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Pruijsten R, Ista E, Maben J, van Heel L, van Dijk M. Nurses' perceptions of the transition to 100% single-occupancy patient rooms in a university hospital in the Netherlands: an uncontrolled before and after study. BMC Nurs 2024; 23:106. [PMID: 38326800 PMCID: PMC10851588 DOI: 10.1186/s12912-024-01758-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/22/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND To improve patients' privacy, comfort and infection control, newly built hospitals increasingly offer 100% single-occupancy patient rooms. Our study examines how nurses perceived the transition from a hospital with multi-bedded patient rooms to one with solely single-occupancy patient rooms designed according to principles of a healing environment. METHODS In a single-centre, before-after survey study, nurses completed a questionnaire of 21 items in three domains: perceived patient safety and monitoring, nurses' working conditions and patient environment. Before-measurements (n = 217) were compared with two after-measurements in the new hospital, respectively after one (n = 483) and two years (n = 191). RESULTS Nurses considered the single rooms in the new hospital worse for visibility and monitoring but this had improved somewhat after two years. In either setting, the majority perceived working conditions (walking distances and designated rest area) as unfavourable. The patient environment in the new hospital was generally perceived as much better than in the former hospital. CONCLUSION The transition to solely single-occupancy patient rooms was largely considered positive by nurses in terms of patient environment. However, monitoring of patients and working conditions remain a concern. When designing new hospitals, attention should be paid to optimal working conditions for nurses. To improve monitoring of patients, we recommend the use of remote-sensoring.
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Affiliation(s)
- Ralph Pruijsten
- Section Nursing Science, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
- Department of Intensive Care, Ikazia hospital, Rotterdam, the Netherlands.
| | - Erwin Ista
- Section Nursing Science, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Liesbeth van Heel
- Department of Public Health, Real Estate Department, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique van Dijk
- Section Nursing Science, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Herlitz L, Crellin N, Vindrola-Padros C, Ellins J, Georghiou T, Litchfield I, Massou E, Ng PL, Sherlaw-Johnson C, Sidhu MS, Tomini SM, Walton H, Fulop NJ. Patient and staff experiences of using technology-enabled and analogue models of remote home monitoring for COVID-19 in England: A mixed-method evaluation. Int J Med Inform 2023; 179:105230. [PMID: 37774428 DOI: 10.1016/j.ijmedinf.2023.105230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/24/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To evaluate patient and staff experiences of using technology-enabled ('tech-enabled') and analogue remote home monitoring models for COVID-19, implemented in England during the pandemic. METHODS Twenty-eight sites were selected for diversity in a range of criteria (e.g. pre-hospital or early discharge service, mode of patient data submission). Between February and May 2021, we conducted quantitative surveys with patients, carers and staff delivering the service, and interviewed patients, carers, and staff from 17 of the 28 services. Quantitative data were analysed using descriptive statistics and both univariate and multivariate analyses. Qualitative data were interpreted using thematic analysis. RESULTS Twenty-one sites adopted mixed models whereby patients could submit their symptoms using either tech-enabled (app, weblink, or automated phone calls) or analogue (phone calls with a health professional) options; seven sites offered analogue-only data submission (phone calls or face-to-face visits with a health professional). Sixty-two patients and carers were interviewed, and 1069 survey responses were received (18 % response rate). Fifty-eight staff were interviewed, and 292 survey responses were received (39 % response rate). Patients who used tech-enabled modes tended to be younger (p = 0.005), have a higher level of education (p = 0.011), and more likely to identify as White British (p = 0.043). Most patients found relaying symptoms easy, regardless of modality, though many received assistance from family or friends. Staff considered the adoption of mixed delivery models beneficial, enabling them to manage large patient numbers and contact patients for further assessment as needed; however, they suggested improvements to the functionality of systems to better fit clinical and operational needs. Human contact was important in all remote home monitoring options. CONCLUSIONS Organisations implementing tech-enabled remote home monitoring at scale should consider adopting mixed models which can accommodate patients with different needs; focus on the usability and interoperability of tech-enabled platforms; and encourage digital inclusivity for patients.
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Affiliation(s)
- Lauren Herlitz
- NIHR Children and Families Policy Research Unit, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Nadia Crellin
- Nuffield Trust, 59 New Cavendish St, London W1G 7LP, UK
| | - Cecilia Vindrola-Padros
- Department of Targeted Intervention, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Jo Ellins
- Health Services Management Centre, School of Social Policy, University of Birmingham, 40 Edgbaston Park Road, Birmingham, B15 2RT, UK
| | | | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, 40 Edgbaston Park Road, Birmingham, B15 2RT, UK
| | - Efthalia Massou
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Pei Li Ng
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, UK
| | | | - Manbinder S Sidhu
- Health Services Management Centre, School of Social Policy, University of Birmingham, 40 Edgbaston Park Road, Birmingham, B15 2RT, UK
| | - Sonila M Tomini
- Global Business School for Health, University College London, Gower Street. Bloomsbury London SC1E 6BT, UK
| | - Holly Walton
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, UK
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Jessup RL, Awad N, Beauchamp A, Bramston C, Campbell D, Semciw A, Tully N, Fabri AM, Hayes J, Hull S, Clarke AC. Staff and patient experience of the implementation and delivery of a virtual health care home monitoring service for COVID-19 in Melbourne, Australia. BMC Health Serv Res 2022; 22:911. [PMID: 35831887 PMCID: PMC9277602 DOI: 10.1186/s12913-022-08173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Provision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic. METHODS A descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews. RESULTS All 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data. CONCLUSION Rapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.
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Affiliation(s)
- R L Jessup
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia. .,Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia. .,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, 3086, Australia. .,School of Rural Health, Monash University, Sargeant St, Warragul, 3820, Australia.
| | - N Awad
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
| | - A Beauchamp
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia.,School of Rural Health, Monash University, Sargeant St, Warragul, 3820, Australia.,Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - C Bramston
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, 3086, Australia
| | - D Campbell
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia.,Faculty of Art, Design and Architecture, Monash University, Clayton, Victoria, Australia
| | - Al Semciw
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, 3086, Australia
| | - N Tully
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
| | - A M Fabri
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
| | - J Hayes
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
| | - S Hull
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
| | - A C Clarke
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia
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Hung L, Yang SC, Guo E, Sakamoto M, Mann J, Dunn S, Horne N. Staff experience of a Canadian long-term care home during a COVID-19 outbreak: a qualitative study. BMC Nurs 2022; 21:45. [PMID: 35189873 PMCID: PMC8860265 DOI: 10.1186/s12912-022-00823-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background COVID-19 has significant impact on long-term care (LTC) residents and staff. The purpose of this paper is to report the data gathered during a COVID-19 outbreak in a Canadian LTC home regarding staff experiences, challenges, and needs, to offer lessons learned and implications. Methods A total of 30 staff from multiple disciplines participated in the study, including nurses, care workers, recreational staff, and a unit clerk. Focus groups (n = 20) and one-on-one interviews (n = 10) were conducted as part of a larger participatory action research (PAR) study in a Canadian LTC home. All data collection was conducted virtually via Zoom, and thematic analysis was performed to identify themes. Results Four main themes were identified: We are Proud, We Felt Anxious, We Grew Closer to Residents and Staff Members, and The Vaccines Help. Conclusions This research details the resilience that characterizes staff in LTC, while highlighting the emotional toll of the pandemic, particularly during an outbreak. LTC staff in this study found innovative ways to connect and support residents and this resulted in stronger connections and relationships. Leadership and organizational support are pivotal for supporting team resilience to manage crisis and adapt positively in times of COVID-19 pandemic, especially during the period of outbreak.
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Affiliation(s)
- Lillian Hung
- University of British Columbia School of Nursing, Vancouver, Canada
| | - Sophie C Yang
- University of British Columbia School of Nursing, Vancouver, Canada.
| | - Ellen Guo
- University of British Columbia School of Nursing, Vancouver, Canada
| | - Mariko Sakamoto
- University of British Columbia School of Nursing, Vancouver, Canada
| | - Jim Mann
- University of British Columbia, Vancouver, Canada
| | - Sheila Dunn
- Community Engagement Advisory Network (Vancouver Coastal Health), Vancouver, Canada
| | - Neil Horne
- Community Engagement Advisory Network (Vancouver Coastal Health), Vancouver, Canada
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Wand T, Collett G, Cutten A, Buchanan-Hagen S, Stack A, White K. Patient and staff experience with a new model of emergency department based mental health nursing care implemented in two rural settings. Int Emerg Nurs 2021; 57:101013. [PMID: 34134083 DOI: 10.1016/j.ienj.2021.101013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/28/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND As part of a larger multi-site translational research project this study explored patient and staff experiences, perspectives and recommendations in relation to a mental health liaison nursing (MHLN) service implemented in the emergency department (ED) of two rural hospitals in New South Wales, Australia. METHODS Semi-structured interviews were conducted across the two sites with a sample of ED patients (n = 32), ED nurses (n = 14), ED medical officers (n = 11) and psychiatrists (n = 3). Data were analysed thematically. FINDINGS Patients highlighted the therapeutic benefits of the MHLNs, particularly being listened to and understood. Patients appreciated being seen promptly and having effective follow-up. Some negative experiences were encountered. Staff recognized that embedding the new model of care in the ED impacted positively on ED culture and practice. A nurse practitioner position as clinical lead instituted at one site made the most substantial contribution to integrating mental health care within the ED. Room for improvement was also noted. CONCLUSIONS Findings from this study indicate that an ED-based model of MHLN care developed in a metropolitan setting was successfully translated to two rural EDs. While translating a model of care from one context to another is not without its challenges, adherence to the key principles of this model of MHLN care was associated with the most positive outcome.
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Affiliation(s)
- Timothy Wand
- University of Sydney and Sydney Local Health District, Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia.
| | - Gemma Collett
- Translational Research Manager, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Alexa Cutten
- Translational Research Manager, Hunter New England Local Health District, Australia.
| | - Sally Buchanan-Hagen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| | - Amanda Stack
- Translational Research Manager, Western NSW Local Health District, Australia.
| | - Kathryn White
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Australia.
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Pomare C, Churruca K, Long JC, Ellis LA, Braithwaite J. Misalignment between policy and staff experience: the case of an Australian hospital redevelopment. J Health Organ Manag 2021; ahead-of-print. [PMID: 33576581 DOI: 10.1108/jhom-06-2020-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Hospitals are constantly redeveloping to improve functioning and modernise the delivery of safe and high-quality care. In Australia, it is expected that different stakeholders have the opportunity to contribute to the design and planning of hospital redevelopment projects. The purpose of this study is to examine the potential for misalignment between policy ("work as imagined") and staff experiences of a hospital redevelopment ("work as done"). DESIGN/METHODOLOGY/APPROACH A case study of a large Australian hospital in a capital city undergoing redevelopment. Forty-six semi-structured interviews were conducted with hospital staff. Staff experiences were identified in corroboration with additional data: key-informant discussions with members of the hospital executive; document analysis (e.g. hospital and government documents) and survey responses about experiences of the hospital redevelopment. FINDINGS A disjuncture was identified between policy and the experiences of hospital staff. Over one in every three (36.0%) staff felt uninformed about the redevelopment and 79.4% were not involved in decisions throughout the process of design and redevelopment, which contradicted the procedure laid out in policy for hospital development. ORIGINALITY/VALUE Despite the seemingly "good news story" of allocating billions of dollars to redeveloping and modernising health services in Australia, the experiences of staff on the front lines suggest a lack of consultation. Rectifying these concerns may be integral to avoid fragmentation during the challenging circumstances of hospital redevelopment.
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Shaw H, Robertson S, Ranceva N. What was the impact of a global pandemic (COVID-19) lockdown period on experiences within an eating disorder service? A service evaluation of the views of patients, parents/carers and staff. J Eat Disord 2021; 9:14. [PMID: 33468242 PMCID: PMC7814524 DOI: 10.1186/s40337-021-00368-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The World Health Organization declared the outbreak of COVID-19 as a global pandemic on the 11th March 2020. As a result, the UK Government imposed severe restrictions on working and social contact as part of "lockdown." Whilst the full extent of the pandemic's impact on eating disorder patients is unknown, the literature suggests that patients with pre-existing mental illness may be more vulnerable to the mental health impacts. In addition, the restrictions greatly reduced the access to mental health services and presented new challenges to service delivery. A service evaluation was carried out to explore how the COVID-19 global pandemic changed service provision in a young person's eating disorder service and how this affected patient, family and staff experiences. METHODS An audit was carried out to explore how the lockdown period had impacted referrals and service delivery. Quantitative data was collected in an online survey and qualitative data was collected in two formats: open ended answers as part of the online survey and open-ended focus groups, structured using narrative enquiry. The 43 participants consisted of 12 patients, 19 parents/carers, and 12 staff members. Patients were under the age of 18 and had a diagnosis of an eating disorder. RESULTS COVID-19 and lockdown increased the pressure on the service and changed service provision significantly. This has impacted the relational experiences for patients and their carers and staff have been faced with new challenges. Patients, parents/carers and staff all preferred face-to-face appointments over virtual options. There was no difference in service satisfaction before and during COVID-19. CONCLUSIONS It is possible to provide an eating disorder service in lockdown restrictions that patients and parents report high satisfaction with. Providing face-to-face appointments at the beginning of treatment and including families in the planning should be prioritised. Staff support is crucial to be able to continue delivering high quality services. The key themes are identified, and clinical recommendations are made to guide service delivery.
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Affiliation(s)
- Hannah Shaw
- The Eating Disorder Young Person's Service, Alder Hey Children's Hospital Foundation Trust, Liverpool, UK. .,Royal Holloway University of London, Egham, UK.
| | - Sarah Robertson
- The Eating Disorder Young Person's Service, Alder Hey Children's Hospital Foundation Trust, Liverpool, UK
| | - Nadia Ranceva
- The Eating Disorder Young Person's Service, Alder Hey Children's Hospital Foundation Trust, Liverpool, UK.,Vilnius University, Vilnius, Lithuania
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Donetto S, Penfold C, Anderson J, Robert G, Maben J. Nursing work and sensory experiences of hospital design: A before and after qualitative study following a move to all-single room inpatient accommodation. Health Place 2017; 46:121-129. [PMID: 28527327 PMCID: PMC5533937 DOI: 10.1016/j.healthplace.2017.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/27/2017] [Accepted: 05/02/2017] [Indexed: 11/27/2022]
Abstract
The embodied experience of nursing practice is rarely studied. Drawing on data from an internationally relevant larger study conducted in 2013-14, here we explore the sensory dimension of the embodied experiences of nursing staff working on two acute NHS hospital wards before and after a move to all-single room inpatient accommodation. We undertook a secondary analysis of 25 interviews with nursing staff (12 before and 13 after the move with half [13/25] using photographs taken by participants) from a mixed-method before-and-after study. This analysis focused on the sensory dimensions of nursing staff's experiences of their working practices and the effect of the built environment upon these. Drawing on Pallasmaa's theoretocal insights, we report how the all-single room ward design prioritises 'focused vision' and hinders peripheral perception, whilst the open ward environment is rich in contextual and preconscious information. We suggest all-single room accommodation may offer staff an impoverished experience of caring for patients and of working with each other.
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Affiliation(s)
- S Donetto
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, Waterloo Road, London SE1 8WA, United Kingdom.
| | - C Penfold
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, Waterloo Road, London SE1 8WA, United Kingdom.
| | - J Anderson
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, Waterloo Road, London SE1 8WA, United Kingdom.
| | - G Robert
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, Waterloo Road, London SE1 8WA, United Kingdom.
| | - J Maben
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, Waterloo Road, London SE1 8WA, United Kingdom.
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Blackwell RWN, Lowton K, Robert G, Grudzen C, Grocott P. Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes. Int J Nurs Stud 2017; 68:83-94. [PMID: 28095347 DOI: 10.1016/j.ijnurstu.2017.01.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Increasing use of emergency departments among older patients with palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of - and preferences for - palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting. OBJECTIVES To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work. SETTING an Emergency Department in a large teaching hospital in the United Kingdom. METHODS Experience-based Co-design incorporating: 150h of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members. FINDINGS the study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patient-family-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Co-design in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the 'voice' of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process. CONCLUSION Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable patients, family and staff in complex healthcare environments. The flexibility of the approach allows the specific needs of participants to be accounted for, enabling fuller engagement with those who typically may not be invited to contribute to quality improvement work. Recommendations for future studies in this and similar settings include testing the 'accelerated' form of the approach and experimenting with alternative ways of increasing involvement of patients/families in the co-design phase.
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Affiliation(s)
- Rebecca Wright Née Blackwell
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, JCMB, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Karen Lowton
- Department of Sociology, University of Sussex, Freeman Building, Falmer, Brighton, BN1 9RH, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, JCMB, 57 Waterloo Road, London, SE1 8WA, UK
| | - Corita Grudzen
- Ronald O. Perelman Department of Emergency Medicine, Associate Professor of Emergency Medicine and Population Health, NYU School of Medicine, USA
| | - Patricia Grocott
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, JCMB, 57 Waterloo Road, London, SE1 8WA, UK
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