Provision Of Effective Patient Care Research Articles

Effect of Clinician Posture on Patient Perceptions of Communication in the Inpatient Setting: A Systematic Review.

Nonverbal communication plays a pivotal role in the provision of effective patient care and has been associated with important patient health outcomes. Clinician posture, a nonverbal form of communication, may influence the patient experience and satisfaction. The relationship between clinician posture (i.e., standing or at the patient's eye level) and patient perceptions of clinician communication in the hospital-a setting with heightened power dynamics between patient and clinician-is currently unknown. We conducted searches of Ovid MEDLINE, EBSCO CINAHL Complete, EBSCO PsycInfo, Elsevier Embase/Embase Classic, Elsevier Scopus, and Web of Science Core Collection upto May 2023. English language studies were included if they compared clinician posture (eye-level or standing) during adult inpatient (including emergency department) interactions. Two authors independently abstracted data from included studies and assessed risk of bias or quality of evidence. A third author arbitrated any disagreements. Studies reported adherence to the posture intervention and/or patient perception outcomes. The latter included encounter duration, preferences for posture type, perceptions of interaction quality and clinician communication and compassion, and standardized assessments of patient satisfaction. Fourteen studies (six randomized controlled trials, four quasi-experimental studies, four observational studies) assessed clinician posture at the bedside. Ten noted at least one favorable outcome for clinicians who communicated at the patient's eye level, three revealed no differences in patient perceptions between standing and sitting, and one noted higher patient ratings for standing clinicians. Findings were limited by variation in interventions and outcomes, generally high risk of bias, and relatively low adherence to assigned posture groups. Compared to standing, eye-level communication by clinicians appears beneficial. The magnitude and types of benefits clinicians and patients may gain from this behavior remain unclear given heterogeneity and generally high risk of bias in available studies. With its relatively easy implementation and potential for benefit, clinicians should consider communicating with their hospitalized patients at eye level. PROSPERO, CRD42020199817.

Barriers in Implementing the PMTCT in Moretele Sub-District, South Africa: An Exploratory Study.

The Prevention-of-Mother-To-Child Transmission (PMTCT) program was introduced to prevent vertical transmission of HIV from a mother to her infant through pregnancy, labor, and breastfeeding. Therefore, it is critical for the program to be accessible in primary health care facilities across the globe to increase treatment uptake and to eliminate child and maternal mortality rates caused by HIV infections. However, barriers are still being experienced by some nurses while implementing PMTCT around Moretele sub-district in the North West Province (NWP). Hence, this qualitative study explored and described the factors influencing the implementation of PMTCT. A qualitative, exploratory-descriptive design was followed. Ten participants were selected purposively, and each participant was interviewed individually using WhatsApp video calling. All participants were made aware of their voices being recorded; data saturation was reached on the eighth participant as no new information evolved. Data were analyzed using Tesch’s method of qualitative data analysis. The findings revealed that factors that influenced PMTCT implementation were due to patient, management, and staff-related factors. Moreover, these factors impacted the provision of effective patient care. The findings of this study show that much still needs to be done to achieve and sustain the PMTCT implementation goal. Therefore, the training of nurses should be of paramount importance. They should be provided and equipped with the necessary resources, support, and encouragement to offer and ensure quality health care. Furthermore, the government should ensure that policies and guidelines are regularly monitored and evaluated.

Perception, experience and knowledge of early physiotherapy in intensive care units of Rome: a survey.

Early physiotherapy (EP) programs on critically ill patients in the intensive care unit (ICU) have proven to be safe, feasible and effective. However, despite being considered by all the professionals involved as a fundamental aspect of integrated care, in most cases they are inadequately applied or not performed at all. The main objective of this study is to evaluate the knowledge, perceptions and activities related to EP among physician, nurses and physiotherapists who practice in ICUs of Rome. Obstacles to its application and possible strategies to overcome them are also examined. The study was conducted according to the CHERRIES recommendations. Two questionnaires with 29 questions were created on the Google Form platform and were sent by mail to all the ICUs of public hospitals or accredited private hospitals with the National Health Service in Rome. Thirty (60%) of the contacted ICUs responded. The physiotherapist is present in 76.7% of ICUs and carries out its activities mainly during daytime hours (60.9%), for less than 3 hours in 39.1% of cases and only after a request for specialist advice (65.2%). Only in 4.3% of cases the service is guaranteed even at weekends but only after a request. All 29 professionals interviewed consider both the presence of a physiotherapist within the interdisciplinary team of the ICU and the implementation of an EP program to be necessary, supporting the positive effects of this program. The most frequently obstacles to the implementation of an EP program are clinical instability (69%), low priority to EP practice (62.1%), cardiovascular instability (58.6%) and lack of experience (58.6%). The most frequently indicated strategies to overcome these obstacles are to organize interdisciplinary briefings (86.2%), to avoid excluding patients from treatment without specific motivation (75.9%), to invest in staff training (75.9%), to use protocols and guidelines (58.6%). EP is not currently exploited to its full potential due to lack of funds, culture, experience, training and a hospital organization that limits the provision of effective patient care and efficient service to the National Health Service.

Author

In the Coronavirus pandemic, desperate times called for desperate measures and this is how Saudi Arabia maintained a low case fatality rate. Early public awareness programs and border closure led to a reduction in the rate of infection especially in those at high risk of mortality from the disease. At a clinical level, adoption of virtual clinics for routine outpatient care allowed the country to focus its efforts on the provision of COVID-19 care in specially adapted isolation centers. On a psychological level, the health care providers were well looked after which led to the provision of effective patient care.

Association of Physicians' Self-Compassion with Work Engagement, Exhaustion, and Professional Life Satisfaction.

Self-compassion has shown promise as an adaptive resource for coping with uncertainties and challenges. This study examined the relationship between self-compassion and professional wellbeing (work engagement, exhaustion, and professional life satisfaction) of physicians, who frequently face uncertainties and challenges in their clinical practice. Fifty-seven practicing physicians in Canada participated in the study. Overall, 65% of the participants were female; 47% were in the early-career stage; 49% were family medicine (FM) physicians, with the rest being non-FM specialists. It was hypothesized that (a) self-compassionate physicians would experience greater work engagement and less exhaustion from work than physicians reporting lower self-compassion and (b) self-compassionate physicians would experience greater professional life satisfaction through their greater work engagement and less exhaustion than physicians reporting lower self-compassion. Sequential regression analyses were performed. The results confirmed the hypothesized associations, indicating that self-compassionate physicians experienced more positive work engagement, felt less emotionally, physically, and cognitively exhausted due to work demands, and were more satisfied with their professional life than physicians who exhibited less compassion toward themselves in uncertain and challenging times. Future studies are needed to determine optimal ways to support practicing physicians and medical trainees in becoming more self-compassionate for their enhanced wellbeing and, ultimately, for the provision of effective patient care.

Identifying Gaps in the Cultural Competence/Sensitivity Components of an Undergraduate Medical School Curriculum: A Needs Assessment.

Physicians and other health care workers are increasingly being called upon to bridge the cultural differences that may exist between themselves and their patients. Adequate cross-cultural education is essential if existing health care disparities are to be reduced. We conducted a needs assessment to identify gaps in the cultural competence/sensitivity components of the undergraduate medical school curriculum at Case Western Reserve University School of Medicine. The 2011 study was designed (1) to assess how first and second year medical school students perceive the adequacy of the medical school curriculum with respect to issues of diversity and (2) the extent to which first and second year medical students believe that an understanding of issues relating to patient culture are important to the provision of effective patient care. Student perspectives were assessed through a web-based anonymous survey of all first year (n = 167) and all second year (n = 166) medical school students, two focus groups (total n = 14) and a Problem-based Case Inquiry Group exercise (n = 6), both with second year students. A substantial proportion of participating first and second year medical students do not believe that self-reflection regarding one's own cultural biases is important to one's performance as a physician, do not view an understanding of diverse patient cultural beliefs as important or very important in the provision of effective patient care, and are uncomfortable with and unsure about how to approach culture-related issues arising in patient care. The inclusion of specified elements--increased contact with diverse patients, more comprehensive resources, increased opportunities to practice communication skills and engage in self-reflection--may be critical to heighten student awareness of and comfort in interacting with diverse populations. Our findings are relevant to the development of medical school curricula designed to improve physician understanding of and responsiveness to diverse patient populations and efforts to reduce health disparities.

Letters

The planned expansion of the NHSnet following the White Paper The New NHS; Modern, Dependable (DoH, 1997) will provide access to a wide variety of information for nurses working in primary health care. The availability of clinical information at the point of care delivery will enhance the provision of effective patient care.