Patient and family engagement in incident investigations: exploring hospital manager and incident investigators’ experiences and challenges

Objective There is growing recognition among health care providers and policy makers that when things go wrong, the patient or their families should be heard and participate in the incident investigation process. This paper explores how Dutch hospitals organize patient or family engagement in incident investigations, maps out incident investigators’ experiences of involving patients or their families in incident investigations and identifies the challenges encountered. Methods Semi-structured interviews were conducted with managers and incident investigators in 13 Dutch hospitals. Study participants (n = 18) were asked about the incident investigation routines and their experiences of involving affected patients or family members. Interview transcripts were coded and analysed using thematic content analysis. Results Our findings reveal that patient or family involvement in incident investigations is typically organized as a one-time interview event. Interviews with patients or their families were considered to be valuable and important in their own right and seen as a way to do justice to the individual needs of the patient or their family. Yet, the usefulness and validity of the patient or family perspective for incident investigations was often seen to be limited, with the professional perspective afforded more weight. This was particularly the case when the patient or their family were unable to provide verifiable details of the incident under investigation. Study participants described challenges when involving patients or family members, including in relation to the available timeframe for incident investigations, legal issues, managing trust and working with intense emotions. Conclusions We propose that by placing patient and family criteria of significance at the centre of incident investigations (i.e. an ‘emic’ research approach), hospitals may be able to expand their learning potential and improve patient-centeredness following an incident.

Download Full-text

Improving infectious TB education for foreign-born patients and family members

Health Education Journal ◽

10.1177/00178969211061522 ◽

2021 ◽

pp. 001789692110615

Author(s):

Nancy Bedingfield ◽

Bonnie Lashewicz ◽

Dina Fisher ◽

Kathryn King-Shier

Keyword(s):

Family Member ◽

Health Care Providers ◽

Family Members ◽

Large City ◽

Well Being ◽

Care Providers ◽

Foreign Born ◽

Structured Interviews ◽

Negative Impacts ◽

Many Sources

Objective: In low tuberculosis (TB) incidence countries, linguistic and cultural dissonance between families experiencing infectious TB and TB health care providers is a barrier to effective communication and successful treatment. The purpose of this research was to explore infectious TB education and counselling from the perspective of patients and family members who are foreign-born. Design/Setting: One component of a multiphase, qualitative case study conducted in Calgary, a large city in western Canada. Method: Data were collected through semi-structured interviews, chart review and field notes and analysed thematically. Eight families were represented in the 6 patient and 13 family member participants who had recently experienced infectious TB. Results: Three themes were generated from the data: ‘learning about TB from many sources’, ‘reassurance and connection’ and ‘missing information’. Participants described learning about TB in different ways, feeling reassured once they knew more and sharing information with others. Overall, participants expressed satisfaction with education and counselling received. However, there were indications that communication problems had occurred. Participants asked questions during the interview, described areas of lingering confusion and shared TB-related behaviours incongruent with medical understanding. Knowledge gaps often increased isolation. Conclusion: Gaps in infectious TB education and counselling have negative impacts on patient and family member well-being. Education and counselling can be improved using multiple modes of communication, proactively addressing common misperceptions and reducing barriers to patient participation. Improvements could empower families to better manage their own experience and share accurate TB information with their communities.

Download Full-text

Building a patient-centered model: Palliative medicine and cancer care.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.75 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 75-75

Author(s):

Kavitha Ramchandran ◽

Derek Galligan ◽

Erika L Tribett ◽

Melissa Valentine ◽

Meryl Selig ◽

...

Keyword(s):

Best Practices ◽

Health Care Providers ◽

Cancer Care ◽

Palliative Medicine ◽

Large Scale ◽

Best Practice ◽

Family Members ◽

Care Providers ◽

Structured Interviews ◽

Patient Centered

75 Background: Palliative medicine (PM) improves outcomes for cancer patients. Still, there is limited evidence around components of an efficient, patient-centered model for integrating PM into oncologic care. While PM is committed to aligning with a patient's goals of care, very few programs incorporate their input into design or evaluation. The aim of this project is to combine best practice in PM with perspectives of patients, families and providers to develop an empathic PM service. We hypothesize that collaboration with stakeholders and user experience experts will result in a feasible, impactful and translatable model of care that aligns with patient and family goals. Methods: We are conducting semi-structured interviews with 30 patients, family members and 30 oncologists. Patient interviews assess needs and coping mechanisms. Provider interviews assess perceptions and experiences around PM. We will conduct observations to understand how patients and providers interact and how current protocols are operationalized. Data will be coded and analyzed for major themes. An expert panel of patients, family members, health care providers and design experts will assimilate the data and make recommendations for the prototype care model design. The model will be piloted and evaluated in fall 2014. Outcome metrics include patient satisfaction, symptom management, utilization, mortality, and others identified during development. Data from the pilot will inform intervention improvements in preparation for a large-scale, 12- month pilot in an outpatient PM clinic. Results: Preliminary work includes the development of a novel patient and family interview protocol that integrates cutting-edge research on PM with best practices for conducting empathic interviews. We will present initial results from these interviews at the symposium, as well as our iterative design process. Conclusions: This project integrates data on patient and family experience with known best practices to develop a patient-centered model for palliative cancer care. The development process and potential outcomes hold significant promise for the design of patient and provider-centered care models, especially those related to chronic and serious illnesses.

Download Full-text

Acceptance of the HPV Vaccine in a Multiethnic Sample of Latinx Mothers

Qualitative Health Research ◽

10.1177/1049732320980697 ◽

2021 ◽

Vol 31 (3) ◽

pp. 472-483

Author(s):

Ana Cristina Lindsay ◽

Madelyne J. Valdez ◽

Denisse Delgado ◽

Emily Restrepo ◽

Yessica M. Guzmán ◽

...

Keyword(s):

Health Care Providers ◽

Thematic Analysis ◽

Hpv Vaccine ◽

Female Adolescents ◽

Future Research ◽

Care Providers ◽

Foreign Born ◽

Structured Interviews ◽

Direct Benefits ◽

Multiethnic Sample

This descriptive qualitative study explored Latinx mothers’ acceptance of the human papillomavirus (HPV) vaccine for their adolescent children. Data were collected through individual, semi-structured interviews and analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Twenty-two ( n = 22), mostly foreign-born, Latinx mothers of male and female adolescents participated in the study. Three main themes and nine subthemes emerged from the analyses. Findings identified the need for increased efforts to raise awareness and knowledge among Latinx mothers of the direct benefits of the HPV vaccine for sons, including stressing prevention of HPV-associated cancers in males. Findings also underscore the need for improved health care providers’ communication and recommendation of the HPV vaccine for Latinx adolescent males. Future research should intervene upon the study’s findings to address barriers that remain and affect Latinx mothers’ acceptance and uptake of the HPV vaccine for their children, in particular their sons.

Download Full-text

Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study

BMC Public Health ◽

10.1186/s12889-021-11395-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hannah Maria Jennings ◽

Joanna Morrison ◽

Kohenour Akter ◽

Hassan Haghparast-Bidgoli ◽

Carina King ◽

...

Keyword(s):

Quality Of Care ◽

Health Care Providers ◽

Low Income ◽

Diabetes Management ◽

Local Health ◽

Care Seeking ◽

Care Providers ◽

Structured Interviews ◽

Rural Bangladesh

Abstract Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.

Download Full-text

Breastfeeding Experiences of Baccalaureate Nursing Students: A Qualitative Study

Journal of Human Lactation ◽

10.1177/0890334420979981 ◽

2020 ◽

pp. 089033442097998

Author(s):

Cheryl Langford ◽

Marcella Gowan ◽

Monica Haj

Keyword(s):

Nursing Students ◽

Health Care Providers ◽

Baccalaureate Nursing ◽

Community Support ◽

Baccalaureate Nursing Students ◽

Care Providers ◽

Structured Interviews ◽

Breastfeeding Support ◽

Cross Sectional

Background Students returning to school who are breastfeeding face unique challenges. There is limited literature on breastfeeding university students. Several researchers have studied breastfeeding employees in the workplace. Institutions of higher education closely mimic the employment environment. Breastfeeding college students who express their milk while at school share similar challenges to employed mothers. A baccalaureate nursing program is rigorous and little is known about the challenges facing breastfeeding student nurses returning to classes. Research aim To explore the breastfeeding experience of baccalaureate nursing students. Methods Our study was a cross-sectional descriptive qualitative design. Purposive sampling was used to enroll participants ( N = 12). In depth, semi-structured interviews were conducted. Qualitative thematic analysis was used to analyze the data both manually and using Dedoose QDA software. Results An overarching theme of pervasive conflict between the role of the breastfeeding mother and the role of the student nurse surfaced. Three interrelated organizing themes also emerged; challenging, vulnerability, and resilience. Time constraints, self-care versus role demands, and structural accommodations contributed to the challenges. Only one participant indicated a knowledge of her breastfeeding rights. All of the participants expressed gratitude for faculty and community support, regardless of conflicts. Conclusion Breastfeeding participants were both vulnerable and resilient. Faculty may improve experiences through providing specific areas of support. A breastfeeding support policy outlining student rights and faculty responsibilities is needed to educate, guide, and enforce protections. Health care providers may enhance breastfeeding students’ experiences through anticipatory guidance, education, and continued support.

Download Full-text

Families' perception, knowledge, and psychological stressors associated with transition of care from the intensive care unit

Journal of Precision Respiratory Medicine ◽

10.2500/jprm.2019.190004 ◽

2019 ◽

Vol 2 (1) ◽

pp. 53-56

Author(s):

Gustavo Ferrer ◽

Chi Chan Lee ◽

Monica Egozcue ◽

Hector Vazquez ◽

Melissa Elizee ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Health Care Providers ◽

Family Members ◽

Expected Improvement ◽

Transition Of Care ◽

Care Providers ◽

Icu Discharge ◽

Family Perceptions

Background: During the process of transition of care from the intensive care setting, clarity, and understanding are vital to a patient's outcome. A successful transition of care requires collaboration between health-care providers and the patient's family. The objective of this project was to assess the quality of continuity of care with regard to family perceptions, education provided, and psychological stress during the process. Methods: A prospective study conducted in a long-term acute care (LTAC) facility. On admission, family members of individuals admitted to the LTAC were asked to fill out a 15-item questionnaire with regard to their experiences from preceding intensive care unit (ICU) hospitalization. The setting was an LTAC facility. Patients were admitted to an LTAC after ICU admission. Results: Seventy-six participants completed the questionnaire: 38% expected a complete recovery, 61% expected improvement with disabilities, and 1.3% expected no recovery. With regard to the length of stay in the LTAC, 11% expected < 1 week, 26% expected 1 to 2 weeks, 21% expected 3 to 4 weeks, and 42% were not sure. Before ICU discharge, 33% of the participants expected the transfer to the LTAC. Also, 72% did not report a satisfactory level of knowledge regarding their family's clinical condition or medical services required; 21% did not receive help from family members; and 50% reported anxiety, 20% reported depression, and 29% reported insomnia. Conclusion: Families' perception of patients' prognosis and disposition can be different from what was communicated by the physician. Families' anxiety and emotional stress may precipitate this discrepancy. The establishment of optimal projects to eliminate communication barriers and educate family members will undoubtedly improve the quality of transition of care from the ICU.

Download Full-text

“What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

BMC Health Services Research ◽

10.1186/s12913-021-06110-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anh Ly ◽

Roger Zemek ◽

Bruce Wright ◽

Jennifer Zwicker ◽

Kathryn Schneider ◽

...

Keyword(s):

Emergency Department ◽

Health Care Providers ◽

Clinical Pathways ◽

Theoretical Domains Framework ◽

Local Context ◽

Emergency Department Physician ◽

Evidence Based ◽

Care Providers ◽

Structured Interviews ◽

Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

Download Full-text

Experiences of Patients With COVID-19 Admitted to the Intensive Care Units: A Qualitative Study

Journal of Patient Experience ◽

10.1177/23743735211007359 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110073

Author(s):

Reza Norouzadeh ◽

Mohammad Abbasinia ◽

Zahra Tayebi ◽

Ehsan Sharifipour ◽

Alireza Koohpaei ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Health Care Providers ◽

Spiritual Support ◽

Care Providers ◽

Structured Interviews ◽

Icu Patients ◽

Life Challenges ◽

Care Models ◽

The Face

This study aimed to describe the experiences of patients with COVID-19 admitted to the intensive care units (ICU). The data were analyzed by content analysis on 16 ICU patients with COVID-19. Data were collected by semi-structured interviews. Three categories were identified: (a) captured by a challenging incident with subcategories: perceived sudden and challenging death, fear of carelessness in overcrowding, worry about the family, and frustration with stigmatizing; (b) the flourishing of life with subcategories: spiritual-awakening, resilience in the face of life challenges, promoting health behaviors, and striving for recovery; and (c) honoring the blessings with subcategories: understanding the importance of nurses, realizing the value of family, and realizing the value of altruism. COVID-19 survivors experienced both positive and negative experiences. The results of this study could help health care providers identify the needs of ICU patients with COVID-19, including psychological, social, and spiritual support and design care models.

Download Full-text

Addressing Mistreatment of Providers by Patients and Family Members as a Patient Safety Event

Hospital Pediatrics ◽

10.1542/hpeds.2021-006267 ◽

2021 ◽

Author(s):

Marianne Hatfield ◽

Rebecca Ciaburri ◽

Henna Shaikh ◽

Kirsten M. Wilkins ◽

Kurt Bjorkman ◽

...

Keyword(s):

Patient Safety ◽

Health Care Providers ◽

Self Efficacy ◽

Tertiary Care ◽

Family Members ◽

Incident Reporting ◽

Care Providers ◽

Cross Sectional ◽

Offensive Behavior ◽

Safety Incident

OBJECTIVE: Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment. METHODS: In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children’s hospital between 2018 and 2019. We used multivariable logistic regression to examine the effect of training on the outcomes of interest and whether this association was moderated by staff role. RESULTS: We received 309 baseline surveys from 72 faculty, 191 nurses, and 46 residents, representing 39.1%, 27.1%, and 59.7%, respectively, of eligible HCPs. Verbal threats from patients or family members were reported by 214 (69.5%) HCPs. Offensive behavior was most commonly based on provider age (85, 28.5%), gender (85, 28.5%), ethnicity or race (55, 18.5%), and appearance (43, 14.6%) but varied by role. HCPs who received training had a higher odds of reporting knowledge, self-efficacy, and experiencing offensive behavior. Incident reporting of mistreatment increased threefold after the intervention. CONCLUSIONS: We report an effective organizational approach to address mistreatment of HCPs by patients and family members. Our approach capitalizes on existing patient safety culture and systems that can be adopted by other institutions to address all forms of mistreatment, including those committed by other HCPs.

Download Full-text

Understanding and supporting women with polycystic ovary syndrome: a qualitative study in an ethnically diverse UK sample

Endocrine Connections ◽

10.1530/ec-17-0053 ◽

2017 ◽

Vol 6 (5) ◽

pp. 323-330 ◽

Cited By ~ 8

Author(s):

Michelle Hadjiconstantinou ◽

Hamidreza Mani ◽

Naina Patel ◽

Miles Levy ◽

Melanie Davies ◽

...

Keyword(s):

Psychological Distress ◽

Polycystic Ovary Syndrome ◽

Health Care Providers ◽

Polycystic Ovary ◽

Ethnically Diverse ◽

Comparative Approach ◽

Care Providers ◽

Structured Interviews ◽

Ovary Syndrome ◽

Group Education

Objective Polycystic ovary syndrome (PCOS) is a lifelong condition. Its symptoms have been linked with psychological consequences, but less attention has been given to the daily implications of living with PCOS. We aimed to explore women’s experiences living with PCOS, and the potential acceptability of group education sessions for this target group. Methods Women with PCOS were recruited from an ethnically diverse UK community. Twelve semi-structured interviews were conducted. Analysis was underpinned by the constant comparative approach and involved the identification and exploration of key themes. Results Participants reported a range of symptoms linked with PCOS, including problems relating to menstruation and weight difficulties. Hirsutism was reported as the most distressing symptom. Emergent themes included perceptions about symptoms and delays in receiving a diagnosis; psychological distress; practical implications of living with the condition; coping with PCOS and perceived support needs. Some findings were specific to cultural backgrounds. Participants were supportive of the idea of group education for women with PCOS and suggested a need to provide education within the community and health care providers. Discussion Women with PCOS experience high psychological distress and difficulties with coping with their condition. Suggested strategies to reduce the negative psychological impact include education at various levels.

Download Full-text