Development of patient-centred care in acute hospital settings: A meta-narrative review

Mapping the translation and psychometric characteristics of the Patient-Practitioner Oriented Scale: A scoping review

BACKGROUND

The Patient-Practitioner Orientation Scale (PPOS) is the most widely used instrument to assess attitudes towards patient-centered care (PCC).

OBJECTIVE

To map and synthesize the psychometric characteristics of available translations of the PPOS.

METHODS

We conducted a scoping review guided by the requirements of the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews. The search was conducted in PubMed, PsycInfo, Cochane, and CINHAL, and included studies published in English.

RESULTS

Nine studies, describing the translation and validation process of the PPOS into Italian, French, Chinese, Sinhala, Turkish, German, Portuguese, and Spanish were included. The quality of the translation process was adequate in all studies. Internal reliability was better for the full scale than for its subscales.

CONCLUSION

This review attests to the importance of conducting a standardized and transparent translation and validation process. We showed that although these requirements are met in the majority of the studies included, differences exist in the number of items included in the scale and its dimensionality.

PRACTICE IMPLICATIONS

Having a clear description of the translation and validation processes will assist researchers and clinicians when implementing and evaluating PCC. It will also advance and improve cross-cultural knowledge in the area.

A cross-sectional survey reporting nurses' perspectives of person-centred care at emergency department triage and waiting room in Australia

BACKGROUND

A person-centred care approach is widely considered a standard for quality healthcare and has been adopted in various acute care settings. However, emergency department (ED) triage presents unique challenges to operationalising person-centred care and provision in this setting is unclear. This study aimed to explore nurses' perspectives of person-centred care at ED triage and waiting room.

METHODS

A cross-sectional study of triage nurses across Australia was conducted to understand nurses' knowledge, attitudes and provision of person-centred care. Quantitative data were analysed using descriptive statistics. Responses to open-ended questions were analysed inductively and deductively using the Picker principles of person-centred care.

RESULTS

176 survey responses from nurses across a range of EDs were received. Nurses reported they understood concepts and benefits of person-centred care, yet provision of it varied. Time constraints, high volumes of patients, inadequate staffing and environmental constraints were common barriers. Nurses reported using communication and interpersonal skills, patient involvement and nurse-initiated interventions as strategies for person-centred care.

CONCLUSIONS

System and organisational-level factors challenge the provision of person-centred care, despite individual efforts by triage nurses. To facilitate person-centred care at ED triage and in the waiting room, consideration of the ED triage context, processes and outcomes is necessary.

Exploring the Gender Preferences for Healthcare Providers and Their Influence on Patient Satisfaction

Background: Patient satisfaction is a key indicator for improving healthcare delivery, yet the influence of gender preferences on healthcare providers remains underexplored. Cultural norms and gender perceptions often shape the patient preferences, affecting access to care, patient-provider relationships, and overall satisfaction. Thus, this study investigates the patients' gender preferences and their impact on satisfaction in Tanzania. Methods: The study utilized a cross-sectional design, collecting data from five health centres: Mikongeni, Konga, Mzumbe, Tangeni, and Mlali. A total of 240 randomly selected respondents participated in the study. Gender preferences were categorized as male, female, and both, and determinants were analyzed using a multivariate probit model (MPM), while satisfaction was analyzed using an ordered logit model (OLM). Results: Results reveal that female providers were preferred for empathy (58.30%), intimate care (50.00%), and receptionist roles (50.00%), while males were favored for surgery (50.00%), professionalism (0.86), and IT roles (41.70%). Professionalism (0.75) and communication (0.70) had the strongest positive effects on very high satisfaction. Male provider preference was strongly linked to higher satisfaction (0.84), while female preference showed a mild effect (0.23). Insurance (0.32) and care at Tangeni Health Centre (0.70) boosted satisfaction, while consultation fees (-0.26) reduced it. Conclusions: The study recommends that healthcare systems address gender stereotypes by equipping all providers with both technical and relational care skills, regardless of gender. It also highlights the need for culturally and religiously sensitive care practices that acknowledge how societal norms shape patient preferences and satisfaction. To enhance patient-centered care, policies should promote affordability, broaden insurance coverage, and integrate patient feedback on gender preferences into healthcare delivery models.

Maternity care experiences of women with a BMI> 35 kg/m2: An interpretive phenomenological analysis

PROBLEM

Maternity care of women with a Body Mass Index > 35 kg/m2 is driven by a biomedical approach, with limited inclusion of women's views or experiences.

BACKGROUND

Body Mass Index > 35 kg/m2 in pregnancy is common. Women with a higher Body Mass Index are more likely to access medical care during their pregnancy owing to increased rates of obstetric complexity.

AIM

To understand experiences of care for women with a Body Mass Index > 35 kg/m2 accessing maternity care.

METHODS

We conducted in-depth, semi-structured interviews with ten women with a Body Mass Index > 35 kg/m2 accessing maternity care in Australia. Data were analysed using Interpretive Phenomenological Analysis.

FINDINGS

Women's experiential data were analysed and three superordinate themes were constructed: Women's knowledge and agency; Healthcare that harms; and Healthcare that heals. Participants recounted their own role in invoking knowledge and enacting agency, describing birth as a significant life event. Participants acknowledged that past life and pregnancy experiences informed present experience, including intuitive knowledge of their own bodies. Harm was experienced when care was discriminatory or stigmatising, in response to inadequate or inconsistent information or inadequate consent. Healing care was experienced when care was relationship-based, knowledgeable, kind and listening, and when adequate preparation was facilitated. Irrespective of the specifics of their maternity care experience, participants in this study rejected Body Mass Index as a measure of health and expected more nuanced and detailed individual health assessment from their maternity carers.

DISCUSSION

Women described variable experiences of maternity care. A woman's knowledge and agency are central to her pregnancy care experience. Delivery of healthcare that heals minimises harmful care experiences. Harms such as stigma, discrimination, inadequate consent, and difficulty gathering and sharing information can be avoided with maternity care that was relationship-based, kind and knowledgeable, and affords adequate preparation.

CONCLUSIONS

Previous experience informs personal agency. Body Mass Index was rejected as a marker of health. Women want personalised care.

Impact of health conditions on daily functioning in Kenyan populations: A scoping review

Background

Kenya faces significant challenges in addressing the impact of various health conditions. Understanding the functioning problems associated with these conditions is crucial for informing targeted interventions and improving overall healthcare outcomes.

Objectives

This study aimed to determine the prevalence and types of functioning problems associated with health conditions contributing most to Years Lived with Disability in the adult Kenyan population and to identify the International Classification of Functioning, Disability, and Health (ICF) domains and categories most affected.

Method

A scoping review was conducted. Searches were performed across multiple databases using relevant keywords and inclusion criteria. Studies published between January 2006 and December 2023 were eligible. Data were extracted from 39 eligible studies using a web-based software application (Rehab4all).

Results

Major depressive disorder, human immunodeficiency virus, low back pain and fractures were identified as the leading conditions contributing to functioning problems in Kenya. The most prevalent problems included walking difficulties, paraesthesia, various forms of pain and depression. The most affected ICF domains were mobility (d4), sensory function and pain (b2) and mental (b1).

Conclusion

The comprehensive description of functioning problems associated with priority health conditions in Kenya can be used to develop targeted interventions to improve health outcomes across affected domains.

Contribution

This research enhances comprehension of disability burden guiding intervention development and policy formulation for improved rehabilitation and offers a platform for further evidence-based strategies to tackle the country's complex health challenges.

How Has 'What Matters to You' Been Used for Patient Care? A Scoping Review

INTRODUCTION

Asking patients 'What matters to you?' (WMTY) was first introduced in 2012 as an approach to person-centred care and has since been integrated into healthcare frameworks internationally. However, it is unclear how extensively and successfully it has been used for patient care. This review aimed to identify and synthesise literature on the use of the WMTY initiative for patient care.

METHODS

The scoping review was guided by the Joanna Briggs Institute scoping review methodology. A systematic search of five databases was undertaken using the term 'What matters to you?' and limited to articles published between 2012 and 2023 in English. Primary research studies that used WMTY for patient care were included. Article characteristics, as well as interventions and key findings relevant to WMTY, were extracted. Quantitative data were analysed for descriptive statistics (counts and percentages). Qualitative content analysis was used to identify themes relevant to the aim.

RESULTS

Twenty articles were included in the review. WMTY was used for designing person-centred services, planning individual patient care, and understanding patients and families. Five key themes were identified from findings reported in the articles: (1) What matters to patients?, (2) Benefits of using WMTY, (3) Shortfalls of using WMTY, (4) Facilitators for implementing WMTY and (5) Barriers to implementing WMTY.

CONCLUSION

WMTY is a simple and versatile tool for supporting person-centred care, with perceived benefits for consumers, users and organisations. Implementation requires understanding of the phrase and consideration of contextual factors.

PATIENT OR PUBLIC CONTRIBUTION

Consumer representatives were involved in the review of findings, identification of key points for discussion and review of the manuscript.

Person-centered workplace culture: insights from an inpatient department for older adults with chronic illnesses

Introduction

An aging population and the increasing prevalence of chronic conditions challenge healthcare systems in developed countries. In response, there is a growing emphasis on person-centered care, as advocated by the World Health Organization and integrated into national health strategies in countries such as the UK and Sweden. However, transitioning to person-centered care is a complex, long-term process shaped by organizational culture and care environments. These contextual factors play crucial roles in the development and sustainability of person-centered practice, significantly transforming the experiences of both older adults and staff.

Objective

To describe how workplace culture within an inpatient hospital department shapes person-centered care practices for older adults with chronic illnesses.

Methods

A qualitative, descriptive, exploratory-observational study was performed. Data were collected through participant observation guided by the Workplace Culture Critical Analysis Tool®. In a deductive thematic content analysis, data patterns of meaning were identified. The themes were generated underpinned by the Person-Centered Practice Framework dimensions of prerequisites, the practice environment, and person-centered processes and their respective constructs.

Results

Themes related to all person-centered practice dimensions were identified. Task demands during shifts create tension between routine-oriented work and the holistic, individualized approach required for person-centeredness. The absence of systematic multiprofessional team meetings further exacerbates this issue, limiting collaborative decision-making and personalized care planning. The contrasts in some subthemes may be related to discrepancies in the care provided by different professionals.

Conclusion

This study highlights the tension between routine-driven care and individualized approaches. Addressing identified challenges, such as formalizing multiprofessional meetings and enhancing reflective practices, is crucial for advancing person-centered care in this setting.

Patient Performance of Care Tasks During Acute Hospitalisation: A Scoping Review

BACKGROUND

Patient self-care is established as improving outcomes, yet acute care in hospitals is provided such that patients tend to be passive recipients of care. Little is known about the extent and type of patient participation in treatment care tasks in acute hospital settings.

AIMS

To map and synthesise available literature on self-performance of care tasks in acute hospital settings.

DESIGN

A scoping review was conducted guided by JBI methodology.

METHODS

A literature search was conducted in July 2021 and updated in March 2024 across five databases: Scopus, PubMed, CINAHL, Embase and Web of Science. Studies were screened using predefined eligibility criteria. Full-text screening and data extraction were performed independently by two researchers. Data were collected using a template specifically designed for this review. Reporting followed the PRISMA-ScR guideline.

RESULTS

Of the 31,361 articles identified, 35 were included. Most of the articles were experimental (n = 20) and conducted in Europe (n = 13), North America (n = 10) and Australia (n = 3). Studies were classified according to investigation of the performance of care tasks (n = 6) or of the outcomes of the performance of the self-care task (n = 29). Most tasks performed involved self-administration of medication (n = 31), only 4 articles referred to other care tasks. Most articles focused on acute tasks (n = 18), while 15 articles referred to chronic care tasks. Ostomy self-care (n = 2) was a separate category, being an acute task that continued into chronic self-care.

CONCLUSION

Performance of care tasks by patients in acute care settings are predominantly related to chronic and pain medication administration.

IMPLICATIONS FOR CARE

Patient preferences and competency to self-perform care tasks during hospitalisation should be assessed and monitored and supported accordingly. Utilising hospitalisation time to observe and assess self-care practices could provide additional teaching opportunities to patient self-care and improve overall care continuity.

REPORTING METHOD

The PRISMA-ScR guideline was followed.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

TRIAL AND PROTOCOL REGISTRATION

This review was registered on Open Science Framework before running the final search: (https://doi.org/10.17605/OSF.IO/D8KS2).

A framework for the continuous monitoring of person-centred hospital care: validation of a checklist for participatory service improvement

BACKGROUND

In 2018, a nationwide survey carried out in 387 acute care hospitals from 16 out of 21 Italian regions, allowed defining an extended checklist for the participatory evaluation of person-centredness in hospital care. We aimed to validate a reduced set of core items for continuous use across the country.

METHODS

Factor analysis was used to validate the construct of the checklist. Varimax rotation with eigenvalues > 1 was used to optimize factor structure. Items with an item-total correlation > 0.30 and factor loadings > 0.4 were attributed to individual factors. Items with inter-item correlation coefficient > 0.70 were submitted to expert opinion for final decision. Overall internal consistency was assessed through Cronbach's alpha.

RESULTS

A total of 183 out of 243 items in the original checklist were submitted to factor analysis. A subgroup of 67 items was retained in 4 main areas, allocated as follows: 16 items in 4 sub-areas of "Person-oriented organizational and care processes", 16 items in 4 sub-areas of "Physical accessibility, liveability and comfort of the facilities", 15 items in 3 sub-areas of "Access to information, streamlining and transparency", and 20 items in 4 sub-areas of "Taking care of the relationship with patients and citizens". Overall values of Cronbach's alpha ranged between 0.77 and 0.90, showing high consistency.

CONCLUSIONS

This study validated a "core" checklist that can be routinely used to monitor the implementation of person-centred care in Italian hospitals. The tool can be applied more widely by multiple stakeholders as a measurement instrument for the participatory evaluation of person-centredness.

Neurosurgical Patients' Preferences and Experiences of Involvement During Hospitalization

BACKGROUND

There has been an increased focus on patient involvement in health care worldwide, with studies showing that involving patients in their treatment and care is associated with positive outcomes. However, there is a dearth of knowledge about inpatient preferences and experiences of involvement in neurosurgery in Scandinavian countries. This study aimed to identify inpatients' preferences regarding their involvement in their treatment and the extent to which they experienced being involved in their treatment and care during admission.

METHODS

A questionnaire survey was administered in a neurosurgical department. Patients' preferences and experiences regarding their involvement in their treatment and care were assessed using a validated questionnaire.

RESULTS

One hundred patients were enrolled in the study. Eighty-two percent of them preferred sharing responsibility for their treatment with their doctor; 16% preferred leaving their treatment decisions entirely up to the doctor; and 2 percent preferred making the final decision about their treatment independently. The average participation score for information, communication, and participation was 4.08, suggesting that the patients experienced a high level of involvement in their care and treatment. Thirty patients reported preferences for changes during admission, while 25 suggested ideas for improvement.

CONCLUSIONS

The patients mostly preferred shared decision-making about their treatment during hospitalization and generally reported high involvement in their treatment and care. The results showed a desire for improved information sharing and dialog among healthcare professionals, patients, and relatives.

How Do Nurses Experience Relational Work in the Emergency Department-Qualitative Study

INTRODUCTION

This study aimed to explore how nurses experience relational work in the emergency department.

METHODS

A qualitative design with 34 focus group interviews using an abductive thematic analysis were completed for this study. Participants were recruited from an annual mandatory continuous learning program in 2020-2022 at 2 university hospitals in the Capital Region of Denmark. We applied semistructured interviews in an instructor-supported reflection session on the topic "relational nursing care." Group discussion was supported by an interview guide addressing key elements of the nurse-patient relationship as described in the fundamentals of care framework.

RESULTS

Acute care nurses' attention was primarily directed toward the initial patient assessment, rather than toward the later stages of the patient trajectory. Forming a relationship with the patient was highly individual and done at the discretion of each nurse. The key elements of relational nursing were not mutually exclusive, but the findings could be separated into biomedical and relational care, where biomedical tasks took precedence.

DISCUSSION

Relational care in the emergency department is optional and individually performed. Moreover, emergency nurses lack a vocabulary to express this type of work. Consequently, there is a risk that patients' psychosocial needs are not sufficiently met. According to the emergency nurses participating in this study, nurses fall short when performing and describing relational care. Nurses need more knowledge to address the psychosocial patient needs during short-term hospital admissions. Relational care and patient centeredness also need to be acknowledged by nursing leaders and further developed.

Structural validation of two person-centred practice inventories PCPI-S and PCPI-C - French version

BACKGROUND

The shift towards person-centred care has become integral in achieving high-quality healthcare, focusing on individual patient needs, preferences, and values. However, existing instruments for measuring person-centred practice often lack theoretical underpinnings and comprehensive assessment. The Person-centred Practice Inventory - Staff (PCPI-S) and the Person-centred Practice Inventory - Care (PCPI-C) were developed in English to measure clinicians' and patients' experience of person-centred practice. The aim of this study was to investigate the psychometric properties of the French version of the PCPI-S and PCPI-C.

METHODS

A multi-centred cross-sectional study was conducted in six hospitals in French-speaking Switzerland. Construct validity of the PCPI-S and the PCPI-C was evaluated by using confirmatory factor analysis and McDonald's Omega coefficient was used to determine the internal consistency.

RESULTS

A sample of 558 healthcare professionals and 510 patients participated in the surveys. Psychometric analyses revealed positive item scores and acceptable factor loadings, demonstrating the meaningful contribution of each item to the measurement model. The Omega coefficient indicated acceptable to excellent internal consistency for the constructs. Model fit statistics demonstrated good model fit for the PCPI-S and PCPI-C.

CONCLUSIONS

The findings support the construct validity and internal consistency of the PCPI-S and PCPI-C in assessing person-centred practice among healthcare professionals and patients in French-speaking Switzerland. This validation offers valuable tools for evaluating person-centred care in hospital settings.

Dementia-Friendly Hospital-The Perspective of Professional Dementia Experts

AIM

To investigate the professional dementia experts' understanding of a dementia-friendly hospital to identify its characteristics.

DESIGN

We used a qualitative design embedded in a case study. A total of 16 semi-structured expert interviews were conducted with 17 professional dementia experts. Using inductive content analysis, the interviews were analysed in a participatory manner involving a group of researchers and dementia experts.

RESULTS

We identified six characteristics of dementia-friendly hospitals: Proud to be dementia-friendly-That's what we want; Seeing the human being-Taking care of everyone; Having everyone on board-It's a collective task; Being professional-It takes more than being nice and kind; Rethinking the 'running' system-We have to change, not them; and Being part of the community-Thinking beyond the hospital.

CONCLUSION

The concept of a dementia-friendly hospital seems complex and requires a rethinking of the traditional hospital. For a conceptualisation, the involvement of people with dementia and their relatives is important to gain a comprehensive understanding.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

A dementia-friendly hospital is characterised by professional care that comprises a safe, familiar and supportive environment, is prepared but also flexible, has everyone on board, and sees the human being. To become dementia-friendly, individual interventions such as training courses can be a starting point. However, an overall concept is required that also includes components that contribute to successful implementation and a welcoming culture of people with dementia.

IMPACT

Our findings on the perspective of professional dementia experts contribute to the conceptualisation of dementia-friendly hospitals.

REPORTING METHOD

We reported our study according to the COREQ checklist.

PATIENT AND PUBLIC CONTRIBUTION

The investigation of the perspective of professional dementia experts is one part of a larger study. In this overall DEMfriendlyHospital study, we interviewed professional dementia experts, people with dementia and their relatives and also involved them in a participatory manner in various stages of the research process.

Becoming partners in rehabilitation with patients in intensive care: physiotherapists' perspectives

PURPOSE

Person-centred care is widely accepted as being central to high quality care, but little is known about how physiotherapists implement person centred rehabilitation in Intensive Care. This study explores the self-reported experiences and interpretations of physiotherapists delivering person-centred rehabilitation in this setting.

METHODS

A qualitative study using Interpretative Phenomenological Analysis explored the lived experiences of physiotherapists and students who have worked in Intensive Care. Three focus groups, with four participants in each, were conducted. Data were fully transcribed, analysed and managed using NVivo software.

RESULTS

Participants shared similar interpretations about the principles of person-centred care. Operationalising person-centred rehabilitation during early recovery was not easily achievable. As the person's clinical condition improved, participants moved away from routine physiotherapy and their practice became more person-centred through the development of a partnership. Participants connected as humans to understand the person and respond to their needs within a culture that valued person-centred care.

CONCLUSIONS

Physiotherapists aspire to develop a partnership with their patients by connecting on a human level with them and addressing their biopsychosocial needs. Physiotherapists with experience of developing patient partnerships influence the culture of the Intensive Care team and are role-models to facilitate collaborative person-centred activity in others.

Perspectives of older adults with chronic illness on person-centered practice at an inpatient hospital department: a descriptive study

BACKGROUND

The growing aging trend associated with a higher prevalence of chronic illnesses is increasing the demand for the development of person-centered practice in specific care settings. Knowing the person's perception of the care and the care experience is essential to improving inpatient care toward person-centeredness. This study aims to characterize the perceptions of person-centered practice of hospitalized older adults with chronic illness at a Portuguese inpatient hospital department.

METHODS

A quantitative, descriptive, cross-sectional approach was followed. Data were collected using a sociodemographic and health history questionnaire and the Person-Centered Practice Inventory - Care (PCPI-C). The effect of the different variables on each PCPI-C construct was determined using analysis of variance (ANOVA).

RESULTS

The results show that person-centered practice was positively perceived in the five constructs of the person-centered processes domain (M = 3.92; SD = 0.47). The highest-scored construct was working with the person's beliefs and values (M = 4.12; SD = 0.51), and the lowest was working holistically (M = 3.68; SD = 0.70). No significant effect of the independent variables was found to influence the perceptions of any of the constructs in the person-centered processes domain.

CONCLUSIONS

These results might indicate that person-centered processes are perceived uniquely by each person through individualized therapeutic relationships rather than a pattern of care shared by hospitalized older adults.

Patient-centered care in diabetes care-concepts, relationships and practice

We still do not have comprehensive knowledge of which framework of patient-centered care (PCC) is appropriate for diabetes care, which elements of PCC are evidence-based, and the mechanism by which PCC elements are associated with outcomes through mediators. In this review, we elaborate on these issues. We found that for diabetes care, PCC elements such as autonomy support (patient individuality), cooperation and collaboration (system-level approach), com-munication and education (behavior change techniques), emotional support (biopsychosocial approach), and family/other involvement and support are critically important. All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation. We present the practical implications of these PCC elements.

Patient experience of emergency department triage: An integrative review

BACKGROUND

Emergency department (ED) triage is often patients' first contact with a health service and a critical point for patient experience. This review aimed to understand patient experience of ED triage and the waiting room.

METHODS

A systematic six-stage approach guided the integrative review. Medline, CINAHL, EmCare, Scopus, ProQuest, Cochrane Library, and JBI database were systematically searched for primary research published between 2000-2022 that reported patient experience of ED triage and/or waiting room. Quality was assessed using established critical appraisal tools. Data were analysed for descriptive statistics and themes using the constant comparison method.

RESULTS

Twenty-nine articles were included. Studies were mostly observational (n = 17), conducted at a single site (n = 23), and involved low-moderate acuity patients (n = 13). Nine interventions were identified. Five themes emerged: 'the who, what and how of triage', 'the patient as a person', 'to know or not to know', 'the waiting game', and 'to leave or not to leave'.

CONCLUSION

Wait times, initiation of assessment and treatment, information provision and interactions with triage staff appeared to have the most impact on patient experience, though patients' desires for each varied. A person-centred approach to triage is recommended.

Multicomponent processes to identify and prioritise low-value care in hospital settings: a scoping review

OBJECTIVES

This scoping review mapped and synthesised original research that identified low-value care in hospital settings as part of multicomponent processes.

DESIGN

Scoping review.

DATA SOURCES

Electronic databases (EMBASE, PubMed, CINAHL, PsycINFO and Cochrane CENTRAL) and grey literature were last searched 11 July and 3 June 2022, respectively, with no language or date restrictions.

ELIGIBILITY CRITERIA

We included original research targeting the identification and prioritisation of low-value care as part of a multicomponent process in hospital settings.

DATA EXTRACTION AND SYNTHESIS

Screening was conducted in duplicate. Data were extracted by one of six authors and checked by another author. A framework synthesis was conducted using seven areas of focus for the review and an overuse framework.

RESULTS

Twenty-seven records were included (21 original studies, 4 abstracts and 2 reviews), originating from high-income countries. Benefit or value (11 records), risk or harm (10 records) were common concepts referred to in records that explicitly defined low-value care (25 records). Evidence of contextualisation including barriers and enablers of low-value care identification processes were identified (25 records). Common components of these processes included initial consensus, consultation, ranking exercise or list development (16 records), and reviews of evidence (16 records). Two records involved engagement of patients and three evaluated the outcomes of multicomponent processes. Five records referenced a theory, model or framework.

CONCLUSIONS

Gaps identified included applying systematic efforts to contextualise the identification of low-value care, involving people with lived experience of hospital care and initiatives in resource poor contexts. Insights were obtained regarding the theories, models and frameworks used to guide initiatives and ways in which the concept 'low-value care' had been used and reported. A priority for further research is evaluating the effect of initiatives that identify low-value care using contextualisation as part of multicomponent processes.

The Concept of Child-Centred Care in Healthcare: A Scoping Review

Although child-centred care is increasingly referred to within the nursing literature, a clear definition of child-centred care and clarity around the concept is yet to be achieved. The objectives of this review were to examine the following: (1) What constitutes the concept of child-centred care in healthcare? (2) How has the concept of child-centred care developed? (3) What is the applicability of child-centred care and what are its limitations? (4) How does the concept of child-centred care benefit and inform children's healthcare? In total, 2984 papers were imported for screening, and, following the removal of duplicates and screening, 21 papers were included in the scoping review. The findings suggest that child-centred care is an emerging, ambiguous poorly defined concept; no clear consensus exists about what constitutes child-centred care. Although it seems antithetical to argue against child-centred care, little robust evidence was identified that demonstrates the impact and benefit of child-centred care. If child-centred care is to be a sustainable, convincing model to guide practice and compete with other models of care, it needs to establish robust evidence of its effectiveness, the impact on children and their families, as well as the wider impacts on the healthcare system.

COVID-19 Mitigation Activities in Inpatient Psychiatry Were Associated With Patient-Reported Institutional Betrayal, Changes in Trust, and Fear of Getting Sick

Institutional betrayal occurs when the institutions that people depend on fail to protect them from harm, which was exemplified by a failure to manage COVID-19 risks. Inpatient psychiatry provides a rich context for which to understand the effects of institutional betrayal, and this is amplified in the context of the COVID-19 pandemic. Using a retrospective cohort design, we administered an online survey to former patients (n = 172) of inpatient psychiatry hospitalized at the height of the COVID-19 pandemic (March 2020 to February 2021) to understand the relationship between facilities' use of COVID-19 mitigation activities (ie, offering or requiring face masks, keeping patients and staff 6 feet apart, access to hand sanitizer, use of telemedicine for clinical consults, and routine cleanliness of the unit) and former patients' reports of institutional betrayal, changes in their trust in mental healthcare providers, fear of getting sick, and having contracted or witnessed someone else contract COVID-19. The quantity of COVID-19 mitigation activities was monotonically negatively associated with the probability of reporting any betrayal, the probability of reduced trust in mental healthcare providers, and the probability of being afraid of getting sick always or most of the time while hospitalized. COVID-19 mitigation activities either directly affected these psychological outcomes, or facilities that engaged in robust mitigation had greater cultures of safety and care quality. Additional qualitative work is needed to understand these mechanisms.

Expanded nursing roles to promote person-centred care for people with cognitive impairment in acute care (ENROLE-acute): study protocol for a controlled clinical trial, process and economic evaluation

BACKGROUND

For people with cognitive impairment, hospitalisation is challenging and associated with adverse events as well as negative outcomes resulting in a prolonged hospital stay. Person-centred care can improve the quality of care and the experience of people with cognitive impairment during hospitalisation. However, current care processes in German hospitals are rarely person-centred. To enable successful implementation of person-centred care on hospital wards, change agents within the interprofessional team are key. The aim of this study is to test the feasibility and initial effects of a newly developed complex person-centred care intervention for people with cognitive impairment provided by expanded practice nurses in acute care.

METHODS

We will conduct an exploratory non-randomised controlled clinical trial with accompanying process and cost evaluation with three intervention and three control wards at one university hospital. The person-centred care intervention consists of 14 components reflecting the activities of expanded practice nurses within the interprofessional team on the intervention wards. The intervention will be implemented over a six-month period and compared with optimised care on the control wards. We will include people aged 65 years and older with existing cognitive impairment and/or at risk of delirium. The estimated sample size is 720 participants. The primary outcome is length of hospital stay. Secondary outcomes include prevalence of delirium, prevalence of agitation, sleep quality, and person-centred care. We will collect patient level data at six time points (t1 admission, t2 day 3, t3 day 7, t4 day 14, t5 discharge, t6 30 days after discharge). For secondary outcomes at staff level, we will collect data before and after the intervention period. The process evaluation will examine degree and quality of implementation, mechanisms of change, and the context of the complex intervention. The economic evaluation will focus on costs from the hospital's perspective.

DISCUSSION

The ENROLE-acute study will provide insights into the effectiveness and underlying processes of a person-centred care intervention for people with cognitive impairment provided by expanded practice nurses on acute hospitals wards. Results may contribute to intervention refinement and evidence-based decision making.

TRIAL REGISTRATION

Current controlled trials: ISRCTN81391868. Date of registration: 12/06/2023. URL: https://doi.org/10.1186/ISRCTN81391868.

Patient's views of empathic and compassionate healthcare interactions: A scoping review

BACKGROUND

Compassion and empathy are integral to safe and effective patient care. However, to date, most studies have focused on exploring, defining, measuring and analysing empathy and compassion from the perspective of researchers or clinicians. There has been limited attention to the perspectives of patients.

OBJECTIVE

The objective of this scoping review was to map the literature to identify patients' views of healthcare provider behaviours that exemplify empathic and compassionate interactions.

METHOD

This review used the Joanna Briggs Institute scoping review methodology. A comprehensive search of eight electronic databases was conducted with English language studies published in the last 10 years considered for inclusion.

RESULTS

Database searching resulted in 459 records for initial screening. After de-duplication and conducting a title and abstract review, 32 full-text articles were screened for eligibility. A total of 14 studies met the inclusion criteria and were critically reviewed using the Mixed Methods Appraisal Tool. The included papers profiled studies that had been conducted in clinical settings across seven countries. The healthcare encounters described in the papers were with a range of healthcare providers. Two overarching and interconnected categories of behaviours were identified as indicative of empathic/compassionate encounters: (1) communication skills such as listening, touch, body language, eye contact and positive demeanour; and (2) helping behaviours demonstrated by small acts of kindness that go beyond routine healthcare.

CONCLUSION

Given the breadth of studies describing the positive impact of empathy/compassion on people's physical and psychosocial wellbeing, the results from this review are valuable and shed new light on patients' views and experiences. The results provide a deeper understanding of healthcare provider behaviours that exemplify empathic and compassionate healthcare interactions and can be used to inform the education and training of healthcare providers from all disciplines.