Patient Support Services Research Articles

Demographics, Personality Traits, Roles, Motivations, and Attrition Rates of Hospice Volunteers

ABSTRACT The authors conducted a review of prior research on hospice volunteering. The results show that, in most cases, the hospice volunteer is a white, married, middle-aged, financially comfortable, unemployed, female who has some college education, strong religious beliefs and has experienced the loss of someone close (see Tables 1 and 2). The results also show that hospice volunteers tend to share certain personality traits reflecting compassion, tolerance, empathy and sensitivity among others. Volunteers tend to fulfill four roles: direct patient support, education, clerical assistance, and professional services (Bunn 1985). Motivations for volunteering and for continuing one's work as a volunteer appear to be for both personal and altruistic reasons. Primary reasons for discontinuing volunteer service include burnout, communication problems, unrealistic expectations, and insufficient use of the volunteer staff. Gaps in this area of research are identified and topics for further research are presented.

Patient support services

Patient support services

Information and support radiographers: a critical review of the role and its significance for the provision of cancer services

The purpose of this paper is twofold; firstly, to present for wider consideration data collected about the role of information and support radiographers (ISRs) in the United Kingdom and secondly, to review critically issues of significance arising from the initial data collection and content analysis.The empirical material is taken from a much larger survey of Oncology Centres1 whose aim was to analyse the extent and effectiveness of information and support services for cancer patients in order to evaluate service provision in a less developed country. A short, self completed postal questionnaire to identified information and support radiographers was employed. It sought to identify the main components of the ISR role, underpinning qualifications, limitations and potential for development. 64% of ISRs surveyed responded (n = 22) and the findings are presented for consideration in this paper.The discussion comprises a critical review by the first author of some issues raised by the findings in the context of the national service framework for integrated provision2 and current developments in the practice and processes of therapeutic radiography. Specifically, the relative contribution of different aspects of the role of the ISR are evaluated, examining the benefits to patients and professionals alike. The difficulties of trailblazing a new role in a traditional, hierarchical service are explored. The necessity of a profession specific base for information and support provision in clinical oncology is questioned and it is suggested that, professionally, there are both advantages and disadvantages to this role development, but there is support for a less predatory, more interprofessional approach.

Improving palliative care services: a pragmatic model for evaluating services and assessing unmet need.

Evaluating local palliative care services and identifying gaps in services for patients are crucial to the development of services which enable people to die at home in a well-supported environment. A review of the local strategy for providing respite and support services for palliative care patients and their carers was carried out in one area of south-east England. The review comprised four elements: identification of services available; interviews with provider 'stakeholders'; interviews with patients and carers; questionnaire survey of general practitioners and district nurses. The findings and outcome are described. It is suggested that this approach could be adopted by health authorities to form one part of a comprehensive system of needs assessment. Alternatively, it could be used by groups of providers to evaluate existing services and to identify potential improvements to services. Advantages and disadvantages of the approach for both commissioners of such reviews and those carrying them out are discussed.

Implementation of an In-Room Patient Menu to Improve Customer Satisfaction.

Utilizing customer feed back as the basis, the need was identified to provide the patient with a permanent in-room menu. This concept not only provides the “WOW” that all food service departments are striving for, but additionally it provides the customer with the perception that they are staying at a luxurious hotel. The content of the menu includes; the scope of patient support services (food service, environmental service, laundry, patient service associate, plant operations and maintenance, safety, security and the service center), the cafeteria hours, patient lunch and dinner daily features, alternative choices, a brief description of diets and the hospital mission and values statement. The in-room menu is utilized in tandem with the spoken menu concept. This collaborative process not only provides the patients with individualized conversation prior to each meal, but a menu which provides both themselves and family members a vehicle to utilize when making meal time selections. The purpose of the menu came from the customer feed back of “never received a menu” as well as from family members who want to assist their loved ones with making meal-time choices. This menu also allows a basic understanding about special diet restrictions that are prescribed. Most importantly this makes the patient feel as through they can take an active part in their care, during their stay. Individuals, whether patients or not, feel they understand food, and like both choices and control over what they receive, regardless if they are at a health care institution or the most luxurious hotel. This in-room menu is a concept that was able to exceed our customers needs and expectations during their stay.

A new barrier-free burn center.

This article describes a barrier-free burn center that is accessible to persons with disabilities and that complies with Title III of the Americans with Disabilities Act. The burn center has 3 separate components: patient rooms, patient support facilities, and staff support facilities. Thirteen rooms are used to care for 16 patients. Two of the 13 rooms are accessible to people with disabilities. These 2 rooms have wide doors that permit a wheelchair to pass through, and they have enough clear floor space for a wheelchair to make a 180 degrees turn. The rooms have a sink that is accessible from a wheelchair. The bathrooms have large, clear floor spaces that allow for the turning of a wheelchair, elevated toilets, grab bars, and showers that permit wheelchair access. Special wheelchairs that provide easier shower and commode access are available. The patient support services feature a large hydrotherapy room that contains a table-shower system that allows a person in a wheelchair to gain access to both sides of the shower table. A tub room has been constructed to provide compact patient bathing and hydromassage, and it is also accessible to people in wheelchairs. The staff support services include a locker room that has a shower accessible to people with disabilities so that staff members with mobility disorders can work in the burn center. Grade II braille writing marks all of the signs that designate the permanent rooms and spacing in the burn center and in the contiguous common use areas. The common use area has a restroom accessible to people with disabilities and a waiting room with a telephone communications system for people with mobility disorders or mobility impairment.

Development of a post-offer screening tool for patient support services.

The purpose of our project was to develop a post-offer screening tool that demonstrates interrater reliability, predictive validity, and face validity and that accurately represents the physical demands of the patient support services (lifting team) job at our health care facility. The screening tool, which consists of 11 static and dynamic tasks, was developed, using the 13 incumbent staff members of the patient support services department, to determine whether the criteria established for each task matched the physical abilities of at least 80% of the total group tested. Test-retest design was used for this study. Intraclass correlation coefficients and the Kappa statistic were used to calculate interrater reliability. Face validity was determined through the Job Similarity Questionnaire completed by all subjects. Subjects did not meet criteria established for the static knee pull and the knuckle-to-elbow lift tasks, resulting in modification of these two criteria. Interrater reliability ranged from .22 for the maximum static pull wall task to .94 for the left-hand grip strength task. Face validity ranged from 53.9% to 92.4%. Although face validity of the Job Similarity Questionnaire represented a wide range, we believe that the results were homogeneous enough to continue with the screening tool unchanged, except for lowering the expected outcome on two tasks. Interrater reliability was established for 75% of the tasks. The lack of variation of data for the other 25% prevented statistical analysis of those tasks but confirmed that all members met the physical criteria.

Quality indicators in clinical nursing: a review of the literature.

The purpose of the present study was, by means of a literature review, to describe and analyse the characteristics of clinical indicators used to assess and promote quality improvement in nursing care. It was found that a generally accepted definition of a clinical indicator is a 'quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities'. By the seriousness of the event and the degree to which it can be avoided, clinical indicators are described as sentinel event or rate-based indicators. They can measure structure, process or outcome of care. Authors have had different approaches in focus when selecting and developing indicators viz. specific aspects of care/nursing diagnosis, medical diagnosis, generic aspects of care and clinical areas. These different points of departure were influenced by research knowledge, theories/frameworks, or by the opinions of patients or staff. The threshold of an indicator is essential when measuring the quality of care as it describes a critical level between what is considered good or not. Thresholds should be dynamic, realistic, and improve over time. However, the literature on how to establish specific thresholds is limited. The review has also revealed that there is an uncertainty regarding the use of terms such as indicators, standards, norm, criteria and aspects of care.

Extending the role of the stoma care nurse

Recently, there has been a great deal of interest, argument and debate regarding the extension of nursing roles and the development of nurse practitioner roles in particular. Much of this argument has centred around whether nurses are seeking to gain professional standing by taking on doctors' tasks, but little is heard about the potential benefits to patients and the possibility of developing new patient support services. In this article, the author looks specifically at the area of stoma care and outlines potential advantages and disadvantages to role extension.

Opportunities on the Internet for child and adolescent psychopharmacologists: net access and mailing lists.

The Internet, a system linking computers around the world, provides clinical and research psychopharmacologists with a convenient and efficient way to exchange information and offers a growing number of services to facilitate patient care. These opportunities are not theoretical, not in the future, and not for a select few. Many patients are already benefitting from practitioners who have sought guidance for their clinical work on the Internet. This article describes, for the novice user, how to begin the Internet journey. It also discusses psychopharmacology-related mailing lists, including a site that specializes in child and adolescent psychopharmacology. Subsequent articles will (1) show how to use Medlines to conduct literature searches and retrieve abstracts and articles from the computer screen, (2) describe ways to enter and traverse the World Wide Web (the "multimedia" portion of Internet), and (3) survey the use of "Web browsers" to find specialized psychopharmacology resources and databases, electronic journals, pertinent bulletin boards, and support services for patients and families-all with an emphasis on direct benefits to the practicing psychopharmacologist.

Distribution of EE and Its Relationship to Relapse in Japan

Psychiatric rehabilitation in Japan faces a number of problems. Policies regarding support for the mentally disabled are unsatisfactory; and community services such as day care, sheltered workshops, and group homes that enable patients to return to the community are still inadequate. In fact, 80% of the patients who are discharged from hospitals return to their families. Families are defined as guardians under the Mental Health Act and are responsible for care of the Guardians are required to make the patient receive treatment, supervise the patient so he or she will not hurt himself or herself or others, and protect the financial interests of the patient. Families must fulfill many roles as caretakers. Despite these conditions, dissemination of information regarding mental illness, professional intervention techniques, and delivery of social services are lacking. The lack of information causes many families to live in a state of physical and emotional fatigue because of caring for the patient and worrying about such concerns as sudden changes in the illness, relapses, and the possibility of suicide. Thus, one of the most important tasks for clinical psychiatry in Japan is to provide appropriate support services for patients and their families. Expressed Emotion (EE) is a scale developed and validated in the West to predict the course of illness. EE studies have produced eviDr. Ito is associated with the Department of Psychiatric Rehabilitation, National Institute of Mental Health, Kohnodai 1-7-3, Ichikawa City, Chiba Pref. 272, Japan, and Dr. Oshima, with the Department of Social Welfare, Tokyo Metropolitan University. 23

Resource utilization in home health care: results of a prospective study.

Resource utilization in home health care has become an issue of concern due to rising costs and recent initiatives to develop prospective payment systems for home health care. A number of issues remain unresolved for the development of prospective reimbursement in this sector, including the types of variables to be included as payment variables and appropriate measures of resource use. This study supplements previous work on home health case-mix by analyzing the factors affecting one aspect of resource use for skilled nursing visits--visit length--and explores the usefulness of several specially collected variables which are not routinely available in administrative records. A data collection instrument was developed with a focus group of skilled nurses, identifying a range of variables hypothesized to affect visit length. Five categories of variables were studied using multiple regression analysis: provider-related; patient's socio-economic status; patient's clinical status; patient's support services; and visit-specific. The final regression model identifies 9 variables which significantly affect visit time. Five of the 9 are visit-specific variables, a significant finding since these are not routinely collected. Case-mix systems which include visit time as a measure of resource use will need to investigate visit-specific variables, as this study indicates they could have the largest influence on visit time. Two other types of resources used in home health care, supplies and security drivers, were also investigated in less detail.

Hospital Admission Through the Emergency Department-Reply

In Reply. —I congratulate Dr Tachakra and colleagues and their medical students for devising adjustments to account for the extended hospital stays seen among patients admitted through EDs. Lack of support services for patients after hospital discharge lengthens hospital stays, and inclusion of a disability factor makes sense. I am somewhat surprised that the recover-ability factor was useful, as the diagnosis related group scale used by Stern et al 1 to account for severity of illness includes comorbidities. The additional time and tests needed to familiarize care givers with patients admitted through EDs and the inability to use preadmission testing or to coordinate in-hospital management are other factors thought to influence the cost and duration of care for such patients. 1-3 Dr Hoffman describes providing facilities as alternatives to EDs for patients without urgent health problems. This would certainly ameliorate the problem of ED overcrowding, as 11% to 15% of visits

The Development of Indicators

The standards set by the Joint Commission on the Accreditation of Healthcare Organizations (ICAHO) and published annually in the Accrediting Manual for Hospitals (AMH) define the framework within which most hospitals conduct their quality assurance (QA) and utilization review (UR) activities. The process known as “monitoring and evaluation,” reviewed here in May, forms a central component of many of these standards. The monitoring and evaluation process, in turn, depends on the identification of “clinical indicators.” The JCAHO has stated that a clinical indicator is “a quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities. An indicator is not a direct measure of quality. Rather, it is a screen or flag that identifies or directs attention to specific performance issues that should be the subject of more intense review”.

Surveillance for Quality Assessment III. The Critical Assessment of Quality Indicators

The first two articles in this series reviewed the reasons for widespread acceptance of surveillence and control methods in hospital infection control programs, and discussed important factors contributing to the successes and failures in applying this approach to noninfectious nosocomial events. The quality assurance program ‘targets of surveillence” identified in these articles are referred to as “quality indicators” by other authors and have been defined as “a quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities.” This article highlights those attributes of quality indicators that should be critiqued prior to implementation in a patient care review environment and discusses methods of improving quality indicator performance with ongoing monitoring and evaluation.

Surveillance for Quality Assessment III. The Critical Assessment of Quality Indicators

Increased attention to healthcare quality issues by insurers, the public and providers has created the desire for quantitative indicators of high quality care. Attributes of quality indicators, including primary and secondary definitions, predictive accuracy and potential to define avoidable problems in care, have been discussed in an effort to allow the reader to critique suggested quality indicators as they appear through legislation and the literature. A continuous feedback process between reviewers and reviewees in the quality assessment process is mandatory to optimize the performance of quality indicators.

Surveillance for Quality Assessment III. The Critical Assessment of Quality Indicators

The first two articles in this series reviewed the reasons for widespread acceptance of surveillence and control methods in hospital infection control programs, and discussed important factors contributing to the successes and failures in applying this approach to noninfectious nosocomial events. The quality assurance program ‘targets of surveillence” identified in these articles are referred to as “quality indicators” by other authors and have been defined as “a quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities.” This article highlights those attributes of quality indicators that should be critiqued prior to implementation in a patient care review environment and discusses methods of improving quality indicator performance with ongoing monitoring and evaluation.

Vertical integration in health services: Theory and managerial implications

A vertically integrated health care system is an arrangement whereby a health care organization offers, either directly or through others, a broad range of patient care and support services. This article discusses the market forces and strategic considerations driving the recent trend toward vertical linkages in health care markets and examines some of the managerial implications and issues associated with this vertical restructuring trend.

Labor-Based Budgeting

SUSAN SHEEDY, RN, MPH, is Vice President, Operations, Nursing and Patient Support Services, Methodist Hospital of Indiana, Inc. ROBERT G. WHITINGER is Director, Management Services, Methodist Hospital of Indiana, Inc.