Patient Perceptions Of Care Research Articles

Transforming Care in a Large Inner City University Hospital Emergency Department

Sadly, arriving to an emergency department in 2012, a patient and his or her family’s initial encounter can bewith a secretary or a registration staff memberwho is less interested in the chief complaint and more concerned with capturing basic demographic information and establishing the method of payment. Patients’ expectations regarding a visit to the emergency department include being greeted, having their complaint or injury assessed, and receiving care in a timely manner. A crowded waiting room can be a dangerous place in the emergency department. On a busy evening, high nurse-patient ratios can result when patients with various chief complaints, of various ages, and often with children and elderly patients present to the emergency department, with one triage nurse being responsible for over 30 to 40 waiting patients. The waiting room is full of potentially or actual critically ill patients who are often unmonitored, often not reassessed, and left without any conduit for communication if they are able to verbalize a change in their presenting condition. If you or your loved one arrives to the emergency department, your expectations are that you are greeted, your complaint or injury is assessed, and you are taken care of in a timely manner. This quality-improvement project was designed to place a triage nurse in the waiting room to greet each patient on arrival, determine the reason for the ED visit, perform an initial evaluation and an across-the-room assessment, and assign triage acuity. Revising the upfront arrival and triage process and moving patients directly from triage to a bed (ie, immediate bedding), when a bed is available, with bedside registration, reduces the door-to-doctor time and can increase overall throughput. The Institute ofMedicine (IOM) indicated in the title of a 2006 report that the emergency care system in the United States is reaching its “breaking point.” The framework the IOM proposed to examine ED crowding was based on the IOM’s 2001 report The Quality Chasm, in which the IOM identified the 6 dimensions of quality—safety, effectiveness, patient centeredness, efficiency, timeliness, and equity—all of which can be compromised when patients experience long delays in seeing a physician or when the number of boarding patients limits the ED staff’s ability to provide effective care. In addition, patients’ perception of care and their overall level of satisfaction with the entire visit may be determined early in the visit if they experience lengthy delays. The goal of the waiting room nurse is “GRASP-ED,” that is, greet-reassure-assess-sort-prioritize in the emergency department: greet each arriving patient and assure him or her that a registered nurse understands his or her reason for arrival; reassure each arriving patient and his or her family or support persons; assess using essential nursing assessment skills and history-taking questions, chief complaint, medical history, and currentmedications; sort in a certain place or ranking, to arrange according to illness; and prioritize by being the eyes and ears of the triage nurse who is behind closed doors performing full assessments, vital signs, and protocols on already sorted patients, allowing the triage nurse to treat patients by acuity versus time of arrival. In addition, the goals for the GRASP-ED nurse are to identify critically ill patients and expedite their care, ensure early isolation of patients with communicable diseases, ensure early reverse isolation for patients who are immunocompromised, assist in facilitating the triage process and throughput, and immediately initiate first aid on arrival, while enhancing the patient experience and changing the perception of patient care, starting immediately upon arrival, while accomplishing this with excellent customer service skills. Jeanne J. Venella,Member, South Jersey Chapter, is Project Manager, Emergency Department, Hospital of the University of Pennsylvania, Philadelphia, PA.

Hospice nurses' perceptions of caring for patients with a non-malignant diagnosis: a single-site case study

In the early stages of its development in the UK, palliative care focused almost exclusively on the care of patients with cancer, with efforts concentrated on relieving distressing physical symptoms in the last few weeks of life-often referred to as terminal care. It is increasingly expanding to include non-malignant conditions, but is still predominantly accessed by cancer patients. This paper presents findings from a small-scale qualitative study into nurses' experiences of providing hospice care for patients with a non-malignant diagnosis. Two focus groups were conducted with nurses in one established UK hospice. The results highlight the importance of timely educational preparation, the need for proactive thinking regarding the shifting medical profiles of health care in the UK, and the need for hospice managers to critically consider existing infrastructures (including supervision and support) in anticipation of diverse patient populations. The paper also reiterates that collaboration remains the key to effective support.

New Zealand nurses perceptions of caring for patients with influenza A (H1N1)

This study aimed to explore the perceptions of the highly specialized nurses who provided extracorporeal membrane oxygenation therapy for the mostly young and critically ill patients during the 2009 H1N1 pandemic. The 2009 influenza A (H1N1) virus caused a global pandemic and also affected New Zealand during that winter. Nine H1N1-infected adult patients with severe acute respiratory distress syndrome were admitted into an intensive care unit of a large urban hospital for rescue extracorporeal membrane oxygenation therapy. The study used a two-phase mix methods study design. Phase 1 of the study involved five nurses attending a focus group interview to collect their views of the challenges and issues of caring for these patients. The results of the focus group were used to formulate the phase 2 survey. In total, 25 eligible nurses were invited to complete an anonymous survey; 18 completed and returned surveys giving a 72% response rate. The survey identified issues including the acuity and high mortality rate of those affected, nurses working in an isolated environment because of infection control requirements, limited support and being asked to work extra shifts. Despite these challenges, the nurses felt positive about their experience of caring for the H1N1 patients, and felt the experience advanced their skills and improved job satisfaction. For future pandemics, this study identified the need for all staff to have a basic understanding of extracorporeal membrane oxygenation; strengthen inter-professional collaboration and communication; provision for more support and recognition of these highly specialized nurses, along with providing regular pandemic updates and offering counselling services.

Excellence in Patient Satisfaction Within a Patient-Centered Culture

Many Healthcare leaders are anticipating the Centers for Medicare & Medicaid Services' (CMS) value-based purchasing (VBP) program, in which payments are based partially on patient satisfaction. To qualify for incentive payouts, hospital executives need to look intently at ways to boost HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores. A patient-centered culture can help facilitate improvements in HCAHPS scores.VBP AND HCAHPSHospital VBP links a portion of hospitals' Inpatient Prospective Payment System payment from CMS to performance on a set of quality measures. The Hospital VBP program was established by the Affordable Care Act of 2010. Many final rules issued in 2011 outline the parameters of the program for fiscal years 2013 and 2014 (CMS 2012). CMS (2012) clarifies:The total performance score for hospital VBP in FY 2013 will have two components: the clinical process domain, which accounts for 70% of the total performance score; and the patient experience domain, which accounts for 30% of the total performance score. The HCAHPS survey is the basis for the patient experience domain.The HCAHPS survey was the first national, standardized, publicly reported survey of patients' perspectives of hospital care. The survey is designed to produce data about patients' views about care that allow objective, meaningful comparisons of hospitals in areas of importance to consumers. Additionally, public reporting of the results incentivizes hospitals to improve quality of care and enhances accountability in healthcare by increasing transparency (CMS 2010).In summary, VBP provides financial incentives for hospitals that meet certain quality performance standards - including measures that focus on patient perceptions of care. That such measures are included further solidifies the economic significance of providing excellent care. These incentives are anticipated to compel more healthcare leaders to champion the importance of providing patient-centered care.PATIENT SATISFACTION IN A PATIENT-CENTERED CULTUREUnder VBP, it will be more important for hospitals to pay attention to patient satisfaction and the overall patient experience. The program is likely to fuel further interest in patient-centered approaches to care. Patient-centered hospitals look to patients to help define a positive and satisfying patient experience. HCAHPS scores can show hospitals how well they are meeting patients' needs and can call attention to opportunities for improvement (Frampton et al. 2008).Planetree Designated Patient-Centered Hospitals represent the highest level of achievement in patient-centered care based on evidence and standards, and the Planetree Designation Program is the only known program to formally recognize excellence in patient-centered care across the continuum of care (Planetree 2012). Demonstrating the positive association between patient-centered care and patient satisfaction, Planetree Designated Patient-Centered Hospitals consistently exceed national HCAHPS performance benchmarks for patient satisfaction (see Exhibit 1). These hospitals as a group perform better than the CMS national average in all ten of the publicly reported HCAHPS categories, most significantly in overall rating and questions about willingness to recommend (Frampton and Channel 2009).CASE IN POINT AT WINDBER MEDICAL CENTERWindber Medical Center (WMC), a 54-bed hospital in western Pennsylvania, is a Planetree Designated Patient-Centered Hospital. We are the only Planetree hospital in Pennsylvania and one of only 13 hospitals in the country to have achieved Planetree Designation status. …

Hospice staff perceptions of caring for patients with a non-malignant illness

IntroductionPalliative care nurses who have been traditionally caring for cancer patients (CP) have started to care for non-cancer patients (NCP) as specialist hospice environments are broadening their patient criteria to...

Hospice staff perceptions of caring for patients with a non-malignant illness in the UK

IntroductionPalliative care nurses who have been traditionally caring for patients with cancer (CP) have started to care for non-cancer patients (NCP) as specialist hospice environments are broadening their patient criteria...

Trauma Resuscitations and Patient Perceptions of Care and Comfort

Journal of Trauma Nursing: October/December 2011 - Volume 18 - Issue 4 - p 239-240 doi: 10.1097/JTN.0b013e31824089cb

Trauma Resuscitations and Patient Perceptions of Care and Comfort

Patients subjected to common trauma resuscitation practices can have varied emotional responses to certain aspects of their initial evaluation and care. Thirty-four patients admitted to the hospital after blunt traumatic injury were randomly selected to complete a self-reported questionnaire regarding their comfort levels with certain aspects of their initial trauma care and resuscitation. Most patients reported higher levels of comfort with procedures generally expected by the lay public and lower levels of comfort with those procedures less well known or for which they were not prepared. Analysis of survey data showed a larger percentage of discomfort with the digital rectal examination than with other aspects of trauma care. Notably, data analysis also showed a significant percentage of patients who were reluctant to disclose receiving a digital rectal examination. Additional investigation into the validity and reproducibility of these trends is warranted; however, there is legitimate evidence that there is room to improve a patient's perception of comfort during a trauma resuscitation and initial workup through improved communication and procedure disclosure.

Patient–physician social concordance, medical visit communication and patients’ perceptions of health care quality

Social characteristics (e.g. race, gender, age, education) are associated with health care disparities. We introduce social concordance, a composite measure of shared social characteristics between patients and physicians. ObjectiveTo determine whether social concordance predicts differences in medical visit communication and patients’ perceptions of care. MethodsRegression analyses were used to determine the association of patient–provider social concordance with medical visit communication and patients’ perceptions of care using data from two observational studies involving 64 primary care physicians and 489 of their patients from the Baltimore, MD/Washington, DC/Northern Virginia area. ResultsLower patient–physician social concordance was associated with less positive patient perceptions of care and lower positive patient affect. Patient–physician dyads with low vs. high social concordance reported lower ratings of global satisfaction with office visits (OR=0.64 vs. OR=1.37, p=0.036) and were less likely to recommend their physician to a friend (OR=0.61 vs. OR=1.37, p=0.035). A graded-response was observed for social concordance with patient positive affect and patient perceptions of care. ConclusionPatient–physician concordance across multiple social characteristics may have cumulative effects on patient–physician communication and perceptions of care. Practice implicationsResearch should move beyond one-dimensional measures of patient–physician concordance to understand how multiple social characteristics influence health care quality.

Patient perceptions of caring and association with emergency department activity and access block

To develop and validate a questionnaire isolating patients' perceptions of caring as individuals provided by ED doctors. This tool was then applied to explore the relationship between ED activity and patient perceptions of caring. Following questionnaire development and reliability analysis, a prospective, cross-sectional study was performed of ED patients who completed the written questionnaire regarding perceptions of caring. The ED tracking database obtained demographic data, patient visit characteristics and markers of departmental activity. Spearman's rho evaluated associations between perceptions of caring and activity. Free text responses were analysed thematically. In reliability testing the questionnaire demonstrated Kappa 0.679, Cronbach's alpha 0.891. The survey was completed by 467 patients. Over 95% of patients agreed that ED doctors: identified themselves; took the problem seriously; treated patients with respect; were courteous and considerate; and demonstrated an overall caring attitude towards patients. Lower agreement occurred with doctors: not distracted by other issues; patient involvement in decisions about care; respect for cultural or religious needs; and doctors going out of their way to help. There were no significant differences in the proportion of patients recruited from different days of the week, shifts or sex. No clinically important associations were demonstrated between perceptions of caring and departmental activity. Least liked aspects of ED care related to system issues rather than the interpersonal relationship with the ED doctors. This study has validated a questionnaire isolating caring attributes. ED activity was not associated with patients' perceptions of being cared for by ED doctors.

Impact on caregiver burden of a patient-focused palliative care intervention for patients with advanced cancer

Caregivers of patients with advanced cancer experience physical and emotional strain that can raise their own risk for morbidity and mortality. This analysis was performed to determine whether ENABLE II, a patient-focused palliative care intervention that increased patients' quality of life, reduced symptom intensity, and lowered depressed mood compared to usual care, would affect caregiver burden. Caregivers of patients with advanced cancer from the parent study completed a caregiver burden scale and patients completed quality of life, symptom intensity, and depressed mood measures. Data were collected at baseline, 1 month, and every 3 months thereafter until patient death or the study ended. Decedents' caregivers were asked to complete an after-death interview regarding the quality of care that the patient received. There were no significant differences in caregiver burden between intervention and usual care conditions. Follow-up analyses showed that higher caregiver objective burden and stress burden were related to lower patient quality of life, higher symptom intensity, and higher depressed mood. Caregivers who perceived that patients had unmet needs at end of life reported higher objective burden, and those who perceived that patients were not treated with respect reported higher demand burden. The results indicate that a successful patient-focused intervention did not have a similar beneficial effect on caregiver burden. Future interventions should focus on caregivers as well as patients, with particular attention to caregivers' perceptions of patient care, and seek to change both negative and positive effects of informal caregiving.

Relationships among Self-Management, Patient Perceptions of Care, and Health Economic Outcomes for Decision-Making and Clinical Practice in Type 2 Diabetes

Objectives Type 2 diabetes (T2D) treatment involves complex interactions between biological, psychological, and behavioral factors of care, requiring multifaceted efforts in clinical practice and disease management to reduce health and economic burdens. We aimed to quantify correlations among these factors and characterize their level of inclusion in economic analyses that are part of informed medical decision-making. Methods A comprehensive, stepwise systematic literature review was performed on published articles dated 1993 to 2008 using medical subject heading and keyword searches in electronic reference libraries. Data were collected using standardized techniques and were analyzed descriptively. Results A total of 97 articles fulfilling all inclusion criteria were reviewed, including 16 on economic models (17% of articles). Most studies were retrospective (41 of 97; 42%) and from managed care perspectives (66%). Oral antidiabetic drugs were a central focus, appearing in 83% of studies. Patient behaviors, particularly medication adherence and persistence in real-world settings, are well researched (n = 65) and may influence diabetes outcomes, cardiovascular risk, mortality rates, and treatment-specific resource use (e.g., hospitalizations) and costs (≤$3400 annually per patient). Nevertheless, they are absent from current economic models. Conclusions Strong correlations exist between patient behaviors, perspectives of care, health outcomes, and costs in T2D. Enhancing their inclusion in pharmacoeconomic modeling, notably the influence on clinical effectiveness of variation in self-management between treatments, should ultimately lead to more accurate estimates of comparative cost-effectiveness, and thereby improve value-based resource allocation and patient access to appropriate therapy.

Effect of music therapy on oncologic staff bystanders: A substantive grounded theory

Oncologic work can be satisfying but also stressful, as staff support patients and families through harsh treatment effects, uncertain illness trajectories, and occasional death. Although formal support programs are available, no research on the effects of staff witnessing patients' supportive therapies exists. This research examines staff responses to witnessing patient-focused music therapy (MT) programs in two comprehensive cancer centers. In Study 1, staff were invited to anonymously complete an open-ended questionnaire asking about the relevance of a music therapy program for patients and visitors (what it does; whether it helps). In Study 2, staff were theoretically sampled and interviewed regarding the personal effects of witnessing patient-centered music therapy. Data from each study were comparatively analyzed according to grounded theory procedures. Positive and negative cases were evident and data saturation arguably achieved. In Study 1, 38 staff unexpectedly described personally helpful emotional, cognitive, and team effects and consequent improved patient care. In Study 2, 62 staff described 197 multiple personal benefits and elicited patient care improvements. Respondents were mostly nursing (57) and medical (13) staff. Only three intrusive effects were reported: audibility, initial suspicion, and relaxation causing slowing of work pace. A substantive grounded theory emerged applicable to the two cancer centers: Staff witnessing MT can experience personally helpful emotions, moods, self-awarenesses, and teamwork and thus perceive improved patient care. Intrusive effects are uncommon. Music therapy's benefits for staff are attributed to the presence of live music, the human presence of the music therapist, and the observed positive effects in patients and families. Patient-centered oncologic music therapy in two cancer centers is an incidental supportive care modality for staff, which can reduce their stress and improve work environments and perceived patient care. Further investigation of the incidental benefits for oncologic staff witnessing patient-centered MT, through interpretive and positivist measures, is warranted.

Primary Care Physician Visit Continuity

To the Editor:—For more than 40 years there has been interest in answering these questions: Is provider continuity beneficial and how do we measure it? From many correlative studies based on patient report, provider continuity seems beneficial.1 If we seek stronger evidence than correlative studies we have the results of one controlled, double-blind trial.2 When 776 patients were randomly placed into two groups (but each group had the same clinicians) provider continuity resulted in the following: a) higher patient assessments both of continuity and of clinician knowledge, thoroughness, and ability to provide excellent education; and b) fewer emergent admissions and shorter average length of stay. It is noteworthy that continuity per se influenced several patient perceptions of care, (such as clinician knowledge and ability to provide excellent education), even when the clinicians in the continuity and discontinuity groups were the same. Regarding measurement, Rodriguez et al.1 in their correlative study recapitulate the fact that patient-reported measures of provider continuity and “administrative measures” give different results. The one double-blind, controlled trial documented decades ago that “patient responses were not sensitive to low continuity of care indices: when the measured continuity of care index was less than 0.25, 51% of patients claimed continuity as compared with 83% of the patients who claimed continuity when the index was greater than 0.60.”2 From a statistical perspective both the correlative and controlled trial results confirm evidence of bias in patient report about continuity of care. This is old news and consistent with the fact that humans generalize from their good and bad experiences. Yet, based on their confirmation of old news, Rodriguez et al. now assert that “studies and quality initiatives seeking to evaluate visit continuity should rely on administrative measures whenever possible.” I hope that the elimination of patient report is not the end result the authors intend. Imagine a future in which we are presented with only statistically different administrative indices (using Rodriguez et al.’s method) of 0.53 from one setting and 0.48 from another. We might grasp the statistical implications of the observed difference between the settings. But how would we understand let alone “rely on” these particular indices when such indices: a) are subject to considerable bias,3,4 and b) tell us nothing about how the patients interpret the continuity of care they are receiving?

Neurologist Versus Nonneurologist Care of Multiple Sclerosis Patients

The purpose of this study was to identify differences between people with multiple sclerosis (MS) who are treated by someone other than a neurologist and those treated by neurologists or specialists at MS clinics. Factors studied included demographics, disease characteristics, and patient perceptions of care. We surveyed 1518 people with MS, organizing respondents into four groups based on who provided their care: a nonneurologist group, two neurologist groups, and an MS clinic group. We analyzed survey results via SPSS, using analysis of variance to identify statistically significant differences. The nonneurologist group was significantly older, had lower income, and had more patients without health insurance than the other three groups. This group was also significantly less satisfied with access to MS-focused care and the quality of that care. The most striking observation was the significantly smaller proportion (18%) of people in the nonneurologist group who were treated with disease-modifying therapies compared with the other three groups (67–72%). Significant and interesting differences were observed for a range of characteristics between the nonneurologist group and groups receiving care from neurologists or at an MS clinic. A carefully constructed outreach program for nonneurologists is suggested as a way of increasing the use of MS therapies.

Implemention of a Division of Internal and Hospital Medicine in a free-standing comprehensive cancer center

17070 Background: In 2004, the Moffitt Cancer Center implemented a Division of Internal and Hospital Medicine. As a free-standing Comprehensive Cancer Center, Moffitt serves complex cancer patients with a wide range of nononcologic medical needs. These co-morbidities had previously been managed through a combination of subspecialty consultations and ‘out-of-specialty‘ care by the attending oncologist or hematologist. With the rapid growth of hospital medicine as an established specialty, Moffitt recognized an opportunity to reduce fragmentation and variation in noncancer care, minimize disruptions to the focused practices of the cancer specialists, cope with resident workload constraints, and enhance efficiency of inpatient care. The institution commited to the establishment of a dedicated internal and hospital medicine program. Methods: The presentation includes a descriptive accounting of this comprehensive project, from initial planning to implementation and consolidation. Scope of services provided, staffing ratios, and unanticipated challenges and opportunities are described. A survey of stakeholder physicians was undertaken to assess perceived value for various aspects of the program. Opportunity for discussion will be provided for those considering implementation of similar services in their host institution. Results: The new program was successfully implemented and is comprised of an active inpatient service, an inpatient consultation service, a high-risk preoperative evaluation and co-management service, a 24-hour urgent care service, and a limited outpatient clinic. There are 5 physicians and 4 midlevel practitioners in the program, which is closely integrated with the internal medicine residency program of the University of South Florida. Conclusions: An Internal and Hospital Medicine program in a free-standing cancer center appears to provide perceived patient care benefits, peer satisfaction, and utilization efficiencies based on initial survey data. No significant financial relationships to disclose.

Witnessing tragedy: Nurses' perceptions of caring for patients with cancer

This paper details one of the findings of a large phenomenological study into the effects of nurse-patient encounters on clinical learning and practice. Every nurse faces the challenge of caring for a patient with cancer at some point in his or her nursing career. The participants, 392 nurses, were asked to discuss a care episode from their practice and the impact this encounter had on clinical learning and practice. The data collection method was by way of a written narrative/clinical exemplar. Meaning units and themes were identified using the Nvivo computer program. The procedural method of Giorgi was followed in all phases of analysis. The participants provided a detached description of the patients' diagnoses but tended to become emotive when discussing the cancer treatment experience. Nurses detailed care episodes with insight and understanding of the consequences of cancer for the patient. Nurses used powerful language to illustrate the enormity of the cancer experience for the patient and family. Although the nurses recognized the emotional impact themselves, they attempted to understate it. Participants spoke of their frustration and their sadness when describing the nurse-patient encounters. The life-threatening potential of cancer for the patient and the perception of potential or actual suffering do impact on nurses, their learning and their clinical practice. This is particularly evident when the cancer experience for the patient is not predictable. Participants clearly felt the influence of patients' cancer experience, personally and professionally. Participants detailed learning from the encounters and reflected with great insight on themselves and their practice. Identifying the learning potential of nurse-patient encounters can contribute to change in clinical practice.

Admiring courage: Nurse’ perceptions of caring for patients with cancer by Sharon Kendall

Admiring courage: Nurse’ perceptions of caring for patients with cancer by Sharon Kendall

Care of patients with chronic obstructive pulmonary disease in primary health care

This paper is a report of a study of nurses' perceptions of caring for patients with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease is a global health problem and the number of patients being treated with this disease in primary healthcare settings is increasing. This places new demands on the nurses involved. A phenomenographic approach was adopted, using a purposive sample. Data were generated between February and May 2003 from 20 interviews with district nurses and general nurses who cared for patients in primary healthcare settings with chronic obstructive pulmonary disease. In most cases, nurses cared for older people with moderate to severe chronic obstructive pulmonary disease. They described this care from two overall orientations: task and individual. The nurses' perceptions of the care of these patients were described as creating commitment and participation by establishing a good relationship with patients and supporting them in their personal care, educating patients by supplying information and knowledge in various ways, co-operation by co-operating with or referring to other caregivers, and arranging and implementing clinical examinations and treatments. The type of care depended on who the patient met: either a task-oriented nurse or an individual-oriented nurse. Therefore, nursing programmes should pay special attention to the support and guidance of new and inexperienced and task-oriented nurses. Healthcare planners should take into consideration the need for individualized care when organizing care and allocating resources for chronically ill people.

Improving Perceptions of Patient Care—A Nursing Education and Nursing Practice Initiative

In January 2005, the University of Texas Medical Branch (UTMB) School of Nursing and the UTMB Hospitals and Clinics launched the first phase of a project to improve perceptions of patient care on the part of nursing faculty and nursing clinicians. A finding on the UTMB annual employee satisfaction survey that nursing faculty and clinicians tended to rate quality of UTMB patient care lower than other UTMB employees provided the impetus for the initiative. When UTMB colleagues noticed the findings, various entities including human resources and the Faculty Senate called for explanations from the dean of the School of Nursing, the chief nursing officer, and the CEO for the hospitals and clinics. In the process of attempting to give reasons for the findings, each of us determined we would take definitive action to address the situation. This article describes our accomplishments for Phase 1 of the initiative. Beginning with a vision for a productive professional community characterized by a pedagogical partnership between nursing education and practice, we share the processes we followed to (1) achieve mutual understanding among task force members, (2) obtain input on perceptions from nursing colleagues, (3) identify the clinical and nursing education aspects of the perceptions, (4) reach consensus on target perceptions for Phase 2 of the project, and (5) outline the next steps for the project.