Search

Aim: To explore how patients with hospital experience construct patient safety, from the identification of a patient safety risk to the decision to file a complaint. Background: Patients play an important role in the prevention of adverse events in hospitals, but the ability of patients to act and influence their own safety is still challenged by multiple factors. Understanding how patients perceive risk and act to prevent harm may shed light on how to enhance patients' opportunities to participate in patient safety. Design: The research design of this study is qualitative and exploratory. Methods: Twelve participants who had experienced Swedish hospital care were interviewed between June 2022 and July 2023. The method of analysis was constructivist grounded theory, focusing on social processes. The COREQ checklist for qualitative research was followed. Results: Four categories were constructed: (1) defining the boundary between one's own capacity and that of the hospital, (2) acting to minimize the impact on one's safety, (3) finding oneself in the hands of healthcare professionals and (4) exploring the boundaries between normality and abnormality of the situation. This process was captured in the core category of navigating the path of least suffering. This illustrated how the participants constructed meaning about patient safety risks and showed that they prevented multiple adverse events. Conclusions: Provided that participants were able to act independently, they avoided a multitude of adverse events. When they were dependent on healthcare professionals, their safety became more vulnerable. Failure to respond to the participants' concerns could lead to long‐term suffering. Relevance to Clinical Practice: By responding immediately to patients' concerns about their safety, healthcare professionals can help prevent avoidable suffering and exhaustive searching for someone in the healthcare system who will take their needs seriously. Patient Contribution: A member check was performed with the help of one of the participants who read the findings to confirm familiarity. [ABSTRACT FROM AUTHOR]

Healthcare professionals have a major responsibility to protect patients from harm. Despite vast efforts to decrease the number of adverse events, the progression of patient safety has internationally been acknowledged as slow. From a social construction perspective, it has been argued that the understanding of patient safety is contextual based on historical and structural rules, and that this meaning construction points out different directions of possible patient safety actions. By focusing on fact construction and its productive and limiting effect on how something can be understood, we explored the discourses about healthcare professionals in 29 written reports of adverse events as reported by patients, relatives, and healthcare professionals. Through the analysis, a discourse about the healthcare professionals as experts was found. The expert role most dominantly included an understanding that adverse events were identified through physical signs and that patient safety could be prevented by more strictly following routines and work procedures. We drew upon the conclusion that these regimes of truth brought power to the expert discourse, to the point that it became difficult for patients and relatives to engage in patient safety actions on their terms. [ABSTRACT FROM AUTHOR]

Background: Personalised care planning is argued for but there is a need to know more about what the plans actually contain. Aim: To describe the content of person-centred health, plans documented at three healthcare levels for patients with acute coronary syndrome. Design: Patients with acute coronary syndrome aged under 75 years and admitted to two coronary care units at a university hospital were enrolled in the study. This retrospective descriptive study documented 89 person-centred health plans at three healthcare levels: hospital, outpatient and primary care. In total, 267 health plans were reviewed and a quantitative content analysis conducted. The health plans included commonly formulated goals, patients’ own resources and support needed. Results: The health plan goals were divided into three categories: lifestyle changes, illness management and relational activities. The most frequently reported goal for better health was increased physical activity, followed by social life/leisure activities and return to paid professional work. In order to reach the goals, patients identified three ways: own resources, family and social support and healthcare system, in total three categories. The most frequently reported own capability was self-motivation. Spouses and children were important sources of family and social support. The most frequently reported healthcare support was cardiac rehabilitation. Conclusion: In traditional care and treatment plans devised by health professionals, patient goals often comprise behavioural changes. When patients identify their own goals and resources with the help of professionals, they include maintaining social relations and being able to return to important activities such as work. [ABSTRACT FROM AUTHOR]

Background: Discharge planning is important to bridge the gap between hospital and home. Many patients with chronic heart failure are often fragile elderly with co-morbidities and functional decline due to increased symptom burden. A structured Gothenburg person-centred care (gPCC) approach may promote better discharge-planning. Aims: To evaluate whether proactive care-planning based on the gPCC model leads to improved efficiency in discharge procedures compared with usual care in patients hospitalized for worsening chronic heart failure. Methods: In a controlled before-and-after design, patients hospitalized for worsening chronic heart failure were assigned to either a usual care group or a gPCC intervention group. The patients’ social situation, their discharge destination and the number of days until the discharge were recorded. The time interval (in days) between notification and start of coordination of care was recorded. Results: In total, 248 patients were included, 123 in the usual care group and 125 in the gPCC intervention. During hospitalization, notifications to the community home help service and/or round-the-clock home nursing care services were more frequent in the gPCC-group (33.8%) compared with patients in the usual care group (12.1%). A confirmed discharge planning conference started within the first five days in the gPCC group whereas the usual care group ranged from one to 28 days. Compared with the usual care group, the gPCC group had fewer days in hospital (11 versus 35) ready for discharge. Conclusion: gPCC improves discharge processes because patients are viewed as competent to be involved in planning their subsequent care. [ABSTRACT FROM AUTHOR]

Background: Person-centred care (PCC) aims to engage patients as active partners in their care and treatment to improve the management of their illness. Self-efficacy is an important concept and outcome in PCC as it refers to a patient’s belief in their capability to manage the events that affect their lives. Recovery after acute coronary syndrome (ACS) is demanding and a PCC approach may promote self-efficacy and thereby facilitate recovery. Aim: The purpose of this study was to evaluate whether a PCC intervention was able to improve self-efficacy after hospitalization for ACS. Methods: In a randomized controlled trial, patients <75 years of age and hospitalized for ACS were assigned to either a usual care group or a PCC intervention group. Self-efficacy was assessed at baseline and up to six months after discharge using the Swedish Cardiac Self-Efficacy Scale (S-CSES), which consists of three dimensions: control symptoms, control illness and maintain functioning. Results: In total, 177 patients were included in the study: 93 in the usual care group and 84 in the PCC group. At the one-month follow-up the PCC group had improved significantly more (p=0.049) on the control symptoms dimension (mean change 0.81; SD 3.5 versus mean change −0.20; SD 3.0). No difference between groups was seen at the six-month follow-up in any of the S-CSES dimensions. Conclusions: Our results indicate that PCC added to usual care promotes and hastens the development of patients’ confidence in their ability to manage symptoms during recovery after ACS. This underlines the importance of initiating and establishing partnerships between patients and health care professionals as early as possible after ACS. [ABSTRACT FROM AUTHOR]

Background: Cardiac self-efficacy is a person’s belief in his/her ability to manage the challenges posed by a coronary disease, and its role has been evaluated in several coronary populations using the Cardiac Self-Efficacy Scale (CSE Scale). Self-efficacy has an important role in person-centred care, however there is a lack of appropriate instruments that evaluate person-centred interventions. Aim: The purpose of this study was to validate the CSE Scale by examining its psychometric properties as a first step in evaluating a person-centred care intervention in persons with acute coronary syndrome (ACS). Methods: The study sample consisted of 288 persons (72 women, 216 men) who completed the Swedish version of the CSE Scale two months after hospitalisation for an ACS event. Construct validity was psychometrically evaluated using confirmatory factor analysis. Additionally, convergent and discriminant validity were tested using correlation analyses. Results: The results revealed that the CSE Scale was represented by three dimensions (control symptoms, control illness and maintain functioning). The analyses also showed that the CSE Scale is suitable for providing a total summary score that represents a global cardiac self-efficacy dimension. Evaluation of convergent and discriminant validity showed the expected correlations. Conclusion: The CSE Scale is a valid and reliable measure when evaluating self-efficacy in patients with ACS. It also seems to be a useful tool to promote person-centred care in clinical practice since it may offer useful guidance in the dialogue with the patient in the common creation of a personal health plan. [ABSTRACT FROM AUTHOR]

Background: Promoting patient participation in care is an international priority identified by the World Health Organization and various national bodies around the world and an important aspect of person-centred care., Aim: The aim of this study was to describe Registered Nurses' experiences with patient participation in nursing care including their barriers and facilitators for participation., Method: The study setting was a University Hospital in Sweden. Interviews were conducted with twenty Registered Nurses working at medical wards in 2013. Thematic data analysis was used to analyse the transcribed interview data., Results: Twenty nurses from four wards in two hospitals were included. Five themes emerged from the analysis including listening to the patient, engaging the patient, relinquishing some responsibility, sharing power and partnering with patients. The core theme 'partnering with patients' was enacted when nurses listened to and engaged patients and when they relinquished responsibility and shared power with patients. In addition, hindering and facilitating factors to participation were identified, such as patients wanted to take on a passive role, lack of teamwork which participants understood would enhance interprofessional understanding and improve patient safety. Patient participation was hindered by medical jargon during the ward round, there was a risk of staff talking over patients' heads but sometimes inevitable having conversations at the patient's bedside. However, nurses preferred important decisions to be made away from bedside., Conclusions: It all came down to partnering with the patient and participants described how they made an effort to respect the patients' view and accept patient as a part of the care team. Identified hindering factors for participation were lack of teamwork, patients' taking on passive roles and communication during ward rounds having conversations at the patient's bedside. Nurses wished for a change but lacked strategies on how. Nurses preferred important decisions to be made away from bedside., (© 2017 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)