scholarly journals “We tend to get pad happy”: a qualitative study of health practitioners’ perspectives on continence care for older people in hospital

2020 ◽  
Author(s):  
John Percival ◽  
Katharine Abbott ◽  
Theresa Allain ◽  
Rachel Bradley ◽  
Fiona Cramp ◽  
...  
Keyword(s):  
Quality Care ◽  
Qualitative Interviews ◽  
Age Groups ◽  
Residential Home ◽  
Care Planning ◽  
Open Communication ◽  
Predisposing Factor ◽  
Patient Dependency ◽  
Health Practitioners ◽  
Care Training

AbstractBackgroundBladder and bowel control difficulties affect twenty and ten per cent of the UK population respectively, touch all age groups and are particularly prevalent in the older (65+) population. However, the quality of continence care is often poor, compromising patient health and wellbeing, increasing the risk of infection and is a predisposing factor to nursing and residential home placement.ObjectiveTo identify factors that help or hinder good continence care in hospital.MethodsWe conducted 27 qualitative interviews with nursing, medical and allied health practitioners in three hospitals. We used a purposive sample and analysed data thematically, both manually and with the aid of NVivo software.ResultsInterviews revealed perspectives on practice promoting or inhibiting good quality continence care, as well as suggestions for improvements. Good continence care was said to be advanced through person-centred care, robust assessment and monitoring, and a proactive approach to encouraging patient independence. Barriers to quality care centred on lack of oversight, automatic use of incontinence products and staffing pressures. Suggested improvements centred on participatory care, open communication and care planning with a higher bladder and bowel health profile. In order to drive such improvements, hospital-based practitioners indicate a need and desire for regular continence care training.ConclusionsFindings help explain the persistence of barriers to providing good quality care for patients with incontinence. Resolute continence promotion, in hospitals and throughout the NHS, would reduce reliance on products and the accompanying risks of patient dependency and catheter associated gram negative bacteraemia. Robust assessment and care planning, open communication and regular continence care training would assist such promotion and also help mitigate resource limitations by developing safer, time-efficient continence care.

scholarly journals ‘We tend to get pad happy’: a qualitative study of health practitioners’ perspectives on the quality of continence care for older people in hospital

2021 ◽  
Vol 10 (2) ◽  
pp. e001380
Author(s):  
John Percival ◽  
Katharine Abbott ◽  
Theresa Allain ◽  
Rachel Bradley ◽  
Fiona Cramp ◽  
...  
Keyword(s):  
Quality Care ◽  
Age Groups ◽  
Well Being ◽  
Residential Home ◽  
Care Planning ◽  
Open Communication ◽  
Predisposing Factor ◽  
Health Practitioners ◽  
Care Training

BackgroundBladder and bowel control difficulties affect 20% and 10% of the UK population, respectively, touch all age groups and are particularly prevalent in the older (65+ years) population. However, the quality of continence care is often poor, compromising patient health and well-being, increasing the risk of infection, and is a predisposing factor to nursing and residential home placement.ObjectiveTo identify factors that help or hinder good continence care for patients aged 65 years and over in hospital medical ward settings. Medical care, not surgical, was our exclusive focus.MethodsWe conducted 27 qualitative interviews with nursing, medical and allied health practitioners in three hospitals. We used a purposive sample and analysed data thematically, both manually and with the aid of NVivo software.ResultsInterviews revealed perspectives on practice promoting or inhibiting good quality continence care, as well as suggestions for improvements. Good continence care was said to be advanced through person-centred care, robust assessment and monitoring, and a proactive approach to encouraging patient independence. Barriers to quality care centred on lack of oversight, automatic use of incontinence products and staffing pressures. Suggested improvements centred on participatory care, open communication and care planning with a higher bladder and bowel health profile. In order to drive such improvements, hospital-based practitioners indicate a need and desire for regular continence care training.ConclusionsFindings help explain the persistence of barriers to providing good quality care for patients aged 65 years and over with incontinence. Resolute continence promotion, in hospitals and throughout the National Health Service, would reduce reliance on products and the accompanying risks of patient dependency and catheter-associated gram-negative bacteraemia. Robust assessment and care planning, open communication and regular continence care training would assist such promotion and also help mitigate resource limitations by developing safer, time-efficient continence care.

scholarly journals Engagement in Advance Care Planning: The Association With Cognitive Impairment and Care Preferences

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 417-418
Author(s):  
Hyo Jung Lee ◽  
Giyeon Kim
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Relative Risk ◽  
End Of Life ◽  
Advance Care Planning ◽  
Multinomial Logistic Regression ◽  
Quality Care ◽  
Care Planning ◽  
Advance Care ◽  
Four Levels

Abstract Although there has been growing evidence that Advance care planning (ACP) benefits people with cognitive impairment nearing death, our understanding about this issue is still limited. This study examines whether cognitive impairment is associated with ACP engagement and end-of-life care preferences among older adults in the U.S. Using data from the 2012 National Health and Trends Study (n=1798, aged 65 to 101), we identified four levels of ACP engagement: None (28%), Informal ACP conversation only (12%), Formal ACP only (14%), and Both informal and formal ACP (46%). Older adults with None showed the highest prevalence of having cognitive impairment (17%), followed by those with Formal ACP only (15%) and the other two (6%, 6%). The results of Multinomial Logistic Regression showed that, compared to those without, respondents with cognitive impairment had 143% increased relative risk of having None (RR = 2.43, CI: 1.58-3.73) and 81% increased relative risk of completing Formal ACP only (RR = 1.81, CI: 1.11-2.95) relative to completing Both informal and formal ACP. In addition, respondents with None were more likely to prefer to receive all treatments available nearing death than those with any ACP engagement. Achieving high quality care at the end of life can be more challenging for older adults with cognitive impairment and their family caregivers due to the limited capacity. Although encouraged, informal ACP conversation with loved ones does not necessarily occur before the formal ACP, especially, for those with cognitive impairment. Therefore, they may merit more attention such as early ACP engagement.

An appreciative inquiry to identify the continuing education needs of Aboriginal and Torres Strait Islander health practitioners in regional Queensland

2020 ◽  
pp. 1-11
Author(s):  
Julie-Anne Martyn ◽  
Ann Woolcock
Keyword(s):  
Continuing Education ◽  
Appreciative Inquiry ◽  
Torres Strait Islander ◽  
Quality Care ◽  
Career Aspirations ◽  
Future Research ◽  
Advisory Group ◽  
Health Practitioners ◽  
Torres Strait ◽  
Torres Strait Islander Health

Abstract Aboriginal and Torres Strait Islander health practitioners (Practitioners) have a broad scope of practice and play a pivotal role in addressing health disparities for Aboriginal and Torres Strait Islander people. Practitioners are required to maintain knowledge and skill levels to provide ongoing quality care. However, continuing education (CE) opportunities for Practitioners in regional areas are limited and little is known about the types of CE best suited to Practitioners. This study aimed to identify the CE needs of Practitioners working in a South-East Queensland region in Australia. Participatory action research and appreciative inquiry were combined in this multi-staged study. A local Aboriginal and Torres Strait Islander advisory group provided cultural guidance for the study design and implementation. Supervisors and Practitioners from two Aboriginal Medical Services consented to participate. In stage one of this study, the supervisors were interviewed and the Practitioners contributed to focus groups. The Practitioners prioritised their CE needs in the second study stage using a questionnaire. The participants identified Practitioner CE needs and group 2 listed their career aspirations and the best practitioners were described as ‘Deadly’. The Deadly practitioner had diverse practice knowledge, skills and attributes. The Practitioners had career aspirations beyond their role and a desire to learn. However, their career advancement was stifled by a lack of CE opportunities. CE in regional areas is limited. Practitioners are disadvantaged by exclusion. Enhancing CE opportunities for Practitioners will positively impact the health of regional Aboriginal and Torres Strait Islander communities by building social capital. Therefore, future research on Practitioner roles and CE is needed.

scholarly journals Leaning Into Whole Health: Sustaining System Transformation While Supporting Patients and Employees During COVID-19

2021 ◽  
Vol 10 ◽  
pp. 216495612110210
Author(s):  
Eileen M Dryden ◽  
Rendelle E Bolton ◽  
Barbara G Bokhour ◽  
Juliet Wu ◽  
Kelly Dvorin ◽  
...  
Keyword(s):  
Healthcare System ◽  
Technology Use ◽  
Care Delivery ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Veterans Health ◽  
Health Administration ◽  
System Transformation ◽  
Virtual Technology ◽  
Exogenous Shock

Background The US Veterans Health Administration (VA) is transforming its healthcare system to create a Whole Health System (WHS) of care. Akin to such reorganization efforts as creating patient-centered medical homes and primary care behavioral health integration, the WHS goes beyond by transforming the entire system to one that takes a proactive approach to support patient and employee health and wellness. The SARS-CoV-2 pandemic disrupted the VA’s healthcare system and added stress for staff and patients, creating an exogenous shock for this transformation towards a WHS. Objective We examined the relationship between VA’s WHS transformation and the pandemic to understand if transformation was sustained during crisis and contributed to VA’s response. Methods Qualitative interviews were conducted as part of a multi-year study of WHS transformation. A single multi-person interview was conducted with 61 WHS leaders at 18 VA Medical Centers, examining WH transformation and use during the pandemic. Data were analyzed using rapid directed content analysis. Results While the pandemic initially slowed transformation efforts, sites intentionally embraced a WH approach to support patients and employees during this crisis. Efforts included conducting patient wellness calls, and, for patients and employees, promoting complementary and integrative health therapies, self-care, and WH concepts to combat stress and support wellbeing. A surge in virtual technology use facilitated innovative delivery of complementary and integrative therapies and promoted continued use of WH activities. Conclusion The pandemic called attention to the need for healthcare systems to address the wellbeing of both patients and providers to sustain high quality care delivery. At a time of crisis, VA sites sustained WH transformation efforts, recognizing WH as one strategy to support patients and employees. This response indicates cultural transformation is taking hold, with WH serving as a promising approach for promoting wellbeing among patients and employees alike.

scholarly journals 956 Patient Satisfaction of Teleconsultation in Plastic Surgery During the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Rafii ◽  
A Freethy ◽  
J Chan
Keyword(s):  
Patient Satisfaction ◽  
Plastic Surgery ◽  
Quality Care ◽  
Age Groups ◽  
Patient Perceptions ◽  
Interaction Quality ◽  
Telephone Interviews ◽  
Key Indicator ◽  
Significant Difference ◽  
Safety Studies

Abstract Introduction The COVID-19 pandemic has witnessed an increased reliance on telemedicine. Patient satisfaction is a key indicator of whether telephone consultations deliver high-quality care. This study evaluates patient perceptions of telephone consultations conducted in a single plastic surgery outpatient department. Method Structured telephone interviews using an adapted Telehealth Usability Questionnaire and the NHS Friends and Family Test were conducted in 98 patients who had undergone outpatient telephone consultations with a plastic surgeon. 13 questions explored domains of usefulness, interaction quality, reliability, patient satisfaction, and future use of telehealth. Results 72 of 98 (73%) completed the survey. Male(49):Female(23). Mean age 59 (range 17-91). 50.4% Strongly agreed (SA) and 24.3% agreed (A) to questions addressing usefulness of the platform. For interaction quality; 63% SA and 21% A. 47% disagreed with questions pertaining to reliability. Overall, 75% were either SA/A for satisfaction and 81% would use telehealth again. No significant difference was found in domain scores when comparing sex or age groups. Conclusions Overall, patient perceptions were positive towards the usefulness and interaction quality of telephone consultations. However, reliability scored poorly. Most patients were satisfied with the care provided. Comparison to other telehealth mediums e.g. video consultation and patient safety studies are needed.

Cultural Differences in Advance Care Planning and Implications for Practice

2021 ◽  
pp. 003022282110295
Author(s):  
Jung-Hwa Ha ◽  
Changsook Lee ◽  
Jennifer Yoo
Keyword(s):  
Social Workers ◽  
Cultural Differences ◽  
Advance Care Planning ◽  
Qualitative Interviews ◽  
Relationship Building ◽  
Cultural Norms ◽  
Care Planning ◽  
The Us ◽  
Health Related ◽  
Advance Care

This study examined cultural differences in advance care planning (ACP) and various strategies that social workers use to initiate conversations on ACP. We conducted qualitative interviews with 12 social workers in South Korea and the US and a thematic content analysis of the transcribed data. Our findings show that different cultural norms and generational viewpoints surrounding death and health-related decision-making influence how people prepare for end-of-life care (EOLC). Whereas principles of self-determination and autonomy guide ACP practices in the US, decisions regarding EOLC are more often made in consultation with family members in Korean and Korean-American communities. Nevertheless, social workers in both countries identified relationship-building, empowerment, and individualized approaches as common strategies in initiating discussions on ACP.

scholarly journals Youth-Centered Maternity Care: A Binational Qualitative Comparison of the Experiences and Perspectives of Latina Adolescents and Healthcare Providers

2020 ◽  
Author(s):  
Martha J. Decker ◽  
Noelle Pineda ◽  
Abigail Gutmann-Gonzalez ◽  
Claire D. Brindis
Keyword(s):  
Decision Making ◽  
Maternity Care ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Qualitative Comparison ◽  
Latina Adolescents ◽  
Provider Perspectives ◽  
Centered Care ◽  
Delivery Options

Abstract Background Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods Qualitative interviews and focus groups were conducted with a total of 89 respondents, including pregnant and parenting adolescents as well as providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. Results Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.

scholarly journals Routes to the top: the developmental journeys of medical, clinical and managerial NHS chief executives

BMJ Leader ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 64-68 ◽  
Author(s):  
Alex Till ◽  
Gerry McGivern
Keyword(s):  
Leadership Development ◽  
Health Service ◽  
Development Strategy ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Chief Executive ◽  
High Quality ◽  
Cross Sectional ◽  
Chief Executives ◽  
Formal Leadership

IntroductionLeadership, and the role of a Chief Executive in healthcare organisations, has never been more important. This review provides one of the first retrospective cross-sectional analyses of the developmental journeys of chief executives within the National Health Service (NHS).MethodsTwenty-eight semi-structured qualitative interviews were conducted with medical, clinical and non-clinical NHS chief executives from the Health Service Journal’s list of ‘Top Chief Executives’ 2014–2018. Through a thematic analysis of their narratives, lessons for the development of aspiring NHS chief executives emerge.ResultsFew proactively sought leadership opportunities and there was a lack of an active leadership development strategy. Yet the ‘seeds of leadership development’ took root early. Combined with a blended approach of formal leadership development and ‘on-the-job’ informal leadership development, emerging NHS chief executives were exposed to multiple ‘crucible moments’ that helped them develop into and excel at the top of their field.DiscussionTop NHS chief executives possess inherent values and a strong sense of social responsibility that underpin their developmental journeys, guide their behaviour, and strengthen their resilience. Capable, high quality leaders are needed from all professional backgrounds to support high quality care and much more needs to be done, particularly for medical and clinical professionals but for non-clinicians too, to maximise leadership potential within the NHS and develop a pipeline of aspiring NHS chief executives.

scholarly journals What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda

2018 ◽  
Vol 23 (1) ◽  
pp. 46-59 ◽  
Author(s):  
Louise Ackers ◽  
Hannah Webster ◽  
Richard Mugahi ◽  
Rachel Namiiro
Keyword(s):  
Public Health ◽  
Low Income ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Health Facilities ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Private Care ◽  
Willingness To Disclose ◽  
Respectful Care

Purpose The purpose of this paper is to present the findings of research on mothers and midwives’ understanding of the concept of respectful care in the Ugandan public health settings. It focusses on one aspect of respect; namely communication that is perhaps least resource-dependent. The research found endemic levels of disrespect and tries to understand the reasons behind these organisational cultures and the role that governance could play in improving respect. Design/methodology/approach The study involved a combination of in-depth qualitative interviews with mothers and midwives together with focus groups with a cohort of midwives registered for a degree. Findings The findings highlight an alarming level of verbal abuse and poor communication that both deter women from attending public health facilities and, when they have to attend, reduces their willingness to disclose information about their health status. Respect is a major factor reducing the engagement of those women unable to afford private care, with health facilities in Uganda. Research limitations/implications Access to quality care provided by skilled birth attendants (midwives) is known to be the major factor preventing improvements in maternal mortality and morbidity in low income settings. Although communication lies at the agency end of the structure-agency continuum, important aspects of governance contribute to high levels of disrespect. Originality/value Whilst there is a lot of research on the concept of respectful care in high income settings applying this to the care environment in low resource settings is highly problematic. The findings presented here generate a more contextualised analysis generating important new insights which we hope will improve the quality of care in Uganda health facilities.

Limited engagement in, yet clear preferences for advance care planning in young-onset dementia: An exploratory interview-study with family caregivers

2019 ◽  
Vol 33 (9) ◽  
pp. 1166-1175 ◽  
Author(s):  
Romy Van Rickstal ◽  
Aline De Vleminck ◽  
Melissa D Aldridge ◽  
Sean R Morrison ◽  
Raymond T Koopmans ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Advance Care Planning ◽  
Quality Care ◽  
Third Party ◽  
Care Planning ◽  
Structured Interviews ◽  
Young Onset ◽  
People With Dementia ◽  
Advance Care ◽  
Young Onset Dementia

Background: The significance of advance care planning in dementia is widely acknowledged. Despite the suggestion that younger people with dementia and their family might have distinct needs and preferences in this area, studies on advance care planning in young-onset dementia are absent. Aim: We aim to explore (1) whether family caregivers had already engaged in advance care planning with patients and/ or professionals and the accompanying reasons and (2) family caregivers’ preferences for how to ideally engage in the process with patients, family and professionals. Design: A qualitative study was conducted: we analysed semi-structured interviews ( n = 15) through the method of constant comparative analysis. Setting/participants: We included Flemish family caregivers of persons with young-onset dementia. Results: Plans for the future typically concerned non-medical affairs. Participants’ limited engagement in advance care planning was clarified through several reasons: not considering it useful, hindering patient behaviour, adopting a day-to-day attitude, caregivers emotionally protecting themselves and uncertainty about patients’ cognitive competence. However, endorsement for advance care planning showed from respondents’ preferences that it should be initiated timely, by a third party, and emphasize patients’ remaining capacities. Finally, the need for information and high-quality care emerged. Conclusion: A gap of knowledge, of information and in care intertwiningly hinder advance care planning. In young-onset dementia, engaging in advance care planning is not an option equally accessible as not doing so. Policy makers, institutions and professionals could reflect on their responsibility in providing these patients and caregivers an actual choice to engage in advance care planning or not.

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