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Background Improving the quality and efficiency of healthcare is an international priority. A range of complex ward based quality initiatives have been developed over recent years, perhaps the most influential programme has been Productive Ward: Releasing Time to Care. The programme aims to improve work processes and team efficiency with the aim of 'releasing time', which would be used to increase time with patients ultimately improving patient care, although this does not form a specific part of the programme. This study aimed to address this and evaluate the impact using recent methodological advances in complex intervention evaluation design. Method The objective of this study was to assess the impact of an augmented version of The Productive Ward: Releasing Time to Care on staff and patient outcomes. The design was a naturalistic stepped-wedge trial. The setting included fifteen wards in two acute hospitals in a Scottish health board region. The intervention was the Productive Ward: Releasing Time to Care augmented with practice development transformational change methods that focused on staff caring behaviours, teamwork and patient feedback. The primary outcomes included nurses' shared philosophy of care, nurse emotional exhaustion, and patient experience of nurse communication. Secondary outcomes covered additional key dimensions of staff and patient experience and outcomes and frequency of emergency admissions for same diagnosis within 6 months of discharge. Results We recruited 691 patients, 177 nurses and 14 senior charge nurses. We found statistically significant improvements in two of the study's three primary outcomes: patients' experiences of nurse communication (Effect size=0.15, 95% CI; 0.05 to 0.24), and nurses' shared philosophy of care (Effect size =0.42, 95% CI; 0.14 to 0.70). There were also significant improvements in secondary outcomes: patients' overall rating of ward quality; nurses' positive affect; and items relating to nursing team climate. We found no change in frequency of emergency admissions within six months of discharge. Conclusions We found evidence that the augmented version of The Productive Ward: Releasing Time to Care Intervention was successful in improving a number of dimensions of nurse experience and ward culture, in addition to improved patient experience and evaluations of the quality of care received. Despite these positive summary findings across all wards, intervention implementation appeared to vary between wards. By addressing the contextual factors, which may influence these variations, and tailoring some elements of the intervention, it is likely that greater improvements could be achieved. [ABSTRACT FROM AUTHOR]

Background Palliative care and rehabilitation both aim to support patients to live as actively as possible. Goal setting has been identified in health policy and clinical guidelines as a mechanism to achieve this. While goal setting is well established in traditional rehabilitation, it is unclear how it should be implemented within palliative care where people are faced with diminishing abilities. Aim To identify and synthesize published literature regarding goal setting in palliative care. Method Electronic searches were carried out on MEDLINE, PSYCHINFO, EMBASE, CINAHL, ASSIA, and Google Scholar databases between November 2010 and January 2011. Papers were included if they focused on patient-centred goal setting in palliative care. No restrictions were placed on study design or type of paper. Papers were classified according to the type and design and research papers were quality appraised. Papers were read and analysed using framework analysis. Findings Sixteen papers met the inclusion criteria. Three themes were identified: 1. Definitions, process, and functions of goal setting; 2. The challenges of delivering goal setting; 3. Theories underpinning goal setting. Conclusions Goal setting is recognized as an important component of patient-centred palliative care, but there is no agreement regarding 'best practice' and clinicians face particular challenges when trying to set goals with patients in this context. Little attention has been paid to developing a robust, theory-based approach to goal setting in this setting. Hope theory and theories of how people adapt to life-threatening illness could inform the process of goal setting in palliative care. [ABSTRACT FROM AUTHOR]

Aim: Empathy is an essential component of any therapeutic encounter. The Consultation and Relational Empathy (CARE) Measure is a validated, reliable patient assessment of practitioners' communication and relational empathy abilities. This study piloted a visual version of the CARE Measure for use by people with communication, cognition and/or literacy difficulties. Methods: A visual version of the CARE Measure was developed and piloted in two routine general practice settings with 42 patients, and in two rehabilitation settings with 13 patients who have communication difficulties while consulting with allied healthcare professionals. Results: The Visual CARE Measure performed well when compared to the standard measure as it had less of a 'ceiling effect' and showed less skew and kurtosis than the standard measure. The internal reliability of the Visual CARE Measure was high, and removal of any items resulted in a reduction in reliability. The number of 'not applicable' values overall was low, suggesting that the items in the measure were regarded by patients as relevant to their consultation. The Visual CARE Measure was reported to be very easy to understand, easy to complete and perceived as important. Conclusions: The Visual CARE Measure appears to perform well in comparison with the standard measure. [ABSTRACT FROM AUTHOR]

Purpose: Clinicians' actions impact the patient care process and pathway. This study identified clinicians' actions associated with successful care processes in one community healthcare setting, children's occupational therapy. Method: A secondary analysis in a form of a quantitative content analysis was conducted of 47 interview transcripts, describing outcomes and therapists' (n = 25) self-reported actions in 25 'successful' and 22 'unsuccessful' care processes. The successful processes were those with positive outcomes (clear and coherent process with easy discharge; achieved patient goals and positive patient-clinician relationships). The transcripts were coded for presence of therapists' actions and non-actions using content analysis; and actions associated with success of the process were identified by Pearson Chi-square test. Results: In total 207 actions were identified. These clustered around six areas: assessment, setting goals and planning actions, treatment, review, discharging, and managing processes and relationships. The key actions associated with successful processes were: gather perspectives from others at assessment (χ2 = 6.65, p < 0.01); identify therapy goals (13.16, p < 0.01); agree/communicate plans, roles and responsibilities (9.10, p < 0.01); involve the child and parents in treatment (6.36, p = 0.01); adapt physical environment (6.01, p = 0.01) and make comparisons between the baseline, current and target levels when reviewing progress (6.36, p = 0.01). Conclusions: The actions identified are congruent with literatures about patient involvement and goal achievement. Specific hypotheses about the mechanisms by which the identified actions may relate to care process are presented. [ABSTRACT FROM AUTHOR]