PATIENT'S VIEW OF ADMISSION TO A LONDON TEACHING HOSPITAL

Informing hospital patients and their relatives about stroke

Seventy-three episodes of stroke leading to hospital admission were followed up over the first two weeks. Patients and their relatives were assessed shortly after admission to hospital for their knowledge about the predisposing causes of stroke, the nature of the patients' illness and the treatment that was being given, their prognoses and the nature of financial and other help that would be available to them when they returned home. After one week, half the patients and relatives received an informative leaflet about stroke. When their knowledge of these factors was later assessed, only 7% of the patients who had not received the leaflet and 30% of their relatives could recall having received any information about stroke since admission. The corresponding figures for those who had received the leaflet were 65% and 62% respectively. Those who had received a leaflet knew significantly more about the aetiology of stroke and the treatment they were receiving than those who had not, but the leaflet made no difference to the level of knowledge about the patient's specific prognosis, nor about the range of benefits that would be available at the time the patient returned home. It is suggested that ward staff underestimate the amount of information that can usefully be absorbed by patients and their relatives and in this way are failing to establish the optimal conditions for their rehabilitation.

Health education, cancer and postgraduate training

Cancer as a term encompasses a multitude of diseases and is consequently misunderstood. Today, it is still considered sinister and, too often, synonymous with death. It is a complex subject, exciting and challenging, yet the myths associated with cancer are perpetuated even by professionals in the health service. This can be attributed to the scant knowledge of its nature and prognosis, the progress made and the services available. When one considers the breadth of basic training needed to prepare both doctors and nurses to practise it is understandable. In a health service based on disease it is difficult to consider prevention as a priority. Financial implications are enormous and inhibit this aspect of the work in thefield of cancer and allied diseases. However, it is estimated that 80--90% of cancers are caused by environmental influences and can, in theory, be prevented. Efforts to promote health and prevent disease are costly and too often ineffective. Early diagnosis is another contentious subject; efforts are being directed to the establishment of clinics for patients presenting with symptoms rather than detection of symptom-free subjects. Improved approaches to prevention, recognition and acceptance through an understanding of cancer will alleviate the task of those directly involved in the cure and control of the disease. Health education in relation to cancer needs to be directed equally at health service professionals and the public. It would be unacceptable and inaccurate to describe the cancer services anywhere as incapable of further improvement. Research and therapy must go hand in hand and depend on the participation of the patient as a knowledgeable member of the team, rather than as a passive recipient of care. Death should not be considered failure, rather the completion of care. We face constantly the risk of despondency and the efforts of the team must be sustained with optimism and encouragement. Achievements have been made and will be made, however slowly, and the end justifies the effort. The need for postgraduate training is greater now than ever before. Adaptability to rapid change, vision and continuity are vital in our technologically orientated society. This should be considered a prerequisite to ensure improved standards of patient care at home and in hospital.

Managing anxiety in ICU patients: the role of pre-operative information provision

Hospital-induced patient anxiety and coping mechanisms are discussed. The value of giving pre-operative information to reduce anxiety in elective admissions to intensive care unit is discussed. Recommendations are given based on the literature evidence to aid service and practice development.

Objective measurement of anxiety in hypertensive pregnant women managed in hospital and in the community

OBJECTIVES

To determine whether pregnant hypertensives women are more anxious when monitored in hospital or at homes.

DESIGN

Prospective randomized controlled trial.

SETTING

Rosie Maternity Hospital and women's homes.

SUBJECTS

Ninety-nine pregnant hypertensive women: 50 had their blood pressure measured telemetrically from home, and 49 had it measured in hospital.

MAIN OUTCOME MEASURES

Number of episodes of monitoring, duration of monitoring, mean blood pressure during monitoring, gestational age at delivery, trait and state anxiety levels.

RESULTS

There were no significant differences in anxiety levels, or in any other outcome measure, between the home and hospital groups.

CONCLUSION

When blood pressure is being monitored serially in pregnant hypertensive women, there is no measurable difference in their anxiety levels, whether they are in hospital or at home.

Coping with an upper limb fracture? A study of the elderly

Upper limb fractures in the elderly, usually managed by immobilisation of the arm, limit activities to an unknown extent. Fifty-one patients in Middlesbrough, aged over 60 years and who had upper limb fractures, were interviewed in the fracture clinic. Most patients had difficulty in performing various activities of daily living (ADL) following their injury. Difficulties with ADL were significantly associated with shoulder immobilisation (P = 0.03) and age (P = 0.01) but not with life satisfaction (P = 0.18) or existing poor health (P = 0.39). Relatives and friends provided most of the necessary help, the contribution of the health and social services being relatively small. Patients received more help with activities like shopping, laundry and housework than personal activities such as bathing, using the toilet and dressing. The injury increased demands on the GPs, meals on wheels, home help, nursing and warden services. Unmet demand was mostly for chiropodists, bath attendants and physiotherapists. Most patients (95%) were satisfied with the help they received from their relatives and friends. Despite difficulty with the activities of daily living most patients coped well with support following their fracture. Demographic changes and the increasing incidence of fractures mean that the burden on both carers and health and social services will increase.

Satisfying patients' needs for surgical information

Patients facing operation need good information. This is implicit in informed consent but it is often lacking. A solution is a comprehensive set of leaflets covering 65 different general surgical operations. The leaflets describe the illness, operation, exact management regimen, some complications and outlook, in a deliberately simple style. Master copies are stored on a wordprocessor to allow unlimited expansion and updating. A retrospective survey of 200 patients showed that those receiving leaflets were significantly more satisfied with information (72 per cent overall) than those not receiving leaflets (42 per cent overall) (P less than 0.01). This was especially apparent for information about postoperative progress, both in hospital (92 per cent versus 52 per cent) and after discharge from hospital (88 per cent versus 39 per cent). The system is effective, cheap and popular with patients and medical and nursing staff. The wordprocessor allows extensive modifications of the information to suit other surgeons' requirements.

No news is bad news: patients' views about communication in hospital

One hundred patients on four general surgical wards in a large teaching hospital were interviewed about the information they had received about their illness and what they had been told about the investigations they had undergone. Fifty-five of them expressed some dissatisfaction and 14 were strongly dissatisfied. The way in which ward rounds were conducted was heavily criticised, but most patients did not object to the teaching of medical students at the bedside. Twenty-four patients would have liked more explanation about why investigations were performed, and 38 though that they had not been told enough about the results of their investigations. This lack of information led to anxiety and fear. The findings suggest that more effort is needed to improve communication between doctors and patients.

Communication in the clinical setting

Recent research on the problem of communicating with the patient is reviewed. It is shown that the frequent failures of both informative and persuasive communications are due in part to patients not understanding and to their forgetting what they are told.

Factors making for difficulties in communication are outlined, and methods are described for reducing failures of understanding and for increasing memory of what is said. Evidence on the effectiveness of these remedial methods is presented.

Psychiatric problems in otolaryngology

Otolaryngology and psychiatry both deal with disorders in communication and numerous clinical problems illustrate an overlap between these two disciplines. Primary psychiatric disorders may find somatic expression through otolaryngologic symptoms. In these situations attention must be directed at the underlying psychological disorder. Conversely, primary otolaryngologic disorders may have a broad range of psychological ramifications and complications. Among the areas in which examples are readily found are congenital problems, tonsillectomy and other childhood surgery, adolescent illnesses, cosmetic surgery, head and neck cancer and care of the dying patient.

Reactions of psychiatric outpatients to teaching interviews

In an attempt to assess some of the reactions of psychiatric outpatients attending a teaching clinic, a group of patients who received a letter warning them of the possible presence of students were compared with a group who did not receive such a letter. The "letter" group were generally more satisfied with their interview and were less likely to say that they had consciously withheld information. Greater satisfaction was also expressed by patients over 35.When asked whether they preferred to see one student in private and then the psychiatrist with a small group of other students, or to have the whole interview conducted by the psychiatrist in front of the group, patients expressed a clear preference for the former choice. This former method may also allow more responsible and active participation by the students.