Staff-patient Interactions Research Articles

Time to detection of serious adverse events by continuous vital sign monitoring versus clinical practice.

Continuous vital sign monitoring detects far more severe vital sign deviations (SVDs) than intermittent clinical rounds, and deviations are to some extent related to subsequent serious adverse events (SAEs). Early detection of SAEs is pivotal to allow for effective interventions but the time relationship between detection of SAEs by continuous vital sign monitoring versus clinical practice is not well-described at the general ward. To quantify the time difference between detection of SAEs by continuous vital sign monitoring and clinical suspicion of deterioration (CSD) in major abdominal surgery patients. Five hundred and five patients had their vital signs continuously monitored in combination with usual clinical practice consisting of National Early Warning Score assessments at least every 8'th hour, assessments during rounds, and other kinds of staff-patient interactions. The primary outcome was the time difference between the first chart note of CSD versus the first SVD, detected by continuous vital sign monitoring, in patients with a subsequent confirmed SAE during or up to 48 h after end of continuous vital sign monitoring. Out of the 505 continuously monitored patients, 142 patients had a combination of both postoperative SAE, CSD and SVD, and thus were included in the primary analysis. The median time from the first SVD to SAE was 42.8 h (interquartile range 19.8-72.1 h) compared to 13 minutes (interquartile range - 4.8 to 3.5 h) for CSD with a median difference of 48.1 h (95% confidence interval 43.0-54.8 h), p-value < .001. Continuous vital sign monitoring detects signs of oncoming SAEs in the form of SVD hours before CSD, potentially allowing for earlier and more effective treatments to reduce the extent of SAEs.

Quality Improvements in Dementia Care in an Acute Hospital Setting

Abstract Background Dementia care in acute hospital settings requires targeted quality improvement initiatives based on national standards. This poster highlights key interventions to enhance care, aligning with local hospital group key performance indicators (KPIs), in one large teaching hospital. Methods Delirium screening (4AT) was implemented in the Emergency Department and geriatric ward, with education to increase staff awareness of delirium screening, prevention, and management. Audits assessed compliance with the 4AT tool. An audit evaluated the geriatric ward environment, including dementia-friendly painting, decorating, and signage, at baseline. Psychotropic prescribing practices were audited in 20 inpatient charts. A Life story Information tool (Sunflower Tool) was implemented to display personalized patient information at the end of the bed. Semi-annual audits assessed usage and effectiveness in the geriatric ward. Results The initial audit showed 85% compliance with the 4AT tool, dropping to 40% in a repeat audit after 6 months. Initially, 17 of 20 charts had complete 4AT scores; in the re-audit, 11 of 20 had scores recorded, with only 8 fully completed. The first environmental audit revealed poor compliance with dementia-friendly standards, especially in signage, clutter, and bedroom colour contrasts. Best compliance was seen with colour contrast in bathroom toilets and handrails. A quality improvement plan was developed to address gaps. The adoption and impact of the Sunflower tool improved patient-staff interactions and personalized care. All ward staff were trained in using the Sunflower tool. Conclusion A robust quality improvement plan, with measurable, achievable, relevant, and time-defined actions, aligned with national standards and local KPIs, is crucial to achieve and sustain positive audit results. Continuous education, resource allocation, and regular audits are required to ensure high-quality care for patients with dementia. Future efforts will focus on addressing identified challenges, refining interventions based on audit feedback, and maintaining care improvements.

A Comparative Study of Government Hospital &amp; Private Hospital Staff &amp; Patient Relationship With Special Reference to Navi Mumbai.

The sociology of healthcare is the focus of this study, which looks at the interactions between employees and patients at Navi Mumbai's public and private hospitals. It investigates how social structures, cultural practices, and organizational designs influence these interactions within healthcare settings. The study begins with a sociological overview of health, then delves into the evolving concepts of health, highlighting the critical role of hospital organization and management. It discusses the structural and functional differences between hospitals, emphasizing their importance within the healthcare framework. The main focus over here is a comparative study of government and private hospitals, with a particular emphasis on the staff-patient interactions. The research observes how these relationships differ between the two hospital types and considers the impact on patient care, staff morale, and overall hospital performance. The study aims to discover the strengths and weaknesses of each system, ultimately providing suggestions to enhance staff-patient relationships and improve the quality of healthcare services in Navi Mumbai.

Healthcare Professionals' Documentation in Supported Accommodation for People with Profound Intellectual Disabilities: An Educational Intervention Study.

Good-quality relationships in which individuals with profound intellectual disabilities (intelligence quotient, IQ < 20-25) are recognized by healthcare professionals (HPs) are essential for the quality of healthcare and promoting autonomy. This study examines the impact of an educational intervention on documentation of the interplay between HP and individuals receiving services in supported accommodation in Norway. An educational intervention study was designed to encourage HPs to document their approaches and interplay. The Scale for the Evaluation of Staff-Patient Interactions in Progress Notes (SESPI) was applied to measure documentation before and after the intervention. Journal notes written over a three-month period before the intervention and a three-month period after the intervention were measured. Prior to the intervention, only 23.1% of the journal notes described the resident's experiences, increasing by 5.4% (p = 0.041) post-intervention. Practical solutions to individual experiences increased from 0.9% to 8.5% (p < 0.001). The educational intervention demonstrated a significant increase in the documentation of residents' experiences and the interplay between HPs and residents. Future research should explore the generalizability of these findings. Incomplete documentation of HPs' relational work conceals important aspects of the healthcare provided, potentially resulting in confining autonomy and participation for individuals with intellectual disabilities.

Revolutionizing Patient Surveillance in Assisted Living Facilities: Insights from AUGi Technology Implementation.

In the face of escalating non-fatal fall-related expenses and an aging population, innovative solutions in assisted living facilities (ALFs) are imperative. This study evaluates the implementation of a remote-surveillance technology (AUGi) across three diverse ALFs, emphasizing its impact on falls and falls with injury across sites. Utilizing comprehensive data collection, AUGi facilitated an average reduction of 64% in falls (p < 0.01) and falls with injury (p = 0.05), a statistically and clinically significant difference. The technology's success in enhancing nurse surveillance, providing prompt notifications, and reducing falls underscores its potential to transform ALF care dynamics. This pioneering approach not only fosters better staff-patient interactions but also provides a foundation for future advancements in clinical decision support systems, offering hope for mitigating falls in ALFs.

Whole-body MRI in oncology: acquisition protocols, current guidelines, and beyond.

Acknowledging the increasing use of whole-body magnetic resonance imaging (WB-MRI) in the oncological setting, we conducted a narrative review focusing on practical aspects of the examination and providing a synthesis of various acquisition protocols described in the literature. Firstly, we addressed the topic of patient preparation, emphasizing methods to enhance examination acceptance. This included strategies for reducing anxiety and patient distress, improving staff-patient interactions, and increasing overall patient comfort. Secondly, we analysed WB-MRI acquisition protocols recommended in existing imaging guidelines, such as MET-RADS-P, MY-RADS, and ONCO-RADS, and provided an overview of acquisition protocols reported in the literature regarding other expanding applications of WB-MRI in oncology, in patients with breast cancer, ovarian cancer, melanoma, colorectal and lung cancer, lymphoma, and cancers of unknown primary. Finally, we suggested possible acquisition parameters for whole-body images across MR systems from three different vendors.

Dr. M. de Vries, Exploring relational security, social ward climate and factors playing a role in patient-staff interaction within high secure forensic psychiatric care (Radboud Universiteit Nijmegen, 16 november 2023)

Dr. M. de Vries, Exploring relational security, social ward climate and factors playing a role in patient-staff interaction within high secure forensic psychiatric care (Radboud Universiteit Nijmegen, 16 november 2023)

‘You Still Need to Care for the patient’. Experiences of Forensic Mental Health Professionals with Inpatient Aggression

Forensic mental health professionals are frequently exposed to inpatient aggression, which may negatively affect their physical and mental health. Current studies offer limited insight into how this may affect staff-patient interactions in the aftermath of aggression. A qualitative study was conducted to explore professionals’ experiences with exposure to aggression. Thirteen semi-structured interviews and three focus groups were conducted with 25 professionals working in a high secure forensic mental health unit. A thematic analysis was conducted in consensus among three researchers. Five main themes were generated in the analysis: exposure to different forms of aggression, factors that shape the impact of aggression, emotional reactions, managing emotional reactions, and managing relationships with patients. These themes form a complex interplay. Feelings of anger and fear, intrusive memories, and avoidant or agitated behavior toward patients are frequently reported, affecting both the personal and professional lives of participants. Interpersonal relationships between team members can promote or hinder adequate management of feelings that arise after exposure to aggressive incidents. The tremendous impact that exposure to inpatient aggression may have on professionals, and the way that they care for their patients requires more attention.

Knowledge and Public Perception of Palliative Care in Germany.

Background: Literature reviews reveal poor knowledge and awareness of palliative care in the public. Health literacy deficits impact access to palliative care. Objectives: The aim of this manuscript is to explore the public perception of palliative care in Germany. Design: Triangulated qualitative research design: a snowball-spread online survey and a random pedestrian survey. Setting/Subjects: Citizens in Germany. Results: The pedestrian survey (n = 100) revealed 34% of the participants being not familiar with palliative care. The online survey (n = 994) 5.7% of participants reported to not know what palliative care was. The public's perception of palliative care is mainly medicine oriented, referring to inpatient care for the immediately dying; however, further significant misperceptions were scarce. Conclusions: The public perception shows an indistinct picture of palliative care, and some misconceptions about the objectives and areas of responsibility of the subject, meanwhile, palliative care is known to a majority of people. Understanding partly incomplete pictures of patients and relatives may help to react appropriately in staff-patient interactions and improve public relations.

Preliminary evaluation of behavior technician burnout when working with boarded and traditional psychiatric inpatients diagnosed with developmental disabilities.

The COVID-19 pandemic has led to a youth mental health crisis, with research demonstrating an increased prevalence of depression, anxiety, and disruptive behavior in youth compared to pre-pandemic years. Consequently, the insurgence of emergency psychiatric evaluations has increased the demands for extended inpatient stay (or patient boarding) at various licensed treatment facilities. Questions remain about the extent of burnout being experienced by behavior technicians who are caring for these patients. The Shirom-Melamed Burnout Measure was used to evaluate symptoms of burnout of behavior technicians practicing at a specialized psychiatric inpatient unit. Comparisons were made for instances of caring for boarded (meeting criteria for discharge but unable to be discharged due to disposition) and traditional patients (short-term treatment). Behavior technicians caring for boarded patients reported significantly higher scores in overall stress, physical exhaustion, cognitive fatigue, and emotional exhaustion than those managing patients getting traditional care. Extensive burnout can have adverse impacts at both the personal level (staff well-being, individual staff-patient interactions) and clinic level (daily operations and service, general quality of care). Efforts need to be made to address this issue to prevent staff turnover.

Indigenous art-themed personalised theatre caps improve patient perioperative experience and perceived staff communication in the operating theatre: a quality improvement project at Royal Darwin Hospital in Australia

BackgroundPersonalised theatre caps have been shown to improve staff communication in the operating theatre. The impact of these caps on the patient perioperative experience, particularly in Indigenous Australian patients, has not been well established.MethodologySurgical patients and operating theatre staff at Royal Darwin Hospital in Australia were surveyed before and after the introduction of Indigenous art-themed personalised (name and role) theatre caps in October 2021 and January 2022. Staff name and role visibility in operating theatres was also audited.ResultsA total of 223 staff and patients completed surveys. Most patients reported the theatre caps to be helpful (90%, 95% confidence interval [CI] 81–99) and felt more comfortable because staff were wearing them (91%, 95% CI 82–100). These results were consistent across Indigenous and non-Indigenous patients. The majority of staff agreed that personalised name and role theatre caps improved staff communication (89%, 95% CI 81–97), improved the staff-patient interaction (77%, 95% CI 67–87), and made it easier to use staff names (100%). Staff name and role visibility increased from 8 to 51% (p < 0.001) after the introduction of personalised theatre caps.ConclusionsThe introduction of Indigenous art-themed personalised theatre caps for operating theatre staff at Royal Darwin Hospital improved perceived staff communication and the patient perioperative experience.

Escaping iatrogenic harm: A journey into mental health service avoidance.

WHAT IS KNOWN ON THE SUBJECT?: Little is known about how mental health services can cause harm in ways other than medication, talking therapies, diagnosis and detention under the Mental Health Act. The outcomes of people who avoid seeking help from mental health services due to previous experiences of harm are not well known. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: I provide a first-person perspective of experiences of harm within mental health services, how this impacted my care, the long-term effects of the harm on my well-being and my ongoing experiences of avoiding mental health services. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Healthcare professionals should be aware of the multitude of ways service provision can harm patients, and how, unknown to professionals, patients may create an internal understanding of how to best navigate harmful service environments. Healthcare professionals should have a deeper understanding of the reasons why people may choose not to engage with mental health services, and what impact this may have on them. ABSTRACT: The recent announcement of the first ever statutory public inquiry into a UK mental health service indicates a growing recognition of iatrogenic harm in mental healthcare. Despite the potential for harm across all services and practices, restrictive practices, psychotherapy, diagnosis and psychiatric medications are often the only areas of mental healthcare given significant attention. While the topic is widely discussed in survivor communities, accounts of harm caused by the everyday workings of services, including team cultures, administrative processes and staff-patient interactions, are missing from academic literature. In this article, I describe my 10-year journey through mental health services, and how everyday practices, cultures and staff behaviour deeply impacted my ability to receive appropriate care, replicated previously traumatic environments, and damaged my mental health. Taking steps to protect myself from further harm, I self-discharged and am currently living as a 'service-avoider'. The ongoing implications of this decision and the long-term impacts of harm are discussed.

Influence of mental health service provision on the perceived quality of life among psychiatric outpatients: associations and mediating factors.

ObjectiveTo investigate the relationship between perceived mental health service provision and quality of life (QoL) as perceived by patients in psychiatric outpatient care.MethodsA total of 373 adult patients registered at 15 psychiatric outpatient clinics in three regions in central and southern Sweden were included in the study. Survey data were collected using a questionnaire on mental health service provision, symptom severity, recovery, clinical diagnosis, sociodemographics (serving as independent variables) and QoL (serving as the dependent variable). Three aspects of mental health service provision were used: patients’ perceived quality of care, perceived staff-patient interaction, and patient reported psychiatric treatments. Structural equation modelling was used to model the relationship among the variables.ResultsVariables in mental health service provision showed few direct associations with patients’ perceived QoL. Instead, the associations of mental health service provision on QoL were mainly mediated through symptom severity and recovery. These relationships were retained after adjusting for sociodemographic variables and clinical diagnoses. The final model achieved excellent goodness of fit (χ2 = 49.502, p = 0.230, RMSEA = 0.020, CFI = 0.997 and a SRMR = 0.024).ConclusionThis study shows that mental health service provision is associated with patients’ perceived QoL; however, this association is mostly indirect and mediated by reduced symptom severity and increased recovery. This finding can help inform the design of future interventions to enhance service provision to improve patients’ QoL.

The Patient Perspective of an Inpatient Addiction Medicine Unit Implemented in an Urban Northern Acute Care Hospital in Ontario, Canada.

An Addiction Medicine Unit (AMU) represents a promising approach to enhancing hospital care for individuals who use substances, but there is limited research to understand patients' perspectives on AMUs. Therefore, the study objectives involved exploring patients' experiences with the AMU. Qualitative semi-structured interviews were conducted with 17 patients to gather their perspectives about the AMU. The AMU offers specialized inpatient addiction support, integrating medical and psychosocial interventions while facilitating connections to community supports to stabilize patients and manage addiction-related issues using a harm reduction philosophy. Factors identified by patients that lead to positive experiences with the AMU included: efficient access to high-quality acute medical care, specialized addiction care, and additional support for non-medical needs. Patients emphasized the benefits of having peer support workers on staff, the overall positive interactions with staff, and how different these experiences were from their hospital admissions outside of the AMU. Factors identified by patients that should be considered in an AMU included: the ease of access to substances, negative interactions with other patients, and self-stigma/internalized discrimination. Also, the patient perspective reflected varied views on harm reduction. Patients' perception of the impact of an AMU overall reflected that the AMU is an effective way to deliver comprehensive treatment, to address the needs of PWUS, both medical and substance-use-related issues. They identified that the unit's intentional harm reduction philosophy facilitated access to care and positive patient-staff interactions, emphasizing the unit's progress in reducing fear and judgment and rebuilding trust in the healthcare system. The introduction of a new AMU in a Northern urban acute care hospital in Ontario has yielded positive patient experiences. The AMU model shows potential to re-establish trust between patients and providers, but ongoing efforts are needed to address underlying stigma to be more effective.

IMPROVING HOSPITAL AND POST-ACUTE OUTCOMES AND EXPERIENCES OF DYADS LIVING WITH DEMENTIA: RESULTS OF THE FAM-FFC TRIAL

Abstract Hospitalizations of persons living with dementia are associated with protracted functional decline, delirium, and behavioral symptoms of distress as well as increased care partner stress. This symposium presents findings from the Family-centered Function -focused Care (Fam-FFC) trial. In Fam-FFC, nurses purposefully empower family care partners in the assessment, decision-making, care delivery, and evaluation of function-focused care during hospitalization and the 60-day post-acute period. The goal is to improve the functional recovery of the patient while increasing family preparedness for caregiving, bridging hospital to post-acute setting. This cluster randomized controlled trial tested the impact of Fam-FFC in 455 dyads of diverse persons living with dementia and their care partners. The first presentation will compare Fam-FFC outcomes for patients and care partners to the attention control group outcomes at discharge, two and six months. The second presentation will report the impact of Fam-FFC upon adverse patient events (falls, emergency department transfers, hospital admissions) in the two arms. Next, the presenter will utilize Fam-FFC data to describe the patient and care partner characteristics that contribute to care partner distress at the time of hospital discharge. The fourth presentation will focus on staff-patient interactions in the Fam-FFC trial, including the influence of clinical factors upon the quality of the interaction. The final paper will report on the trajectory of behavioral symptoms of distress, and associated outcomes, from hospital admission to six-month follow-up. Our discussant, Karen Rose will lead a discussion of unanswered questions, next steps, and implications of this work for policy and practice.

CLINICAL FACTORS ASSOCIATED WITH THE QUALITY OF INTERACTIONS BETWEEN STAFF AND HOSPITALIZED PERSONS WITH DEMENTIA

Abstract The quality of care greatly depends on the quality of interactions between staff and hospitalized older adults with dementia which in turn can be influenced by many factors. This paper examines the clinical factors associated with the quality of interactions between staff and hospitalized older adults with dementia. Following the examination of bivariate associations, we conducted multiple linear regression in a sample of 140 hospitalized older patients with dementia who participated in the final cohort of Fam-FFC. On average, the participants (male = 46.1%, female = 52.9%) were 81.43 years old (SD = 8.29) and had positive interactions with staff. Accounting for 17.5% of the variance in the model, non-pharmacological interventions (b= 0.181; p&amp;lt;.001) and pain (b= -0.201; p&amp;lt;.01) were significantly associated with the quality of staff-patient interactions. To optimize care of hospitalized patients with dementia, staff should be encouraged to use non-pharmacological interventions and prioritize pain management in patients.

Experiences of Abused Health Care Workers – Findings from an online qualitative self-report study on child psychiatry

Aim: Emergency psychiatric care for children is a priority. It is inevitable that sometimes in some situations patients or their relatives abuse psychiatric staff. There are many factors that facilitate this violence, but also some that are protective. It is a crucial question whether the causes of abuse can be found in the patients, in external factors or in the situation.Methodology: Following an extensive Hungarian and international literature review, Authors used a self-developed semi-structured online questionnaire with a total of ten questions, involving 51 participants, from which 21 responded. The topics of the questions were: definition of intentional and non-intentional violence, description of the abuse, perceived risk factors, consequences of the incident, cause and goal, treatment, reporting, prevention, and other comments. The data corpus was examined using content analysis and coded in two stages.Findings: During the coding process, Authors found that situational causes underlie abuse in most areas. In case descriptions, external causes were also emphasized. In topics consequences and goals, patient-related criteria were the most frequent, and external factors were the first only in topic of risk factors. Staff-patient interaction is a crucial issue related to violence against health workers, but the potentially triggering psychiatric disorder of the child cannot always be excluded.Value: Most psychiatric disorders are caused by early trauma, and trauma is underpinned by adverse childhood experiences and deviant parental behaviour. However, the hospital is a part of a larger system and health problems have social roots. It should be underlined that direct causes of abuse are hidden in the staff-patient interaction, but in many cases parental deviance is also responsible for the onset of psychiatric disorders. Our research may contribute to a deeper understanding of this phenomenon and provide a basis for future quantitative research.

Clinical factors associated with the quality of interactions between staff and hospitalized older patients with dementia

This study examines the clinical factors associated with the quality of interactions between staff and hospitalized older patients with dementia. Following examination of bivariate associations, we conducted multiple linear regression in a sample of 140 hospitalized older patients with dementia who participated in the final cohort of an intervention study implementing Family-centered Function-focused Care (Fam-FFC). On average, the participants (male = 46.1%, female = 52.9%) were 81.43 years old (SD = 8.29) and had positive interactions with staff (mean QUIS score = 5.84, SD = 1.36). Accounting for 17.8% of variance in the model, non-pharmacological intervention use (b= 0.170; p<.001) and pain (b= -0.198; p<.01) were significantly associated with the quality of staff-patient interactions. To optimize care of hospitalized patients with dementia, staff should be encouraged to use non-pharmacological interventions. It is also important for staff to assess pain among the patients with dementia and prioritize pain management.

Patient satisfaction with radiology services in the UAE: A comprehensive analysis of care, comfort, service, and accessibility

IntroductionThis paper analyses patient satisfaction with radiology services in the United Arab Emirates (UAE). The study evaluates the care, comfort, service, and accessibility of the services and patient satisfaction with imaging procedures. MethodsThe research design employed a descriptive, cross-sectional approach, and data were collected through a survey consisting of eight sections. A total of 444 participants completed the survey, providing valuable insights into their demographics, appointment experiences, waiting times, staff attitudes and overall satisfaction. Results70.4% of the participants stated that it was easy to make appointments, and 66.1% stated that they were satisfied with the efficiency of check-ins. 54.9% felt they waited the right amount of time to make an appointment, and 56.1% were satisfied with the time waiting to receive the imaging report. The findings indicate that waiting times and staff attitudes significantly influence patient satisfaction, while demographic factors, such as nationality, education, and age, do not significantly impact them. The study concludes that healthcare providers should prioritise efficient appointment scheduling, reduce waiting times and foster positive patient–staff interactions to enhance patient satisfaction. The open-ended feedback provided by the participants also offers valuable suggestions for improving service quality. ConclusionThis study is a foundation for future research and provides healthcare organisations with valuable insights to enhance patient satisfaction in UAE radiology services. Implications for practiceHealthcare providers should focus on patient satisfaction to improve retention and loyalty, attract new patients and enhance their reputation.

Pattern of utilization of dental services among Nigerian population in the University of Benin community: A prospective study

Abstract Introduction: Underutilization of dental services is a global concern that is frequently reported in developing countries among different groups of subpopulations but it is unclear if the same have been studied among population in the university community. Aim: The aim of the study was to determine the pattern and barriers to the utilization of dental services among Nigerian population in the University of Benin. Materials and Methods: This was a descriptive cross-sectional study conducted between October 2021 and January 2022 that involved all consecutive staff of the University of Benin, Benin City. The data were collected with an 18-item, structured, close-ended, self-administered questionnaire which was pretested for feasibility. Descriptive and inferential statistics were performed. Data were entered into a computer and analyzed using the Statistical Package for the Social Sciences (SPSS) version 21 (IBM, Chicago, USA). Results and Discussion: The age range was 25–55 years, with a mean age of 42.8 ± 8.8 years. There were more males (51.8%) than females. Higher (58.4%) proportions of the respondents claimed to have visited the dentist before this study compared to those who claimed never to have visited for any dental services. Long waiting time was ranked highest (27.1%) as the barrier to good utilization of dental services, and this was followed by high cost of treatment (21.1%), fear of dental treatments (12.8%), and poor staff–patient interaction (11.2%). Most (28.5%) of the respondents answered that a reduction in the cost of treatment can help to improve the utilization of dental services, and this was followed by adequate staff–patient interaction (25.3%) and procurements of hospital equipment (24.2%). More males significantly poorly utilized dental services compared to their female counterparts (P = 0.01). Furthermore, more Christians poorly utilized dental services compared to Muslims (P = 0.03). Conclusion: The prevalence of university staff with poor utilization of dental services is relatively high, and this was significantly more in males and among Muslims. Long waiting time and high cost of treatment were the most common barriers mitigating the optimal utilization of dental services.