Development of an on-job mentorship programme to improve nursing experience for enhanced patient experience of compassionate care

Abstract Background Evidence suggests improvement in nursing staff satisfaction, competence, and retention after implementation of evidence-based mentorship programmes. When guided by a framework of compassion, mentoring as a caring action can not only build healthy, transformative relationships but a similar behavior is reciprocated to patients which subsequently can drive patient experience of care. However, examples of on-job mentorship programs for nurses in low- and middle-income countries (LMIC) are limited. Objective The objective of the study was to develop an on-job nursing mentorship programme using a compassionate framework aimed at improving nurses’ experience and thus enhancing patient experience in a tertiary care hospital in Pakistan. Methods Designed as an intervention development study, it was completed between January 2018–December 2019. The programme was developed by a team composed of service and nursing leadership, director patient experience of care and a compassion specialist using a theory of change model. The package followed a series of steps, a) identification of a framework, b) creation of working group c) needs assessment and d) multiple meetings to frame the model followed by implementing the preconditions for roll-out of the programme with the frontline staff. Results The eventual outcome was improving the patient’s experience of compassion while the intermediate outcome was to have nurses demonstrate compassionate care. The pre-conditions were identified as: recruitment of staff with appropriate skills for pediatric care, provision of compassionate experience to the frontline nurses by addressing their specific pain points, development of competent head nurses as supervisors and creation of a compassionate culture. To ensure the pre-conditions, various interventions were planned with some implemented through the course of the study while others are in the process of being rolled out. These involved, inclusion of pediatric compassion specific module during orientation of new hires, creation of space to talk about compassionate skills with staff, provision of trainings and mentorship to create competent head nurses, and creating a culture that promoted and recognized compassionate care values. Conclusion The approach helped to delineate feasible pathways for an on-job compassionate mentorship programme enhancing routine supervisors' role as facilitators of compassionate care.

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How to improve patient experience of compassion through nursing: Development of an on-job mentorship programme in a tertiary care hospital, Pakistan

10.21203/rs.3.rs-122995/v1 ◽

2020 ◽

Author(s):

Alma Arshad ◽

Naureen Lalani ◽

Noureen Sultan ◽

Aly Zubairi ◽

Ayesha Hussain ◽

...

Keyword(s):

Nursing Education ◽

Patient Experience ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Theory Of Change ◽

Pediatric Care ◽

Care Hospital ◽

Intervention Package ◽

Middle Income ◽

Experience Of Care

Abstract Background Evidence suggests improvement in nursing staff satisfaction, competence, and retention after implementation of evidence-based mentorship programmes. When guided by a framework of compassion, mentoring as a caring action can not only build healthy, transformative relationships and energize the workplace environments but a similar behavior is reciprocated to patients which subsequently can drive patient experience of care. However, examples of on-job mentorship programs for nurses in low- and middle-income countries (LMIC) are limited owing to human and financial constraints. Objective The current study describes the development of a feasible an on-job nursing mentorship program using a compassionate framework aimed at improving nurses’ experience and thus enhancing patient experience from a tertiary care hospital in Pakistan. Methods The intervention package was built by a team composed of service and nursing leadership, director patient experience of care and a compassion specialist using a theory of change model. The package followed a series of steps that were based on the principles of implementation science, a) identification of a framework, b) creating a working group and c) multiple meetings to frame the model followed by implementing the preconditions for roll-out of the programme. Results The intermediate outcome was to have nurses demonstrate skills of compassion with the eventual outcome of improving the patient's experience of compassion. The pre-conditions were identified as: recruitment of staff with appropriate skills for pediatric care, precision of compassionate experience definition, creation of a compassionate culture and development of competent head nurses as supervisor. In order to ensure the pre-conditions, various interventions were planned and some were implemented through the course of designing. These involved, creation of space to talk about compassionate skills with staff, provide trainings and on-job coaching, revising career ladder of supervisors, inclusion of pediatric compassion specific nursing education service orientation program, recognition of efforts and promotion of compassionate values in numerous communication platforms, arrangement of training workshops, creation of checklists and development of dashboards. Conclusion The approach helped to delineate feasible pathways for an on-job compassionate mentorship programme through strengthening routine supervision leading to improved patient experience of care in the pediatric service.

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Development and feasibility testing of a play-based psychosocial intervention for reduced patient stress in a pediatric care setting: experiences from Pakistan

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00781-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Muneera A. Rasheed ◽

Vardah Bharuchi ◽

Waliyah Mughis ◽

Ayesha Hussain

Keyword(s):

Parental Stress ◽

Psychosocial Intervention ◽

Tertiary Care ◽

Theory Of Change ◽

Pediatric Care ◽

Clinical Psychologist ◽

Play Intervention ◽

Middle Income ◽

Psychology Trainees ◽

Parent Interactions

Abstract Background Hospitalization can be a source of great stress for children and their families. In high-income countries, there are specialized staff to help children cope using different techniques including play. However, it is a major challenge in low and middle-income countries (LMIC) due to financial constraints and untrained human resource. The objective of study was to develop and test the feasibility and acceptance of a psychology trainee-delivered model postulated on employing play as a means of enhancing child-parent interactions leading to reduced stress during hospitalization. Methods This study was conducted in the paediatric ward of a tertiary care private hospital in Pakistan. Pre-intervention survey revealed that parental stress stemmed mainly from seeing their child irritable, distressed, or in pain. Using a theory of change model, a play-based psychosocial intervention was developed to address these factors. The intervention approach was informed by principles of Nurturing Care Framework and play therapy. Children between birth and 6 years admitted in the acute care ward were eligible. The intervention was delivered between March 2019 and December 2020 by psychology trainees who were supervised by a clinical psychologist. The play-based sessions were delivered at the bedside and ranged from 20 to 40 min. Parents receiving the intervention were later interviewed for their stress, child emotions, and feedback about the service using structured surveys administered by psychology graduates. The trainees delivering the intervention were requested to provide their feedback as a written qualitative open-ended narrative. These narratives were analyzed using an inductive approach. Results The survey was conducted with 223 families with about half of the sample having children under 2 years of age. Forty-five percent of parents reported play intervention to be one of 3 key factors in improving their experience during hospital stay. Only 5% of parents reported feeling stressed about the child illness after the intervention. Ninety to 96% parents felt respected, listened to, and understood by the therapists. Thematic analysis of the feedback by trainees indicated the internship to be a useful experience and a new avenue for professional life whereas physicians appreciated the interventions. Conclusions The authors conclude that psychology trainees can feasibly deliver a play-based intervention under supervision for reduced stress in children and their parents during hospitalization with mutual benefits.

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Are There Racial Disparities in Family-Reported Experiences of Care in Inpatient Pediatrics?

Clinical Pediatrics ◽

10.1177/0009922816668497 ◽

2016 ◽

Vol 56 (7) ◽

pp. 619-626 ◽

Cited By ~ 10

Author(s):

Neeraja Nagarajan ◽

Sydur Rahman ◽

Emily F. Boss

Keyword(s):

Patient Satisfaction ◽

Interpersonal Communication ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Pediatric Care ◽

Care Hospital ◽

Minority Children ◽

Experience Of Care ◽

Patient Satisfaction Scores ◽

One Year

Despite increased emphasis on patient satisfaction as a quality measure in health care, little is known about the influence of race in parent-reported experience of care in pediatrics. This study evaluates the association of race with patient satisfaction scores in an inpatient pediatric tertiary care hospital in one year. Risk-adjusted multivariable logistic regression was performed to evaluate the association of minority race with the likelihood to provide a top-box (=5) satisfaction score for 38 individual questions across 8 domains. Of the 904 participants, 269 (29.8%) identified as belonging to a minority race. Parents of minority children reported 30% to 50% lower satisfaction across questions related to well-established themes of interpersonal communication and cultural competency. Overall, minorities also reported lower satisfaction for the domain of nursing care (odds ratio 0.7, P = .016). These findings suggest a need for training and interventions to improve communication and mitigate disparities in how minority patients and their families perceive pediatric care.

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Effective Utilization of Limited Isolation Rooms to Provide Safe Patient Care and Staff Safety in a Low- and Middle-Income Country

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.746 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s203-s204

Author(s):

Rozina Roshanali

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Limited Resource ◽

Multidrug Resistant ◽

Communicable Diseases ◽

Care Hospital ◽

Middle Income ◽

Safe Patient Care ◽

Bed Management ◽

Resource Setting

Background: My tertiary-care hospital is a 750-bed hospital with only 17 airborne infection isolation room (AIIR) and negative-pressure rooms to isolate patients who have been diagnosed or are suspected with prevalent diseases like tuberculosis, measles, and chickenpox. On the other hand, only 14 single-patient isolation rooms are available to isolate patients with multidrug-resistant organisms (MDROs) such as CRE (carbapenum-resistant Enterobacter) or colistin-resistant MDROs. Due to the limited number of isolation rooms, the average number of hours to isolate infected patients was ~20 hours, which ultimately directly placed healthcare workers (HCWs) at risk of exposure to infected patients. Methods: Plan-Do-Study-Act (PDSA) quality improvement methodology was utilized to decrease the average number of hours to isolate infected patients and to reduce the exposure of HCWs to communicable diseases. A detailed analysis were performed to identify root causes and their effects at multiple levels. A multidisciplinary team implemented several strategies: coordination with information and technology team to place isolation alerts in the charting system; screening flyers and questions at emergency department triage; close coordination with admission and bed management office; daily morning and evening rounds by infection preventionists in the emergency department; daily morning meeting with microbiology and bed management office to intervene immediately to isolate patients in a timely way; infection preventionist on-call system (24 hours per day, 7 days per week) to provide recommendations for patient placement and cohorting of infected patients wherever possible. Results: In 1 year, a significant reduction was achieved in the number of hours to isolate infected patients, from 20 hours to 4 hours. As a result, HCW exposures to communicable diseases also decreased from 6.7 to 1.5; HCW exposures to TB decreased from 6.0 to 1.9; exposures measles decreased from 4.75 to 1.5; and exposures chickenpox decreased from 7.3 to 1.0. Significant reductions in cost incurred by the organization for the employees who were exposed to these diseases for postexposure prophylaxis also decreased, from ~Rs. 290,000 (~US$3,000) to ~Rs. 59,520 (~US$600). Conclusions: This multidisciplinary approach achieved infection prevention improvements and enhanced patient and HCW safety in a limited-resource setting.Funding: NoneDisclosures: None

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Surgical Site Infections at a Level I Trauma Center in India: Data From an Indigenously Developed, e-SSI Surveillance System

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1041 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s397-s398

Author(s):

Ayush Lohiya ◽

Samarth Mittal ◽

Vivek Trikha ◽

Surbhi Khurana ◽

Sonal Katyal ◽

...

Keyword(s):

Surveillance System ◽

Trauma Center ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Surgical Site Infections ◽

Trauma Patients ◽

Care Hospital ◽

Middle Income ◽

Predominant Pathogen ◽

Level I

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None

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Family-Centered Approach to Monitoring Children’s Development in a Paediatric Outpatient Setting: Feasibility Study from Pakistan

10.21203/rs.3.rs-194080/v1 ◽

2021 ◽

Author(s):

Muneera A. Rasheed ◽

Waliyah Mughis ◽

Kinza N Elahi ◽

Babar S. Hasan

Keyword(s):

Service Providers ◽

Psychosocial Support ◽

Tertiary Care ◽

Wait Time ◽

Well Being ◽

Parent Report ◽

Outpatient Setting ◽

Theory Of Change ◽

Care Hospital ◽

Family Centered

Abstract Background: The purpose of the study was to design and test the feasibility of a recent guideline of family-centered psychosocial support as an approach to developmental monitoring in a pediatric outpatient setting.Methods: The patient experience team at a private tertiary care hospital leveraged an on-going patient and family-centric initiative in the service to implement the intervention. The intervention delivery model was designed using the theory of change model and entailed the following i) the service providers: paediatricians but with support from psychology trainee volunteers to address time constraints; ii) monitoring form: Survey of Well-Being of Young Children (SWYC) being feasible and designed for regular developmental monitoring as parent report; iii) family support intervention: the Care for Child Development module to enhance parent-child interactions given team’s successful experience with inpatient children; iv) timing: utilize wait time to also enhance families’ experience and v) reinforcement: reinforced by the paediatrician in the consultation visit to capitalize on the established rapport and relationship with families. All families with children under 5 years 5 months of age in selected clinics (acute care, complex care, developmental issues) were eligible. The study was evaluated for acceptability and implementation feasibility. Families were interviewed about their experience; trainees provided a written narrative while physicians provided feedback on email. These were thematically analyzed using an inductive approach.Results: A total 182 families were administered the SWYC with 54% children detected for further review on cognitive milestones and 76% on social-emotional milestones. Forty-eight families were interviewed regarding their experience with the intervention. They reported the monitoring process to be useful and important for them as parents indicating acceptability. Paediatricians and trainees found the intervention to be important for parents and children’s health also requesting further understanding about child’s functioning. The trainees further expressed the experience to be significant for their own learning.Conclusion: The authors conclude that the intervention model for a family-centric approach to monitoring was acceptable to the families and the service providers. The intervention when implemented using a robust behaviour change framework can enhance feasibility.

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Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

African Journal of Laboratory Medicine ◽

10.4102/ajlm.v5i1.187 ◽

2016 ◽

Vol 5 (1) ◽

Cited By ~ 3

Author(s):

Kirtika Patel ◽

R. Matthew Strother ◽

Francis Ndiangui ◽

David Chumba ◽

William Jacobson ◽

...

Keyword(s):

Cancer Care ◽

Cost Model ◽

Tertiary Care ◽

Care Hospital ◽

Middle Income ◽

Western Kenya ◽

Middle Income Countries ◽

Resource Limited ◽

Limited Setting ◽

Low And Middle Income

Background: Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.Objectives, methods and outcomes: Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to are source-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.Conclusion: Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.

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Triaging the triage: reducing waiting time to triage in the emergency department at a tertiary care hospital in New Delhi, India

Emergency Medicine Journal ◽

10.1136/emermed-2019-208577 ◽

2019 ◽

Vol 36 (9) ◽

pp. 558-563

Author(s):

Akshay Kumar ◽

Dheeneshbabu Lakshminarayanan ◽

Nitesh Joshi ◽

Sonali Vaid ◽

Sanjeev Bhoi ◽

...

Keyword(s):

Emergency Department ◽

Waiting Time ◽

Tertiary Care ◽

Time Of Arrival ◽

New Delhi ◽

Care Hospital ◽

Senior Leadership ◽

Frontline Staff ◽

Patient Load ◽

Hot Weather

BackgroundProlonged wait times prior to triage outside the emergency department (ED) were a major problem at our institution, compromising patient safety. Patients often waited for hours outside the ED in hot weather leading to exhaustion and clinical deterioration. The aim was to decrease the median waiting time to triage from 50 min outside ED for patients to <30 min over a 4-month period.MethodsA quality improvement (QI) team was formed. Data on waiting time to triage were collected between 12 pm and 1 pm. Data were collected by hospital attendants and recorded manually. T1 was noted as a time of arrival outside the ED, and T2 was noted as the time of first medical contact. The QI team used plan–do–study–act cycles to test solutions. Change ideas to address these gaps were tested during May and June 2018. Change ideas were focused on improving the knowledge and skills of staff posted in triage and reducing turnover of triage staff. Data were analysed using run chart rules.ResultsWithin 6 weeks, the waiting time to triage reduced to <30 min (median, 12 min; IQR, 11 min) and this improvement was sustained for the next 8 weeks despite an increase in patient load.ConclusionThe authors demonstrated that people new to QI could use improvement methods to address a specific problem. It was the commitment of the frontline staff, with the active support of senior leadership in the department that helped this effort succeed.

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Non-communicable disease pattern in adults seeking preventive general health checkup

Grande Medical Journal ◽

10.3126/gmj.v1i1.22401 ◽

2019 ◽

Vol 1 (1) ◽

pp. 21-25

Author(s):

Bikash Shrestha ◽

Bipin Nepal ◽

Ravi Mahat ◽

Abish Adhikari

Keyword(s):

General Health ◽

Communicable Disease ◽

Tertiary Care ◽

Communicable Diseases ◽

Care Hospital ◽

Mineral Density ◽

Health Checkup ◽

Middle Income ◽

Normal Bone Mineral Density ◽

The Government

Non Communicable diseases (NCDs) are now endemic in low and middle income countries. Nepal had a high burden of communicable diseases (CDs) which has now been overtaken by NCDs. Although prevention and control of NCDs is prioritized in national policies and strategies, there is no proper monitoring system. This study aims to review the morbidity pattern among the adults seeking preventive general health checkup in a major tertiary care hospital in Kathmandu. 3000 cases were evaluated. 53.6% were males and 46.4% were females. The mean age of cases was 44.9 yrs. Most of the cases ranged from 40 to 60 years of age. Almost half of them were from Kathmandu district. Nearly 78% participants live a sedentary life. Abdominal obesity was seen in 27.5% of females and 21.7% of males. Nearly 49% of cases were overweight and 24% were obese. Almost 21 % of the cases were smokers and about 36% of them consumed alcohol. Only 9% are vegetarians. 10% have diabetes and 20% have hypertension. 69% of females and 43% of males have less than normal bone mineral density. The government and private sectors must focus on strengthening preventive and curative services for early detection of risk factors and management of NCDs.

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The Integration of Adult Acute Care Surgeons into Pediatric Surgical Care Models Supplements the Workforce without Compromising Quality of Care

The American Surgeon ◽

10.1177/000313481508100916 ◽

2015 ◽

Vol 81 (9) ◽

pp. 854-858 ◽

Cited By ~ 5

Author(s):

Rudy J. Judhan ◽

Raquel Silhy ◽

Kristen Statler ◽

Mija Khan ◽

Benjamin Dyer ◽

...

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Tertiary Care ◽

Disease Process ◽

Pediatric Care ◽

Care Hospital ◽

Late Night ◽

General Surgeons ◽

The Impact

Acute care of children remains a challenge due to a shortage of pediatric surgeons, particularly in rural areas. In our institutional norm, all cases in patients age six and older are managed by dedicated general surgeons. The provision of care to these children by these surgeons alleviates the impact of such shortages. We conducted a five-year retrospective analysis of all acute care pediatric surgical cases performed in patients aged 6 to 17 years by a dedicated group of adult general surgeons in a rural tertiary care hospital. Demographics, procedure, complications, outcomes, length of stay, and time of consultation/operation were obtained via chart review. Elective, trauma related, or procedures performed by a pediatric surgeon were excluded. Descriptive statistics are reported. A total of 397 cases were performed by six dedicated general surgeons during the study period. Mean age was 11.5 ± 3.1 years. In all, 100 (25.2%) were transferred from outlying facilities and 52.6 per cent of consultations/operations occurred at night (7P–7A), of which 33.2 per cent occurred during late night hours (11P–7A). On weekends, 34.0 per cent occurred. Appendectomy was the most commonly performed operation (n = 357,89.9%), of which 311 were laparoscopic (87.1%). Others included incision/drainage (4.5%), laparoscopic cholecystectomy (2.0%), bowel resection (1.5%), incarcerated hernia (0.5%), small bowel obstruction (0.5%), intraabdominal abscess drainage (0.3%), resection of intussusception (0.3%), Graham patch (0.3%), and resection omental torsion (0.3%). Median length of stay was two days. Complications occurred in 23 patients (5.8%), of which 22(5.5%) were the result of the disease process. These results parallel those published by pediatric surgeons in this age group and for the diagnoses treated. Models integrating dedicated general surgeons into pediatric call rotations can be designed such that quality of pediatric care is maintained while providing relief to an overburdened pediatric surgical workforce.

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