and health complaints is important for development of improved care satisfaction for older people receiving public care and service.