Non-clinical Care Research Articles

Providing comfort and support to older people

This article reports on a scheme run by Age UK at Hillingdon Hospital, Middlesex, to help support emergency department (ED) staff with the care of older people. The A&E support-worker team assists patients with non-clinical activities, such as going to the toilet, eating meals and finding out care-related information. The support-worker scheme has been running for nine years and its success has prompted Age UK to consider expanding it nationally. It comes at a time when there is a growing focus on the care Solder patients receive in hospitals.

Hand Hygiene Opportunities in Pediatric Extended Care Facilities

Introduction: Children in extended care facilities (ECFs) are at risk of healthcare-associated infections, but little hand hygiene (HH) research has been conducted in this unique setting. Eight children across four pediatric ECFs were observed for a cumulative 128 hours, and all care giver HH opportunities were characterized by the World Health Organization's '5 Moments for HH'. Data were analyzed using Pearson's χ2 test. Observers documented 865 HH opportunities. Overall HH adherence was 43% and was significantly higher among clinical care givers than among non-clinical care givers (61% and 14%, respectively, (p < .01). Hand hygiene adherence was low, suggesting multiple opportunities for transmission of infectious agents.

A CAUTI Bundle with a Twist

World Health Organization, 5 Moments, to characterize the types and frequency of HH opportunities and tomonitor adherence to HH by various care givers. Clinical care givers were defined as physicians, nurses, nurse aides and respiratory, physical or occupational therapists and non-clinical care givers were defined as teachers, teachers aides, recreational support staff, environmental service workers, social workers, volunteers and adult visitors. Data analyses were descriptive. Comparisons of categorical data were performed using Pearson test. Results:Weobserved 865 HH opportunities of which amean of 108 HH opportunities (range, 60 196) occurred per child during the 16 hours of observation. Prior to patient contact (39%) and prior to aseptic technique (1%) were the most and least common HH opportunities, respectively. Nurses and nurse aides had the highest number of HH opportunities (50%), while visitors; therapists; school staff; other staff and physicians were associated with 22%, 9%, 9%, 8% and 1% of HH opportunities, respectively. Overall HH adherence was 43% (27-65% per facility) and was significantly higher among clinical care providers than among non-clinical individuals (61% and 14%, respectively, P < 0.01). Adherence was highest after exposure to body fluids (66%) and lowest before patient contact (36%).

Hand Hygiene Opportunities in Pediatric Extended Care Facilities

Introduction Introduction: Children in extended care facilities (ECFs) are at risk of healthcare-associated infections, but little hand hygiene (HH) research has been conducted in this unique setting. Methods Eight children across four pediatric ECFs were observed for a cumulative 128 hours, and all care giver HH opportunities were characterized by the World Health Organization's ‘5 Moments for HH’. Data were analyzed using Pearson's χ2 test. Results Observers documented 865 HH opportunities. Overall HH adherence was 43% and was significantly higher among clinical care givers than among non-clinical care givers (61% and 14%, respectively, ( p Conclusions Hand hygiene adherence was low, suggesting multiple opportunities for transmission of infectious agents.

Delivering palliative care in a rural setting

Palliative care delivery in rural settings requires a flexible multidisciplinary team approach, drawing on various levels of knowledge and expertise to optimally support the patient, and their relatives/carers. The model...

Effect of non-clinical inter-hospital critical care unit to unit transfer of critically ill patients: a propensity-matched cohort analysis

IntroductionNo matter how well resourced, individual hospitals cannot expect to meet all peaks in demand for adult general critical care. However, previous analyses suggest that patients transferred for non-clinical reasons have worse outcomes than those who are not transferred, but these studies were underpowered and hampered by residual case-mix differences. The aim of this study was to evaluate the effect of transferring adult general critical care patients to other hospitals for non-clinical reasons.MethodsWe carried out a propensity-matched cohort analysis comparing critical care patients who underwent a non-clinical critical care unit to unit transfer to another hospital with those who were not transferred. The primary outcome measure was mortality at ultimate discharge from acute hospital. Secondary outcomes were mortality at ultimate discharge from critical care, plus length of stay in both critical care and acute hospital.ResultsA total of 308,323 patients were admitted to one of 198 adult general critical care units in England and Wales between January 2008 and September 2011. This included 759 patients who underwent a non-clinical transfer within 48 hours of admission to the unit and 1,518 propensity-matched patients who were not transferred. The relative risk of ultimate acute hospital mortality was 1.01 (95% confidence interval = 0.87 to 1.16) for the non-clinical transfer group, compared with patients who were not transferred but had a similar propensity for transfer. There was no statistically significant difference in ultimate critical care unit mortality. Transferred patients received on average three additional days of critical care (P < 0.001) but the difference in length of acute hospital stay was of only borderline significance (P = 0.05).ConclusionIn our analysis the difference in mortality between non-clinical transferred and nontransferred patients was not statistically significant. Nevertheless, non-clinical transfers received, on average, an additional 3 days of critical care. This has potential ramifications in terms of distress, inconvenience and cost for patients, their families, and the National Health Service. We therefore need further evidence, including qualitative data from family members and cost-effective analyses, to better understand the broader effects of non-clinical transfer.

Small wonders: a change programme to empower parents to be the cornerstone of their sick and premature infant's care

Sick and preterm infants are at high risk of sub-optimal physical and psychological development. Current research highlights the pivotal role that parents could play in minimizing early risk factors and...

The structure and content of telephonic scripts found useful in a Medicaid Chronic Disease Management Program

In 2003, the Indiana Office of Medicaid Policy and Planning launched the Indiana Chronic Disease Management Program (ICDMP), a programme intended to improve the health and healthcare utilization of 15,000 Aged, Blind and Disabled Medicaid members living with diabetes and/or congestive heart failure in Indiana. Within ICDMP, programme components derived from the Chronic Care Model and education based on an integrated theoretical framework were utilized to create a telephonic care management intervention that was delivered by trained, non-clinical Care Managers (CMs) working under the supervision of a Registered Nurse. CMs utilized computer-assisted health education scripts to address clinically important topics, including medication adherence, diet, exercise and prevention of disease-specific complications. Employing reflective listening techniques, barriers to optimal self-management were assessed and members were encouraged to engage in health-improving actions. ICDMP evaluation results suggest that this low-intensity telephonic intervention shifted utilization and lowered costs. We discuss this patient-centred method for motivating behaviour change, the theoretical constructs underlying the scripts and the branched-logic format that makes them suitable to use as a computer-based application. Our aim is to share these public-domain materials with other programmes.

Interventions for young people in Australia to reduce HIV and sexually transmissible infections: a systematic review

Like young people in other developed countries, sexually active young Australians can have an increased risk of acquiring sexually transmissible infections (STIs). This paper reviews intervention programs that aim to reduce the incidence and transmission of HIV and STIs among young people in Australia. Articles were identified from seven databases. Intervention studies conducted in Australia that included young people aged 12-25 years were reviewed. A two-dimensional matrix consisting of 'setting' and 'intervention type' was developed to categorize each study. Forty-two studies met the inclusion criteria, and the majority were uncontrolled intervention studies. Of these, 23/42 studies measured participation in chlamydia +/- other STI testing and found that the highest participation rates took place in non-clinical and non-general practice health care settings. Four studies facilitated access to testing indirectly, through the internet or other media. Ten studies involved the provision of education and measured its impact on factors such as knowledge, attitudes and/or behaviour. Three studies involved novel immunisation strategies for either hepatitis B or human papillomavirus vaccines. Two studies evaluated the impact of enhanced STI surveillance programs on prevalence rates. Proactive STI testing in non-clinical and some health settings appears feasible and achieves higher testing rates than in general practice; however, more evaluation of testing strategies in general practice settings is required. New technologies such as the internet and SMS are useful adjuncts for influencing behaviours such as condom use and STI testing. Media campaigns that promote STI testing can have a positive impact on testing rates.

Adapting to the Context and Learning From Earlier Experience

Although often used in health care settings as a method for continuous quality improvement, experience with the breakthrough collaborative in nonclinical health care settings is limited. In this article, we report pilot data from a social services collaborative conducted in 2007 to 2009 in Sweden, with special attention given to features of the implementation context that appeared to facilitate or hinder its success. We used a case study approach to describe the processes used in the pilot project as well as to characterize the context. Our analysis was guided by a framework consisting of earlier identified factors for success including "motivate and empower the teams" and "ensure teams have measurable and achievable targets." We observed several context-specific factors. These included measuring challenges connected to large cooperating teams. Specifically, teams representing different organizations needed more time to carry out a breakthrough collaborative than those in clinical health care settings. As in breakthrough collaboratives conducted in health care settings, early measurement efforts enabled a clearer sense of direction, which may have served to reinforce motivation among team members. This study highlights features that may have universal importance in influencing the success of breakthrough collaboratives to improve the quality of social services.

Depressive personality disorder, dysthymia, and their relationship to perfectionism

This paper reports the results of two studies in a nonclinical (n=105) and primary care outpatient sample (n=110), in which Depressive Personality Disorder (DPD), Dysthymia, and depression were assessed for their distinctive relationship with perfectionism. Results from both studies found that self-reported DPD, Dysthymia, and depressive symptoms were all intercorrelated, and that DPD, Dysthymia, and depressive symptoms were correlated with three dimensions of perfectionism-Concern over Mistakes, Doubts about Actions, and Parental Criticism. In the nonclinical sample, variance in measures of DPD was predicted by measures of perfectionism after controlling for depression and Dysthymia symptoms. A similar pattern of findings was observed in the primary care sample. This relationship with perfectionism did not occur when Dysthymia or depressive symptoms were predicted. Nevertheless, much of the variance in measures of DPD, Dysthymia, and depressive symptoms is associated with each other and not perfectionism. It is concluded that a common factor or set of factors underlies these disorders, but that DPD may be more strongly related to perfectionism than Dysthymia and depression. As a common factor(s) is identified, measures of DPD and Dysthymia may be refined, thereby increasing the discriminant validity of their measures.

Male Patient Perceptions of HIV Stigma in Health Care Contexts

Individuals living with HIV may have a heightened sensitivity to the behaviors of others that may signal bias or discrimination. Identifying and avoiding these potentially problematic behaviors may be especially important for service providers, such as health care personnel, who regularly interact with HIV-positive clientele. This study examines the experiences of 50 male American military veterans living with HIV and their perceptions of HIV stigma within health care contexts. Participants described a variety of behaviors performed by health care personnel that they perceived to be indicative of HIV stigma, ranging from ambiguous nonverbal cues (e.g., minimal eye contact) to blatant discrimination (e.g., physical abuse of HIV-positive patients). These findings extend previous research on HIV stigma in health care settings by (1) focusing on health care personnel's actual behaviors rather than their attitudes and beliefs about HIV-positive patients, (2) including patients' perceptions regarding the behaviors of both clinical and nonclinical health care personnel, and (3) identifying behaviors patients perceive as stigmatizing that are unique to health care contexts. Combined, these findings provide health care personnel a tangible list of behaviors that should either be avoided or further explained to HIV-positive patients, as they may be interpreted as stigmatizing.

Exploring patient, visitor and staff perspectives on inpatients' experiences of care

Abstract Delivering patient-centred healthcare is now seen as one of the basic requirements of good quality care. Despite a shift towards more community-based healthcare, being treated in hospital remains a reality for many thousands of people each year. While most patients say they are generally satisfied with their care overall, anecdotal evidence and individual case reports show that care can often leave much to be desired, especially in terms of the basic elements of non-clinical care. Which? carried out a qualitative study of patient, visitor and hospital staff views of non-clinical care, to identify patients' needs and expectations and areas for improvement. Analysis of results showed that patients' experiences were varied, and hospitals were consistently not meeting expected service levels in key areas. Four elements of the 'softer side' of care were found to be necessary for a 'good' patient experience: the ward environment, the organisation of care, being kept informed and attention from caring s...

Annual Infection Control Education: Create an Attitude of Fun and Engage the Customer!

ISSUE: It is imperative to provide a venue for learning that instills in the customer, both clinical and nonclinical health care workers, the desire to learn that infection prevention and control is integrated in every job function!

Patient‐centred quality improvement audit

This article aims to describe the research process, and the development of the instrument now employed in auditing patients' perceptions of quality improvement in a community health care trust in a coastal town in Essex, England. The new instrument is currently being implemented and the findings thus far are described. The instrument has measured health outcomes in terms of quality improvement from the users' perspective, and has also highlighted gaps between what the service offers in terms of quality and users' perceptions of what is delivered. The study demonstrates the importance of the professional role in quality improvement. Patient-centred quality improvement audit should be undertaken regularly so that both non-clinical managers and health care professionals can establish whether or not they are providing services that are patient-friendly and effective from the user's viewpoint. In the course of their work, professionals and managers discuss patients and speak on their behalf in various forums, and knowing what patients actually expect and perceive before speaking on their behalf may be of great benefit in such instances.

Increasing Knowledge, Skills, and Empathy Among Direct Care Workers in Elder Care: A Preliminary Study of an Active-Learning Model

We describe the development of a 24-hr curriculum for nonclinical direct care workers in elder care that features active-learning strategies and consumer-directed approaches. Our curricular design was based on adult education theory and a survey of 70% of the community's service providers. Training was completed by 88 participants, 90% of whom had no prior formal training in elder care. Questionnaires measured participant knowledge, attitudes, and perceived improvements in understanding, empathy, and skills. A subgroup of participants and employers provided additional feedback through focus groups. Participants significantly improved their scores on knowledge and attitude measures. In addition, direct care workers and employers gave the training high marks and identified ways in which the course helped increase workers' competence, empathy toward elders, and self-esteem. Lack of time and funds for training were two major barriers to broader participation. This active-learning curriculum represents a frugal yet effective way to train current and future direct care workers.

329 - Evidence of work-induced stress among oncology clinical and non-clinical health care personnel in Glasgow and the West of Scotland

329 - Evidence of work-induced stress among oncology clinical and non-clinical health care personnel in Glasgow and the West of Scotland

Quality of hospital service: A study comparing ‘Asian’ and ‘non-Asian’ patients in Middlesbrough

To compare 'Asian' and 'non-Asian' patients' experience of and satisfaction with non-clinical aspects of their hospital care, and to evaluate the effect of subsequent provision of 'Asian' food, we undertook interview surveys of recently discharged adult patients in Middlesbrough. Fifty-two 'Asians' and 52 'non-Asians' matched for sex, age, specialty of admission and hospital reported similar experiences in regard to the amount of information received, the presence of medical students during examination, and satisfaction with privacy and visiting arrangements. The main differences between the groups related to the receipt of written information in the patients' first language, 'Asian' patients' inability to communicate because of lack of English and their dissatisfaction with existing interpreting arrangements, 'Asian' women's attitudes to examination by male doctors, and provision of and satisfaction with hospital food. For example, 47 (90 per cent) 'Asians' and 14 (27 per cent) 'non-Asians' required a special diet but 19 per cent and 86 per cent, respectively, received it; and 'Asians' were less satisfied with the food overall. Despite being disadvantaged 'Asian' patients seldom complained. Following the provision of 'Asian' food, 'Asian' patients reported satisfaction levels comparable with those of 'non-Asians'. Equitable health care provision for ethnic minorities requires a level of service comparable with that enjoyed by the majority community. Written information in minority languages, professional interpreters, examination of female patients by women doctors and culturally suitable food were confirmed as priority needs. Staff training and community education may ensure successful implementation of policy on health care of ethnic minorities. Finally, the quality of non-clinical care in hospital needs to be raised for all groups of patients.

Redesigning roles for patient-centered care. The hospitality representative.

Nurses cannot always meet patients' expectations for nonclinical care. The authors describe the operational redesign of several hotel-related functions to enhance the provision of nonclinical care. This system enhances care delivery to better balance patients' perceptions of the clinical with the non-clinical components of care.