scholarly journals The moral significance of capturing micro-inequities in hospital settings

2018 ◽  
Author(s):  
Supriya Subramani
Keyword(s):  
Family Doctor ◽  
Family Members ◽  
Patient Centered ◽  
Moral Significance ◽  
South Indian ◽  
Medical Institutions ◽  
Centered Care ◽  
Indian City ◽  
Institutional Ethos ◽  
Depth Interviews

This paper illustrates and reflects on subtle micro-level events and practices that sustain and reproduce unequal relationships in healthcare encounters, and draws attention to their moral significance in two hospitals in the south Indian city of Chennai. Based on observational data and in-depth interviews with 16 surgeons, 11 nurses, and 36 patients and their family members between February 2016 and July 2017, it reveals how both victims and perpetrators normalize instances of micro-inequities, often failing to recognize or acknowledge them. The findings illustrate how the prevalence of micro-inequities varies between different medical institutions, and suggest that while subtle in nature, their effect raises concerns regarding dignity and respect for patients and family members. Drawing on existing philosophical analyses of micro-inequities, the study concludes that their production in hospital settings creates an institutional ethos that disdains and marginalizes patients and their family members. Further, it negatively influences the patient/family-doctor relationship and functions as a barrier to reflective patient-centered care.

scholarly journals The construction of incompetency: moving beyond embedded paternalism toward the practice of respect

2018 ◽  
Author(s):  
Supriya Subramani
Keyword(s):  
Qualitative Research ◽  
Social Construction ◽  
Family Members ◽  
Ethical Framework ◽  
Respect For Persons ◽  
The South ◽  
South Indian ◽  
Indian City ◽  
Normative Justification ◽  
Depth Interviews

This paper illustrates the less-acknowledged social construction of the concept of “incompetency” and draws attention to the moral concerns it raises in healthcare encounters in the south Indian city of Chennai. Based on in-depth interviews with 16 surgeons, drawn from qualitative research, this study reveals that surgeons subjectively construct the idea of incompetency through their understanding of the perceived circumstantial characteristics of the patients and family members. The findings largely suggest that surgeons dismiss their capacity based on constructed assessments, which leads to paternalistic practice. The findings illustrate how these assessments structure the surgeons’ practices and provide the moral and practical justifications for their actions. The constructed knowledge becomes a source for drawing normative justification for surgeons’ actions and, in conjunction with socially enforced relationships, leads patients and family members to be on the receiving end of disrespectful attitudes. By employing the ethical framework, this paper argues for physicians to pursue “respect for persons,” beyond the framework of “capacity/autonomy,” and to practice respect in hospital settings.

Providing Patient Centered Care for Adolescents with Chronic Conditions

2016 ◽  
Vol 6 (1) ◽  
pp. 22-29
Author(s):  
Nabeel Al-Yateem
Keyword(s):  
Young Adults ◽  
Healthcare Professionals ◽  
Transition Process ◽  
Healthcare Services ◽  
Adolescents And Young Adults ◽  
Study Phase ◽  
Patient Centered ◽  
Centered Care ◽  
Group Interviews ◽  
Depth Interviews

Background: It is well acknowledged that clear, structured healthcare services that are mutually developed between the patient and the healthcare professionals are likely to be of high quality, desirable, and effective. Such service should address the complexity of the illness-health experience in terms of the factors that influence it as well as the physical and psychosocial consequences on the patient. The required focus should be on treating the patient rather than just treating the disease.Objectives: To develop relevant and feasible care guidelines that may inform more competent and patient centered services for adolescents and young adults with chronic conditions.Methodology: A sequential exploratory mixed method design guided this study. The first qualitative phase employed in-depth interviews to explore the experiences of adolescents and young adults about the health services they were receiving. This was followed by focus group interviews with healthcare professionals to discuss the patients’ reported needs and to suggest interventions that would address them. Finally, a second quantitative phase was carried out through a survey to explore the views of a larger sample of service stakeholders about the relevance and feasibility of the suggested guidelines for clinical practice.Results: The in-depth interviews revealed four main themes, as follows: a current amorphous service, sharing knowledge, the need to be at the center of service, and easing the transition process to adulthood. The second study phase yielded 32 proposed guidelines that may contribute to more competent and patient centered health care.

scholarly journals What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study

2021 ◽  
Vol 30 (1) ◽  
pp. 11-20
Author(s):  
Catherine L. Auriemma ◽  
Michael O. Harhay ◽  
Kimberley J. Haines ◽  
Frances K. Barg ◽  
Scott D. Halpern ◽  
...  
Keyword(s):  
Qualitative Content Analysis ◽  
Decision Rules ◽  
Family Members ◽  
Life Quality ◽  
Patient Comfort ◽  
Patient Centered ◽  
Surrogate Outcomes ◽  
Constant Pain ◽  
Centered Care ◽  
Family Centered

Background Despite increased emphasis on providing higher-quality patient- and family-centered care in the intensive care unit (ICU), there are no widely accepted definitions of such care in the ICU. Objectives To determine (1) aspects of care that patients and families valued during their ICU encounter, (2) outcomes that patients and families prioritized after hospital discharge, and (3) outcomes perceived as equivalent to or worse than death. Methods Semistructured interviews (n = 49) of former patients of an urban, academic medical ICU and their family members. Two investigators reviewed all transcripts line by line to identify key concepts. Codes were created and defined in a codebook with decision rules for their application and were analyzed using qualitative content analysis. Results Salient themes were identified and grouped into 2 major categories: (1) processes of care within the ICU— communication, patient comfort, and a sense that the medical team was “doing everything” (ie, providing exhaustive medical care) and (2) patient and surrogate outcomes after the ICU—survival, quality of life, physical function, and cognitive function. Several outcomes were deemed worse than death: severe cognitive/physical disability, dependence on medical machinery/equipment, and severe/constant pain. Conclusion Although survival was important, most participants qualified this preference. Simple measures of mortality rates may not represent patient- or family-centered outcomes in evaluations of ICU-based interventions, and new measures that incorporate functional outcomes and patients’ and family members’ views of life quality are necessary to promote patient-centered, evidence-based care.

scholarly journals Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions

2017 ◽  
Vol 13 (5) ◽  
pp. e421-e430 ◽  
Author(s):  
Sarina R. Isenberg ◽  
Chunhua Lu ◽  
John McQuade ◽  
Kelvin K.W. Chan ◽  
Natasha Gill ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Average Length ◽  
Care Program ◽  
Financial Impact ◽  
Palliative Care Program ◽  
Patient Centered ◽  
Average Length Of Stay ◽  
Medical Institutions ◽  
Centered Care

Purpose: Palliative care inpatient units (PCUs) can improve symptoms, family perception of care, and lower per-diem costs compared with usual care. In March 2013, Johns Hopkins Medical Institutions (JHMI) added a PCU to the palliative care (PC) program. We studied the financial impact of the PC program on JHMI from March 2013 to March 2014. Methods: This study considered three components of the PC program: PCU, PC consultations, and professional fees. Using 13 months of admissions data, the team calculated the per-day variable cost pre-PCU (ie, in another hospital unit) and after transfer to the PCU. These fees were multiplied by the number of patients transferred to the PCU and by the average length of stay in the PCU. Consultation savings were estimated using established methods. Professional fees assumed a collection rate of 50%. Results: The total positive financial impact of the PC program was $3,488,863.17. There were 153 transfers to the PCU, 60% with cancer, and an average length of stay of 5.11 days. The daily loss pretransfer to the PCU of $1,797.67 was reduced to $1,345.34 in the PCU (−25%). The PCU saved JHMI $353,645.17 in variable costs, or $452.33 per transfer. Cost savings for PC consultations in the hospital, 60% with cancer, were estimated at $2,765,218. $370,000 was collected in professional fees savings. Conclusion: The PCU and PC program had a favorable impact on JHMI while providing expert patient-centered care. As JHMI moves to an accountable care organization model, value-based patient-centered care and increased intensive care unit availability are desirable.

scholarly journals Patient perceptions of students in a longitudinal integrated clerkship in Taiwan: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yaw-Wen Chang ◽  
David A. Hirsh ◽  
Wen-Hui Fang ◽  
Honghe Li ◽  
Wen-Chii Tzeng ◽  
...  
Keyword(s):  
Identity Formation ◽  
Clinical Education ◽  
Family Members ◽  
Patient Centered Care ◽  
Structured Interviews ◽  
Patient Centered ◽  
Education Leaders ◽  
Centered Care ◽  
Longitudinal Integrated Clerkship ◽  
Patients Experience

Abstract Background Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students’ clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients’ perceptions of longitudinal relationships with the LIC students within Taiwan’s Confucian cultural and social context. Methods We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients’ descriptions of their experiences interacting with the LIC students. Results Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients’ experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients’ experience, feelings, and mood. Conclusion In our study, Taiwanese patients’ perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.

scholarly journals Patient perceptions of students in a longitudinal integrated clerkship in Taiwan: a qualitative study

2021 ◽  
Author(s):  
Yaw-Wen Chang ◽  
David A. Hirsh ◽  
Wen-Hui Fang ◽  
Honghe Li ◽  
Wen-Chii Tzeng ◽  
...  
Keyword(s):  
Identity Formation ◽  
Clinical Education ◽  
Family Members ◽  
Patient Centered Care ◽  
Structured Interviews ◽  
Patient Centered ◽  
Education Leaders ◽  
Centered Care ◽  
Longitudinal Integrated Clerkship ◽  
Patients Experience

Abstract Background: Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students’ clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients’ perceptions of longitudinal relationships with the LIC students within Taiwan’s Confucian cultural and social context.Methods: We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients’ descriptions of their experiences interacting with the LIC students. Results: Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients’ experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients’ experience, feelings, and mood.Conclusion: In our study, Taiwanese patients’ perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.

scholarly journals Assessing Communication during Remote Follow-Up of Users with Pacemakers in Norway: The NORDLAND Study, a Randomized Trial

2020 ◽  
Vol 17 (20) ◽  
pp. 7678
Author(s):  
Daniel Catalan-Matamoros ◽  
Antonio Lopez-Villegas ◽  
Knut Tore Lappegård ◽  
Remedios Lopez-Liria
Keyword(s):  
Remote Monitoring ◽  
Healthcare Services ◽  
Models Of Care ◽  
Patient Centered ◽  
Remote Communication ◽  
Quality Healthcare ◽  
Centered Care ◽  
Observational Design ◽  
Depth Interviews

As effective communication is a key ingredient for the provision of quality healthcare services, this study aimed to explore the communication experiences in the remote monitoring of older adults with a pacemaker. The study was based on a non-masked randomized observational design. The Healthcare Communication Questionnaire and in-depth interviews were conducted for data collection. A total of 49 patients participated in the study. The study findings reveal overall positive communication experiences by pacemaker users in remote monitoring with no significant differences from users in hospital monitoring. The remote option is perceived as safe and convenient, and communicating with the clinicians from home is considered comfortable and confidential. The study provides insights into the content of communication experiences in telehealth and practical implications in healthcare contexts. In a world that increasingly relies on remote communication, it is crucial to match technologies to patient needs and assess communication with patients. This will ensure the success of new models of care and establish appropriate criteria for the use of telehealth services. These criteria are all relevant in the implementation of health technology in the future as a part of effective patient-centered care.

Environmental Affordances: Designing for Family Presence and Involvement in Patient Care

2013 ◽  
Vol 6 (4) ◽  
pp. 53-75 ◽  
Author(s):  
Young-Seon Choi ◽  
Sheila J. Bosch
Keyword(s):  
Patient Care ◽  
Family Involvement ◽  
Empirical Studies ◽  
Family Members ◽  
Patient Centered ◽  
Family Presence ◽  
Significant Difference ◽  
Unit Design ◽  
Centered Care ◽  
The Impact

OBJECTIVE: This comparative study in two ICUs examines the impact of the patient-centered unit design on family involvement, operationalized as percentages of family presence and family–patient/family–staff interaction in patient rooms. BACKGROUND: As hospitals have become more patient-centered, there has been a trend toward including a family area inside the patient area to promote family presence, support, and involvement in patient care. There is growing evidence that family members play an important role in supporting patient care, and that the physical environment affects family involvement. However, few empirical studies have attempted to show the effectiveness of the patient-centered design on family members' presence and their behavior. METHODS: This study compared the degree of family presence and family–patient and family–staff interactions in two intensive care units (ICUs) with different physical environmental conditions, but housing patients of similar acuity and disease type. RESULTS: The analysis identified a significant difference in family presence in patient rooms ( t = −2.176; df = 79.0; p = 0.03) between the traditional and the patient-centered units. Patients in the family-centered care unit ( M = 37.77; SD = 34.02) spent significantly more time with their family members in patient rooms than did patients in the traditional unit ( M = 23.89; SD = 21.90). Patient-related variables other than unit design had no significant impact on family presence and interactions. CONCLUSIONS: Findings demonstrated that the patient-centered unit (5K) was associated with increased family presence in the patient rooms and increased family interaction with patients, when compared with the traditionally designed unit.

scholarly journals Patient Perceptions of Students in a Longitudinal Clerkship in Taiwan: A Qualitative Study

2020 ◽  
Author(s):  
Yaw-Wen Chang ◽  
David A. Hirsh ◽  
Wen-Hui Fang ◽  
Honghe Li ◽  
Wen-Chii Tzeng ◽  
...  
Keyword(s):  
Clinical Education ◽  
Family Members ◽  
Patient Centered Care ◽  
Medical Professionalism ◽  
Structured Interviews ◽  
Patient Centered ◽  
Education Leaders ◽  
Centered Care ◽  
Longitudinal Integrated Clerkship ◽  
Patients Experience

Abstract Background:Patient-centered care is a core component of medical professionalism. East Asian cultures hold different conceptualizations of medical professionalism than Western cultures. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship (LIC) in East Asia. We aimed to investigate patients’ perceptions of longitudinal relationships with the LIC students within Taiwan’s Confucian cultural and social context.Methods:We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients’ descriptions of their experiences interacting with the LIC students.Results:Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients’ experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients’ experience, feelings, and mood.Conclusion: In our study, Taiwanese patients’ perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.

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