Empowerment, disempowerment and the care of older people

Visualized Emotion Ontology: a model for representing visual cues of emotions

BACKGROUND

Healthcare services, particularly in patient-provider interaction, often involve highly emotional situations, and it is important for physicians to understand and respond to their patients' emotions to best ensure their well-being.

METHODS

In order to model the emotion domain, we have created the Visualized Emotion Ontology (VEO) to provide a semantic definition of 25 emotions based on established models, as well as visual representations of emotions utilizing shapes, lines, and colors.

RESULTS

As determined by ontology evaluation metrics, VEO exhibited better machine-readability (z=1.12), linguistic quality (z=0.61), and domain coverage (z=0.39) compared to a sample of cognitive ontologies. Additionally, a survey of 1082 participants through Amazon Mechanical Turk revealed that a significantly higher proportion of people agree than disagree with 17 out of our 25 emotion images, validating the majority of our visualizations.

CONCLUSION

From the development, evaluation, and serialization of the VEO, we have defined a set of 25 emotions using OWL that linked surveyed visualizations to each emotion. In the future, we plan to use the VEO in patient-facing software tools, such as embodied conversational agents, to enhance interactions between patients and providers in a clinical environment.

Hospital discharge: lost opportunities to promote or maintain older people’s mental health

Purpose

The purpose of this paper is to explore the impact of hospital discharge on the wider wellbeing of older people, drawing out implications this can have on mental health.

Design/methodology/approach

This paper is based on research from the Healthwatch England Special Inquiry into hospital discharge. The paper focuses on the experiences of 1,300 older people, with the majority of the research being undertaken by the local Healthwatch network. The 58 local Healthwatch who submitted evidence on the experiences of older people as part of the inquiry were autonomous in how they were able to carry out the research, with results being analysed through use of a qualitative framework.

Findings

Older people often felt they were not ready for discharge due to not feeling involved in planning of their discharge, being discharged without the information they need and having difficulties accessing aftercare support. This paper examines the impact these issues can have on the mental health and wellbeing of older people, their carers and specifically patients with dementia both during and after discharge from hospital. Through examination of these issues the discharge process can be viewed from the perspective of the individual, and start to conceptualise where the hospital discharge process could further support older people’s mental health and wellbeing.

Research limitations/implications

This paper examines these issues in detail through case studies collected regarding older people, and exposes the impact poor discharge can have on physical and mental wellbeing for older patients. The paper presents a number of issues which have implications for policy and practice in both health and social care, and the integration of the two services.

Originality/value

This is the first Special Inquiry conducted by Healthwatch England in conjunction with the local Healthwatch network and presents a large scale piece of research led by the experiences of older people.

Reasons for inpatients not to seek clarity at Dr George Mukhari Academic Hospital, Pretoria

Background

Healthcare practitioners should provide patients with information regarding their clinical conditions. Patients should also feel free to seek clarity on information provided. However, not all patients seek this clarity.

Objectives

To explore the reasons inpatients gave for not seeking clarity on information that was received but not understood.

Methods

This was a qualitative arm of a larger study, titled ‘Are inpatients aware of the admission reasons and management plans of their clinical conditions? A survey at a tertiary hospital in South Africa’, conducted in 2010. Of the 264 inpatients who participated in the larger study, we extracted the unstructured responses from those participants (n = 152) who had indicated in the questionnaire that there was information they had not understood during their encounter with healthcare practitioners, but that they had nonetheless not sought clarity. Data were analysed thematically.

Results

Themes that emerged were that inpatients did not ask for clarity as they perceived healthcare practitioners to be ‘too busy’, aloof, non-communicators and sometimes uncertain about patients’ conditions. Some inpatients had unquestioning trust in healthcare practitioners, whilst others had experiences of bad treatment. Inpatients had poor self-esteem, incapacitating clinical conditions, fear of bad news and prior knowledge of their clinical conditions. Some inpatients stated that they had no reason for not seeking clarity.

Conclusion

The reasons for not seeking clarity were based on patients’ experiences with the healthcare practitioners and their perceptions of the latter and of themselves. A programme should be developed in order to educate inpatients on effective communication with their healthcare practitioners.

Concept Analysis of Empowerment From Survivor and Nurse Perspectives Within the Context of Cancer Survivorship

The liberal usage of the concept of empowerment has led to the development of a broad and ambiguous term. In health care, empowerment is a core principle of patient-centered care that promotes patient engagement in health management. This is an analysis of the concept of empowerment within the context of cancer survivorship using both Rodgers’ evolutionary concept analysis and Caron and Bower’s dimensional analysis. The dimensional analysis followed the evolutionary concept analysis as the perspectives of patients and nurse providers emerged in the analysis. Data sources included a sample of 249 papers from multiple disciplines covering the period 2000–2013. Empowerment is defined as power-with that is actualized through a beneficial relationship of mutual trust and respect for autonomy that develops within a dynamic and patient-centered process. The attributes, along with the antecedents and consequences, provide a foundation for future theory development of empowerment in the context of cancer survivorship. This analysis demonstrated that although nurses and survivors may have a similar definition of the concept of empowerment, the uses and assumptions of that definition may differ. Future studies should be conducted measuring the effectiveness of an intervention that uses the components of the process of empowerment from survivors’ perspectives.

Factors influencing older patients' participation in care: a review of the literature

BACKGROUND

Over the past 10 years, there has been an increase in the literature promoting patient involvement in health care at all levels of the decision-making process.

AIM

To review the literature on factors influencing patient participation in care with a particular focus on the perspective of older people.

METHOD

Various search engines were used to conduct the review and articles were identified through the following databases; CINAHL, CSA ILLUMINA, Science Direct, Blackwell Synergy, the Cochrane Library, OVID, SAGE, AHMED, BNI and MEDLINE. Research studies ranging from 2000-2007 were selected for inclusion on the basis that they investigated patient participation and/or older peoples' involvement in health care.

FINDINGS

Seven key themes emerged from the literature: the concept of participation, the need for older people to be involved, autonomy and empowerment, patients' expectations, benefits of participation, factors influencing participation and precursors to participation.

CONCLUSIONS

Although patient participation has received considerable attention in the literature, this review highlights the dearth of research from the perspective of older people. There is a general consensus that preference for participation should be assessed and not assumed, and the review offers a sobering reminder that participation should not be achieved at the expense of patient autonomy and choice.

RELEVANCE TO PRACTICE

Quality care and the most productive use of resources are dependent on the public's engagement with health service providers. However, despite being central to contemporary nursing practice, this review suggests that the reality is not matched by the rhetoric. Future initiatives should focus on supporting nurses and other healthcare professionals to develop the competencies required to facilitate greater participation by older people who wish to become more involved in their care.

The care of older people with dementia in acute hospitals

AIM

To explore the experiences of patients and nursing staff of the care received by older people with dementia in acute hospitals.

BACKGROUND

The prevalence of dementia is steadily increasing as is the number of people with the condition requiring acute hospital care. Significant concerns about the quality of this care have been raised. There is a paucity of knowledge about the views of such care from the perspectives of people with dementia and nurses.

METHOD

An ethnographic approach was used and data were collected thorough observation and interviews in one acute hospital in the United Kingdom.

FINDINGS

Findings suggest that care for older people with dementia in acute hospitals is not always optimum although there are clear exceptions. Generally, people with dementia found the delivery of care and the experience of being in hospital distressing as they did not know what was happening and they were often ignored. Nurses strive to give good care but do not always achieve this.

CONCLUSION

Bourdieu's Model of Practice assists in explaining why care is as it is. There is a clear need to improve current practice.

RELEVANCE TO CLINICAL PRACTICE

It is imperative that innovative methods of developing practice are implemented and evaluated. Education alone will not lead to sustained changes in practice. Further research into this subject needs to be undertaken.

Empowerment in older psychiatric inpatients: development of the empowerment questionnaire for inpatients (EQuIP)

OBJECTIVE

To develop a questionnaire that measures levels of empowerment experienced by older adults admitted to a psychiatric ward.

DESIGN

Diverse views were sought to inform the questionnaire through a triangulation method; opinions of researchers were collected through a Delphi survey, clinical staff from different disciplines completed questionnaires, and patients participated in two focus group sessions. Once the questionnaire was developed, the authors asked patients to complete it alongside other instruments.

SETTINGS

Eight psychiatric wards of seven hospitals in and around London for people aged more than 65 years with a range of organic and functional mental health problems.

PARTICIPANTS

Eighty-seven patients with a functional psychiatric diagnosis participated in the psychometric evaluation of the instrument; 28 completed the scale twice for test-retest reliability.

MEASURES

Measures of quality of life (World Health Organisation Quality of Life - Abbreviated Version), degree of dependency (Care Dependency Scale), satisfaction with care (Psychiatric Care Satisfaction Questionnaire [PCSQ]), and psychosocial functioning (GAF) were used to evaluate psychometric properties of the empowerment questionnaire for inpatients (EQuIP).

RESULTS

The EQuIP is a measure of empowerment, which computes the subjective importance of the different aspects of psychiatric care for the individual patient. It had high internal consistency (Cronbach's alpha = 0.88) and reasonable concurrent validity (correlation with PCSQ as a measure of satisfaction with care, r(85) = 0.65, p = 0.01). High test-retest variability may signify fluidity of the construct of empowerment.

CONCLUSION

The EQuIP may be used to assess empowerment in older psychiatric inpatients.

Experiences of women with osteoarthritis in assisted living facilities

PURPOSE

Osteoarthritis is one of the most common causes of disability in older adults. To help patients self-manage their arthritis, nurses need a better understanding of experiences of living with arthritis. Many older adults with symptomatic osteoarthritis may reside in supportive housing such as assisted living facilities. Recognizing challenges and symptoms may lead to improved health and quality of life, as well as greater independence, for older adults with osteoarthritis.

METHODS

A naturalistic inquiry design was used to gather data from 23 older women. Transcriptions were analyzed by deconstruction and reconstruction.

RESULTS

Final themes are Restricting and Constricting, with intermediate categories of Not doing because of disability, Not doing by choice, Limiting ability to move without assistive devices, and Living within confining spaces.

CONCLUSIONS/IMPLICATIONS

Findings suggest the need for further examination of symptoms, symptom management, and interventions to improve healthcare and quality of life of patients with osteoarthritis.