Dissertations / Theses on the topic 'Patient-centred education'

Patient-centred communication and patient education: a multimodal social semiotic approach This study explores the phenomenon of patient-centred communication within the South African health context. Patient-centred communication involves several distinct but interlinked elements, namely, taking a holistic approach to illness, 'seeing' through the patient's eyes, 'co-constructing' a shared understanding or therapeutic alliance, and sharing decision-making and responsibility where possible. While adopted by medical curricula across the world, a lack of conceptual clarity is common among students, educators, researchers and policy-makers. Furthermore, little research has been done that accounts for contextual factors and non-western settings. This study looks at how fourth year medical students operationalise the 'classroom-taught' principles of patient-centred communication during a health education encounter with patients. Drawing on a qualitative, interpretivist paradigm, the research focuses on communication in the context of language barriers, cultural value differences and socio-economic inequality. This study views students' multimodal health education artefacts as instances of 'informed flexibility' to patients' needs and challenges. The research is located within a Pharmacology curriculum activity where medical students produce personalized health promotion artefacts for rheumatic heart disease patients. Their artefacts are instances of patient-centred communication as well as instances of purposeful pedagogic recontextualisation, in that they realise both epistemic and relational dimensions of health education. Students also write a critique on the process, reflecting on the patient interview and motivating their design choices. Taking a multimodal social semiotic approach, the study draws on Bezemer and Kress' semiotic principles of recontextualisation (2008) for analysis of artefacts. Thematic analysis of students' critical reflections as well as follow-up interviews with their patients illuminate the context and assumptions underpinning students' design choices. The study is significant in several ways. It highlights the complex, multifaceted, multi-layered nature of doctor-patient communication, argues for realism in what can be taught and assessed in a classroom and suggests novel pedagogic approaches. The study also brings an African perspective to patient-centred communication, and in highlighting challenges relevant to the South African health care system, it supports contemporary calls for 'decolonisation' of health sciences curricula. The research contributes to ongoing efforts to eradicate rheumatic heart disease by giving patients a 'voice', raising awareness and supporting preventative programs. Methodologically, the study contributes to Bezemer and Kress' (2008) pursuit of articulating a semiotic methodological framework for multimodal texts.

This thesis contributes to the stream of studies that indicate a transformation of the future education of medical professionals to better address patients’ needs and promote a positive attitude towards patientcentredness in medical education. The main goal is to identify the characteristics of patient-centred care (PCC) as ideas, processes, and practices from a medical student’s perspective in Portugal and Sweden. The comparative study aims to answer where the differences between these two students’ groups stand within PCC education, patient-centred beliefs, and self-perceived ability to practice PCC and, specifically, how Portuguese medical students perceive Portuguese PCC practice and potential barriers. Quantitative (questionnaires) and qualitative data collection (curriculum analysis and interviews) are performed. Curriculum analysis indicates that learning about the PCC phenomena in both countries is fragmented across the various courses, considering that in Portugal a significant number (40%) of courses are elective. While the Portuguese curricula focus on the knowledge, the Swedish encourages skills development. Medical students show more caring than sharing attitudes in both countries, and female medical students have a more positive attitude toward PCC. Previous work experience does not affect the attitudes of a medical student to the PCC; nonetheless, it does affect the self-perception of medical student confidence in the information and power-sharing segment and dealing with communicative challenges. Portuguese students consider that the barriers to the implementation of the PCC in Portuguese practice come from the system, doctor, and patient. The implications of the study findings are discussed concerning both wider theoretical perspectives and practical solutions for policymakers and doctors on these aspects of their work. The present study reveals the need for developing an In-Service PCC Guide with all the key elements and activities that reflect the essence of the PCC concept in practice, and that could help medical students when they start their daily practical work with patients; RESUMO: Cuidado centrado no paciente (PCC) como ideia, processo e prática Esta tese contribui para a corrente de estudos que apontam para uma transformação, no futuro, da educação dos profissionais médicos para melhor atender às necessidades do paciente e promover uma atitude positiva em relação à centralização no paciente, da educação médica. O objetivo principal é identificar as características dos cuidados centrados no paciente (PCC), nomeadamente ideias, processos e práticas na perspetiva dos estudantes de medicina em Portugal e na Suécia. O estudo comparativo realizado visa conhecer as diferenças entre esses dois grupos de estudantes relativamente à educação/formação em PCC, as crenças centradas no paciente e capacidade auto percebida de praticar o PCC; e ainda, compreender como os estudantes de medicina portugueses percebem a prática portuguesa do PCC e as potenciais barreiras à mesma. Foram realizadas recolhas de dados quantitativos (questionários) e qualitativos (análise curricular e entrevistas). A análise curricular indica que a aprendizagem sobre o fenómeno PCC nos dois países está fragmentada nos vários cursos, sendo que em Portugal grande parte (40%) ainda integra currículos optativos. Enquanto o currículo de português se concentra no conhecimento, o sueco incentiva o desenvolvimento de habilidades. Os estudantes de medicina mostram atitudes mais carinhosas do que compartilhadas em ambos os países, e as estudantes femininas têm uma atitude mais positiva em relação à PCC. A experiência anterior de trabalho não afeta as atitudes do estudante de medicina em relação à PCC; no entanto, afeta a autopercepção da confiança do estudante de medicina no segmento de partilha de informações e poder e de lidar com os desafios comunicativos. Os estudantes Portugueses consideram que as barreiras à implementação da PCC na prática portuguesa vêm do sistema, do médico e do paciente. As implicações dos resultados do estudo são discutidas em relação a perspetivas teóricas mais amplas e soluções práticas para os formuladores de políticas e para os médicos, sobre esses aspetos de seu trabalho quotidiano. Este estudo revela a necessidade de desenvolver um “In-Service PCC Guide” com todos os elementos e atividades que refletem a essência do conceito de PCC na prática e que possam ajudar os estudantes de medicina quando iniciam o seu trabalho prático quotidiano com os pacientes.

My thesis examines patients’ and caregivers’ perspectives on educating healthcare providers(HCPs). Specifically, it examined two research questions: 1) What do patients think about their involvement in the education of HCPs? and 2) What roles do patients want to have in the education of HCPs? It is important for educational leaders and HCPs to understand answers to these questions, from patients’ own perspectives, to make effective changes in current and future health professions education and ultimately, the delivery of patient-centred care. I conducted semi-structured interviews with 27 patients and caregivers for this study. Through conventional content analysis, I identified five themes for what patients think about their involvement in the education of HCPs. Namely, patient involvement in the education of HCPs: (1) is challenging because of power-differentials between themselves and HCPs; (2) requires patient training; (3) needs to start early in HCPs’ education process; (4) can improve patient-HCP partnerships; and (5) requires compensation for patients. I also identified three roles that patients want to have in the education of HCPs. Specifically, they want to: (1) teach HCPs about patients’ expectations, experiences, and perspectives through case studies, storytelling, and research; (2) provide direct feedback to HCPs; and (3) advise on curricula development and admission boards for HCPs. My research adds to the limited research on patients’ and caregivers’ perspectives on their involvement in the education of HCPs, identifies barriers to patient involvement, and provides a foundation that HCPs and educational leaders can use to improve patients’ active involvement in the education of HCPs. Further, it highlights that patients’ voices are important to the education of HCPs. It also illuminates my own perspectives on patient involvement in the education of HCPs, which I share as part of my positionality as a researcher who conducted this study.

Dagens patient står idag inför svåra val av behandlingar och vård. Det är därför viktigt att patienten ges möjlighet att hantera det dagliga livets krav och att sjuksköterskan stödjer och stärker patientens kontroll över sjukdom och behandling. Patientundervisning är av central betydelse och bör integreras i den dagliga omvårdnaden av patienten och dennes anhöriga. Föreliggande studie syftar därför till att studera de faktorer som påverkar sjuksköterskans roll i patientundervisningen och hur Internet kan integreras i undervisningen. Teoretisk ram för arbetet är Hildegard Peplaus terapeutiska interpersonella process. För att besvara frågeställningarna har en litteraturstudie genomförts, vilket har medfört en kritisk granskning och sammanvägning av resultat från tio vetenskapliga artiklar. Resultatet visar på att sjuksköterskan inte alltid har den kunskap som behövs för att bedriva bra patientundervisning och att mer utbildning krävs för att kunna genomföra undervisningen på bästa tänkbara sätt. Med dagens tekniska utveckling kan Internet med sin lättillgängliga information fungera som ett ypperligt hjälpmedel vid patientundervisning.
Todays patients face difficulties in choosing between methods of treatment and care. Therefore it is very important that nurses give the patient an opportunity to handle their daily life and support them in their choises. Patient education is of central importance and should be integrated in the daily care of patients and their relatives. This literature review aims to investigate the factors that influence the nurse role in patient education and in what way Internet can be used. Peplau’s theory of Interpersonal relations underlie this study. The sudy is based on the results of ten scientific publications. The results indicate that nurses not always have enough knowledge to provide good patient education. More education is needed in the nursing education programme. With todays technical evolution Internet can function as an excellent tool in patient education.

Chronic kidney disease affects 10% of Australians. This thesis reports a three-phase project involving development, implementation, and evaluation of a novel intervention, the Chronic Kidney Disease Self-Management Support program (CKD-SMS), designed to support people with early stages of this disease. After receiving the intervention, participants displayed significant improvements in multiple clinical outcomes and reported a high level of satisfaction with the program. This study has implications for supporting people with CKD in general practice and indicates that, by tailoring support to individual needs, positive health outcomes which may help to slow disease progression can be achieved.

Philosophiae Doctor - PhD
Diabetes is a chronic, metabolic disease that requires lifelong medical management, health education and self-management. According to a World Health Organisation report, there is a global increase in the prevalence of diabetes and even more so in the low-and middle-income countries, specifically Nigeria, which has the highest number of people with diabetes in the African region of the World Health Organisation. As a global issue, the positive health outcomes of diabetes are tied to health education and self-management of the disease and using the health resources of nations. However, in the context of limited resources in Nigeria, there is a need for improvement of health education in self-management of Type 2 diabetes. Health education that is provided in some Nigerian health facilities is reported to be unstructured, without patients’ active participation, not tailored to the needs and the interests of the patients and limited collaboration between multi-disciplinary professionals. In this context, the aim of the study was to develop a structured health education programme for self-management of patients with Type 2 diabetes, to facilitate the quality of the lives of these patients .An adapted intervention mapping framework provided a structured process for development of an evidenced based programme. A mixed method approach was followed. In the first phase of the study an exploratory descriptive qualitative research design was followed. A purposive sampling approach was used in selecting (i) participants, who were patients with Type 2 diabetes and (ii) health-care professionals working in two health-care institutions in Benin City, Edo State, Nigeria. In phase 1, Step1 of the research was a situation analysis, which consisted of conducting 30 semi-structured interviews with patients; observation of nurses providing health education; and five focus group discussions with health-care professionals (nurses, dieticians and social workers). Qualitative data analysis was accomplished through using Tesch’s (1990) steps of analysis to identify themes and categories. The situation analysis revealed, firstly, that there was a lack in the knowledge and self-management of Type 2 diabetes among patients. Secondly, that the health-care professionals acknowledged their collective role in health education and were burdened with the patients who were non-adherent to self-management. The result also revealed the necessity to change from a traditional teaching method to a structured educational process that is patient-centred. The second phase of the research was the stage of developing the educational programme through collaboration with the stakeholders (health-care professionals and patients with Type 2 diabetes) using the findings from the data-analysis of the first phase supported with literature. In phase 2, Step 2 was to develop matrices from the data analysis in Phase 1 for the programme. Step 3 added theory-based intervention methods and practical applications to the preliminary program and in Step 4 the programme was described. This was followed in Step 5 by preparing health-care professionals for offering the programme to patients and implementing and evaluating the programme. The evaluation of the programme was by means of a quantitative pilot study in which a pre-post-test in a quasi-experiment was conducted with 28 patients and qualitative interviews after the program and post intervention interviews with the participants. The evaluation showed that the program was effective in meeting its objectives. In Step 6 a plan for the adoption, implementation, sustainability and evaluation of future implementations was developed.

Asthma affects over 2.2 million people in Australia. Asthma morbidity is increasing while mortality is decreasing. People with asthma experience shortness of breath as their airways narrow and become inflamed. After an episode of acute asthma many patients experience a relapse requiring further emergency department care. Numerous studies have been undertaken to identify the determinants of asthma morbidity and these studies have primarily used asthma oriented and co-morbidity scales such as anxiety and depression indices. Other studies in this area have indicated psychosocial factors such as coping, asthma attitudes and beliefs that may be linked to people with asthma who are non-compliant or adherent to treatment. Currently, there is no research available that has examined the link between general health promoting behaviours, an individual’s risk behaviour assessment and a brief asthma education encounter that is patient-centred. This study provides a description of the health promoting and risk taking behaviours of people who attend the emergency department with acute asthma. Secondly, it examines the effectiveness of patient-centred education compared with standard education. One hundred and forty-six people with acute asthma who attended the emergency departments of the Princess Alexandra and Mater Adult Public Hospitals were enrolled in this study. Participants self-reported health promoting and risk taking behaviours by completing the questionnaire that contained the Health Promoting Lifestyle Profile (HPLPII) and the Health Risk Appraisal (HRA) instruments. The Hospital Anxiety and Depression Scale (HADS) was also incorporated into the questionnaire to ascertain levels of anxiety and depression in this acute asthma group of people. The asthma education curriculum had the same topics for both the standard education and the patient-centred groups. However, the patient-centred group were able to prioritise the order of the topics according to their identified need. Secondly, the patient-centred group were asked two questions to ascertain the most important issue and asthma issue for them at that point in time. Both groups of participants were educated using the Asthma Foundation Leaflet “Asthma - Basic Facts” during the individual education session. There were 56% females and 44% males with a mean age (+SD) of 34 (13.8) years with 70.3% reported year 12 or above education and 49% of participants earned less that $20,000. Nearly half of the participants were admitted to a hospital ward following emergency department assessment and care. A large proportion of the participants had either moderate or severe asthma. The health behaviour findings from this study suggest people with acute asthma follow preventive health recommendations and safety guidelines more so than the wider community. However, they did not self-initiate home based health actions such as breast self-examination. At the time of attendance to the emergency department with acute asthma there were no statistical difference between the patient-centred education and standard format education groups for age, gender, education, income, asthma control and previous emergency department attendances. The patient-centred education group had fewer re-attendances in the four months after the education intervention when compared with prior emergency department attendances than the control group (p=0.057; p=0.486). In conclusion, people with acute asthma report undertaking a number of preventive health behaviours and actions according to national guidelines and safety recommendations. They report a lack of self-initiated home based health behaviours. Further research is required to investigate the impact on the National Asthma Council’s recommendations of the importance of asthma action plans on people who follow preventive health guidelines and who lack self-initiative abilities. In terms of asthma education, patient-centred education when compared to standard format education may be useful in reducing further emergency department attendances for acute asthma. More research is required to identify other key education issues for people with acute asthma.

Asthma affects over 2.2 million people in Australia. Asthma morbidity is increasing while mortality is decreasing. People with asthma experience shortness of breath as their airways narrow and become inflamed. After an episode of acute asthma many patients experience a relapse requiring further emergency department care. Numerous studies have been undertaken to identify the determinants of asthma morbidity and these studies have primarily used asthma oriented and co-morbidity scales such as anxiety and depression indices. Other studies in this area have indicated psychosocial factors such as coping, asthma attitudes and beliefs that may be linked to people with asthma who are non-compliant or adherent to treatment. Currently, there is no research available that has examined the link between general health promoting behaviours, an individual’s risk behaviour assessment and a brief asthma education encounter that is patient-centred. This study provides a description of the health promoting and risk taking behaviours of people who attend the emergency department with acute asthma. Secondly, it examines the effectiveness of patient-centred education compared with standard education. One hundred and forty-six people with acute asthma who attended the emergency departments of the Princess Alexandra and Mater Adult Public Hospitals were enrolled in this study. Participants self-reported health promoting and risk taking behaviours by completing the questionnaire that contained the Health Promoting Lifestyle Profile (HPLPII) and the Health Risk Appraisal (HRA) instruments. The Hospital Anxiety and Depression Scale (HADS) was also incorporated into the questionnaire to ascertain levels of anxiety and depression in this acute asthma group of people. The asthma education curriculum had the same topics for both the standard education and the patient-centred groups. However, the patient-centred group were able to prioritise the order of the topics according to their identified need. Secondly, the patient-centred group were asked two questions to ascertain the most important issue and asthma issue for them at that point in time. Both groups of participants were educated using the Asthma Foundation Leaflet “Asthma - Basic Facts” during the individual education session. There were 56% females and 44% males with a mean age (+SD) of 34 (13.8) years with 70.3% reported year 12 or above education and 49% of participants earned less that $20,000. Nearly half of the participants were admitted to a hospital ward following emergency department assessment and care. A large proportion of the participants had either moderate or severe asthma. The health behaviour findings from this study suggest people with acute asthma follow preventive health recommendations and safety guidelines more so than the wider community. However, they did not self-initiate home based health actions such as breast self-examination. At the time of attendance to the emergency department with acute asthma there were no statistical difference between the patient-centred education and standard format education groups for age, gender, education, income, asthma control and previous emergency department attendances. The patient-centred education group had fewer re-attendances in the four months after the education intervention when compared with prior emergency department attendances than the control group (p=0.057; p=0.486). In conclusion, people with acute asthma report undertaking a number of preventive health behaviours and actions according to national guidelines and safety recommendations. They report a lack of self-initiated home based health behaviours. Further research is required to investigate the impact on the National Asthma Council’s recommendations of the importance of asthma action plans on people who follow preventive health guidelines and who lack self-initiative abilities. In terms of asthma education, patient-centred education when compared to standard format education may be useful in reducing further emergency department attendances for acute asthma. More research is required to identify other key education issues for people with acute asthma.

Bakgrund: Diabetes mellitus typ 2 är en sjukdom som blir allt vanligare. Personer som diagnostiserats med sjukdomen behöver bryta gamla rutiner och tillämpa livsstilsförändringar som är anpassade för sjukdomen. För att kunna genomföra dessa livsstilsförändringar krävs kunskap om diabetes mellitus typ 2. Hälso- och sjukvårdspersonalen har ett stort ansvar att ge personerna relevant och personcentrerad patientundervisning för att livsstilsförändringar ska kunna ske.Syfte: Att beskriva vad personer med diabetes mellitus typ 2 upplever främjar och hindrar livsstilsförändringar. Metod: En litteraturöversikt med kvalitativ design och ett induktivt förhållningssätt gjordes. Resultat: Det framkom att bra bemötande och personcentrerad patientundervisning av hälso- och sjukvårdspersonal genererade god självhantering och motivation till livsstilsförändringar hos personerna med diabetes mellitus typ 2. Bristande kunskap om sjukdomen på grund av otillfredsställande patientundervisning ledde till osäkerhet om behandlingen, och oro över att göra fel hindrade personerna att utföra livsstilsförändringar. Slutsats: En personcentrerad patientundervisning är nyckeln till goda livsstilsförändringar för personer med diabetes mellitus typ 2. När personerna får individanpassad undervisning genererar det god kunskap om sjukdomen som förbättrar personernas genomförande av livsstilsförändringar.
Background: Type 2 diabetes mellitus is an increasingly common disease. People diagnosed with type 2 diabetes mellitus need to break old routines and apply lifestyle changes that are appropriate for the disease. To be able to implement these lifestyle changes, knowledge of type 2 diabetes mellitus is required. The healthcare staff have a huge responsibility to give the persons relevant and person-centred patient education, so that lifestyle changes can take place. Purpose: to describe what people with diabetes mellitus type 2 experience promote and prevent lifestyle changes.Method: A literature review with qualitative design and an inductive approach was made. Result: It emerged that a good encounter and person-centred patient education of healthcare professionals generated good self-management and motivation for lifestyle changes in the persons with type 2 diabetes mellitus. Lack of knowledge about the disease due to unsatisfactory patient education led to uncertainty about the treatment, and concerns about wrongdoing prevented people from lifestyle changes. Conclusion: A person-centred patient education is the key to good lifestyle changes for people with type 2 diabetes mellitus. When the individuals receive individualized education, it generates good knowledge of the disease that improves the self-management and performance of lifestyle changes.

RESUMO - O consumo de tabaco foi responsável por 100 milhões de mortes no século XX. Apesar dos grandes avanços alcançados no controlo deste problema a nível mundial, sob os auspícios da OMS, no contexto da Convenção-Quadro para o Controlo do Tabaco da OMS, se não forem adoptadas medidas consistentes e efectivas de saúde pública, a morbi-mortalidade que lhe está associada continuará a aumentar durante o presente século. A promoção da cessação tabágica constitui a estratégia populacional que permitirá obter ganhos em saúde a mais curto prazo. Embora a larga maioria dos fumadores faça, ao longo da vida, várias tentativas para parar de fumar sem apoio, apenas uma pequena minoria consegue manter-se abstinente a longo prazo. Os médicos de Medicina Geral e Familiar são, de entre todos os profissionais de saúde, os que podem intervir de modo mais consistente e efectivo neste âmbito e que melhores resultados obtêm na cessação tabágica dos pacientes fumadores, dado o vínculo terapêutico e a interacção frequente e continuada que com eles estabelecem ao longo do seu ciclo de vida. O aconselhamento breve, tendo por base a adopção de um estilo de comunicação motivacional centrado no paciente, adaptado aos estádios de mudança comportamental, tem-se revelado efectivo no apoio à mudança de comportamentos relacionados com a saúde e à resolução da ambivalência que caracteriza este processo. A revisão de literatura evidenciou o facto de os médicos nem sempre intervirem nas áreas preventivas e de promoção da saúde, em particular na área da cessação tabágica, com o investimento e a continuidade desejáveis. Por outro lado, muitos pacientes fumadores referem nunca ter sido aconselhados pelo seu médico a deixar de fumar.. Não são conhecidos estudos de âmbito nacional que permitam conhecer esta realidade, bem como os factores associados às melhores práticas de intervenção ou as barreiras sentidas pelos médicos de MGF à actuação nesta área. O presente trabalho teve como objectivos: (i) avaliar a hipótese de que os médicos que disseram adoptar o método clínico centrado no paciente teriam atitudes mais favoráveis relativamente à cessação tabágica e uma maior probabilidade de aconselhar os seus pacientes a parar de fumar; (ii) estudar a relação entre as atitudes, a percepção de auto-eficácia, a expectativa de efectividade e as práticas de aconselhamento sobre cessação tabágica, auto-referidas pelos médicos; (iii) Identificar as variáveis preditivas da adopção de intervenções breves de aconselhamento adaptadas ao estádio de mudança comportamental dos pacientes fumadores; (iv) identificar as barreiras e os incentivos à adopção de boas práticas de aconselhamento nesta área. A população de estudo foi constituída pelo total de médicos de medicina geral e familiar inscritos na Associação Portuguesa de Médicos de Clínica Geral, residentes em Portugal. Para recolha de informação, foi utilizado um questionário de resposta anónima, de autopreenchimento, aplicado por via postal a 2942 médicos, em duas séries de envio. O questionário integrou perguntas fechadas, semifechadas, escalas de tipo Likert e escalas de tipo visual analógico. Para avaliação da adopção do método clínico centrado no paciente, foi usada a Patient Practitioner Orientation Scale (PPOS). O tratamento estatístico dos dados foi efectuado com o Programa PASW Statistics (ex-SPSS), versão 18. Foram utilizados: o índice de α de Cronbach, diversos testes não paramétricos e a análise de regressão logística binária. Foi obtida uma taxa de resposta de 22,4%. Foram analisadas 639 respostas (67,4% de mulheres e 32,6% de homens). Referiram ser fumadores 23% dos homens e 14% das mulheres. Foi identificada uma grande carência formativa em cessação tabágica, tendo apenas 4% dos médicos afirmado não necessitar de formação nesta área. Responderam necessitar de formação em entrevista motivacional 66%, em prevenção da recaída 59%, de treino numa consulta de apoio intensivo 55%, em intervenção breve 54% e em terapêutica farmacológica 55%. Cerca de 92% dos respondentes consideraram que o aconselhamento para a cessação tabágica é uma tarefa que faz parte das suas atribuições, mas apenas 76% concordaram totalmente com a realização de uma abordagem oportunística deste assunto em todos os contactos com os seus pacientes. Como prática mais frequente, perante um paciente em preparação para parar, 85% dos médicos disseram tomar a iniciativa de aconselhar, 79% avaliar a motivação, 67% avaliar o grau de dependência, 60% marcar o “dia D” e 50% propor terapêutica farmacológica. Apenas 21% assumiram realizar com frequência uma intervenção breve com pacientes em preparação (5 Ás); 13% uma intervenção motivacional com pacientes não motivados para mudar (5 Rs) e 20% uma intervenção segundo os princípios da entrevista motivacional, relativamente a pacientes ambivalentes em relação à mudança. A análise multivariada de regressão logística permitiu concluir que as variáveis com maior influência na decisão de aconselhar os pacientes sobre cessação tabágica foram a percepção de auto-eficácia, o nível de atitudes negativas, a adopção habitual do Programa-tipo de cessação tabágica da DGS, a posse de formação específica nesta área e a não identificação de barreiras ao aconselhamento, em particular organizacionais ou ligadas ao processo de comunicação na consulta. Embora se tenha confirmado a existência de associação entre a adopção do método clínico centrado no paciente e as atitudes face à cessação tabágica, não foi possível confirmar plenamente a associação entre a adopção deste método e as práticas autoreferidas de aconselhamento. Os médicos que manifestaram um nível baixo ou moderado de atitudes negativas, uma percepção elevada de auto-eficácia, que nunca fumaram, que referiram adoptar o Programa-tipo de cessação tabágica e que não identificaram barreiras organizacionais apresentaram uma maior probabilidade de realizar uma intervenção breve (“5 Ás”) de aconselhamento de pacientes fumadores em preparação para parar de fumar. Nunca ter fumado apresentou-se associado a uma probabilidade de realizar uma intervenção breve (“5 Ás”) com frequência, superior à verificada entre os médicos que referiram ser fumadores (Odds-ratio ajustado = 2,6; IC a 95%: 1,1; 5,7). Os médicos com o nível de auto-eficácia no aconselhamento mais elevado apresentaram uma probabilidade superior à encontrada entre os médicos com o menor nível de auto-eficácia de realizar com frequência uma intervenção breve de aconselhamento, integrando as cinco vertentes dos “5 Ás” (Odds ratio ajustado = 2,6; IC a 95%: 1,3; 5,3); de realizar uma intervenção motivacional breve com fumadores renitentes a parar de fumar (Odds ratio ajustado = 3,1; IC a 95%: 1,4; 6,5) ou de realizar com frequência uma intervenção motivacional com pacientes em estádio de ambivalência (Odds ratio = 8,8; IC a 95%: 3,8; 19,9). A falta de tempo, a falta de formação específica e a falta de equipa de apoio foram as barreiras ao aconselhamento mais citadas. Como factores facilitadores de um maior investimento nesta área, cerca de 60% dos médicos referiram a realização de um estágio prático de formação; 57% a possibilidade de dispor do apoio de outros profissionais; cerca de metade a melhoria da sua formação teórica. Cerca de 25% dos médicos investiria mais em cessação tabágica se dispusesse de um incentivo financeiro e 20% se os pacientes demonstrassem maior interesse em discutir o assunto ou existisse uma maior valorização desta área por parte dos colegas e dos órgãos de gestão. As limitações de representatividade da amostra, decorrentes da taxa de resposta obtida, impõem reservas à possibilidade de extrapolação destes resultados para a população de estudo, sendo de admitir que os respondentes possam corresponder aos médicos mais interessados por este tema e que optam por não fumar. Outra importante limitação advém do facto de não ter sido estudada a vertente relativa aos pacientes, no que se refere às suas atitudes, percepções e expectativas quanto à actuação do médico neste campo. Pesem embora estas limitações, os resultados obtidos revelaram uma grande perda de oportunidades de prevenção da doença e de promoção da saúde. Parece ter ficado demonstrada a importante influência que as atitudes, em especial as negativas, e as percepções, em particular a percepção de auto-eficácia, podem exercer sobre as práticas de aconselhamento auto-referidas. Todavia, será necessário aprofundar os resultados agora encontrados com estudos de natureza qualitativa, que permitam compreender melhor, por um lado, as percepções, expectativas e necessidades dos pacientes, por outro, as estratégias de comunicação que deverão ser adoptadas pelo médico, atendendo à complexidade do problema e ao tempo disponível na consulta, tendo em vista aumentar a literacia dos pacientes para uma melhor autogestão da sua saúde. Parece ter ficado igualmente patente a grande carência formativa neste domínio. A adopção do modelo biomédico como paradigma da formação médica pré e pós-graduada, proposto, há precisamente cem anos, por Flexner, tem contribuído para a desvalorização das componentes psicoemocionais e sociais dos fenómenos de saúde e de doença, assim como para criar clivagens entre cuidados curativos e preventivos e entre medicina geral e familiar e saúde pública. Porém, o actual padrão de saúde/doença próprio das sociedades desenvolvidas, caracterizado por “pandemias” de doenças crónicas e incapacitantes, determinadas por factores de natureza sociocultural e comportamental, irá obrigar certamente à revisão daquele paradigma e à necessidade de se (re)adoptarem os grandes princípios Hipocráticos de compreensão dos processos de saúde/doença e do papel da medicina.
SUMMARY - Tobacco consumption was responsible for 100 million deaths during the 20th century. Despite the great worldwide achievements in the control of this problem, under the WHO Framework Convention on Tobacco Control (FCTC), if no consistent and effective public health measures are implemented, related morbid-mortality will increase in the present century. In order to achieve short-term health gains due to the reduction of tobacco related deaths, strategies to promote smoking cessation must be reinforced. Throughout their life, the large majority of smokers attempt to quit smoking without any assistance. However, evidence shows that only a small minority of them achieve long-term abstinence. Due to the therapeutic alliance they may establish and the multiple opportunities of contact with their patients throughout their life cycle the general practitioners can intervene in a very effective way in this area. According to smoking cessation guidelines the general practitioner should adopt a brief motivational patient-centered way of communicating with their patients, based on the stages of health behaviour change. However, literature review pointed out that professional practices are often not as consistent and patient-centered as desirable. Moreover, several inquired smoker patients referred that they never had been counselled by their physician about quitting smoking. Regarding the Portuguese situation, to the author’s knowledge, no studies have been published, so far, not only describing the current situation, but also establishing which variables may be related to optimal intervention practices and which limitations are felt by general practitioners, while providing smoking cessation counselling. The main objectives of this study were: (i) to assess the hypothesis that the GPs who are more patient-centered in their consultation will have more favourable attitudes to smoking cessation and an higher probability of advising their patients to quit smoking; (ii) to assess the hypothesis of relation between selfreported smoking behaviour, attitudes, self-efficacy, effectiveness expectations and the aforementioned self-reported counselling practices; (iii) to identify the predictive factors of performing a brief smoking cessation counselling adapted to the behaviour stage of change of smoker patients; (iv) to identify the incentives and barriers to this kind of intervention. The study population was constituted by the entire body of general and family health practitioners, registered in the Portuguese General Practitioners Association, currently living and working in Portugal. The information was gathered through a self-administered anonymous questionnaire sent to 2942 practitioners through mail in two batches. The questionnaire included closed answers, semi-closed answers, Likert type scales and visual analogical scales. In order to evaluate the adoption of the patient cantered clinical method, the Patient Practitioner Orientation Scale (PPOS), was utilized. The data statistical treatment was performed by the PASW Statistics software (former SPSS), version 18. The most relevant statistical tests considered were: the α of Cronbach, several non-parametric tests and binary logistic regression analysis. The response rate was 22.4%, with an amount of 639 answers (67.4% by female practitioners and 32.6% by male practitioners). In terms of smoking habits, 23% of the males referred to be smokers, against 14% amongst female physicians. In general terms, a severe lack of training in smoking cessation was identified, as only 4% of the physicians stated they did not need any further training in this field. In terms of those who answered they needed training, the main referred subjects were: (i) further training in motivational interviews (66%); (ii) further training in relapse prevention (59%); (iii) practical training in a smoking cessation consultation; (iv) brief intervention (54%); (v) pharmacologic therapeutics (55%). Despite 92% of the respondents considered smoking cessation counselling as an assignment of the GP, only 76% totally agreed with an opportunistic approach to the subject, in every contact with their patients. As most common practice regarding a patient ready for smoking cessation, 85% of the practitioners answered they take the initiative of advising, 79% stated they evaluate the motivational to quit, 67% assess the dependency level, 60% schedule the “D day” and 50% propose a pharmacological treatment. Only 21% of the respondents stated they frequently perform a brief intervention with the patient, following the “5 As” model, while 13% perform a brief motivational intervention following the “5 Rs” model (patients in pre-contemplation). In terms of performing interventions following the motivational interview principles (ambivalent patients), 20% of the respondents answered positively. The multivariate analysis lead to the conclusion that the variables which play the most important role on frequently adopting the latter forms of intervention were: (i) the self-efficacy on counselling; (ii) the negative attitudes; (iii) the systematic adoption of the smoking cessation guidelines provided by the central services of Ministry of Health; (iv) the specific training level in the current subject; (v) the non-identification of barriers, either due to organizational reasons or in relation to the practitioner-patient encounter communication process. Despite the fact that the hypothesis which relates the adoption of the patient-centered clinical method with more favourable attitudes towards smoking cessation was confirmed, no clear relationship between said clinical method and self reported counselling practices was found. Physicians who (i) presented a low or moderate negative behaviour level, (ii) evidenced high self-efficacy perception, (iii) had never smoked, (iv) referred adopting the national guideline for smoking cessation and (v) did not face any organizational barriers evidencing an higher probability of performing a brief counselling intervention (“5As”). Respondents that assumed they never ever smoked showed a higher probability of counselling their patients, according the “5 As” brief intervention model, than that of the practitioners who assumed to be smokers (adjusted odds ratio = 2.6; CI 95%: 1.1; 5.7). Physicians with higher self-efficacy perception about their ability to help patients on quitting, when compared with the practitioners with lower self-efficacy, showed (i) an higher probability of frequently engaging with the patient through brief counselling interventions following the “5 As” model (adjusted odds ratio = 2.6; CI 95%: (1.3; 5.3) (ii) performing a frequent motivational brief intervention (“5 Rs”) with non motivated patients (adjusted odds ratio = 3.1; CI 95%: (1.4; 6.5) or (iii) adopting a motivational interviewing style with ambivalent patients (adjusted odds ratio = 8.8; CI 95%: 3.8; 19.9). Considering the identification of barriers to perform this kind of work, the respondents highlighted the following aspects: (i) lack of time, (ii) lack of specific training and (iii) lack of a support team. When considering factors which could motivate them for intervene more in this field, about 60% of the respondents referred attending a practical training course and 57% suggested the possibility of receiving support from other professionals in a teamwork approach, while 50% would be eager to improve their theoretical knowledge on smoking cessation. About 25% of the respondents stated their effort would be more significant if a financial incentive were provided and 20% if the patients showed more interest in discussing the subject, or if this kind of intervention were more valued by either colleagues or responsible management of health services. The limitations of the sample representativeness due to the low response rate imposes some reservations on the generalization of conclusions. It is possible to admit that responders were more interested in the subject and more likely to be non-smokers. Moreover, the fact that no information about the attitudes, perceptions, expectations and practices of the patients was collected, also constitutes a limitation of this study. Nevertheless, the results obtained revealed that currently many opportunities for disease prevention and health promotion are missed. Furthermore, it was clear the severe lack of training in this field of knowledge. Evidence was also given on the fact that both negative attitudes and self-efficacy perception play a major role on the self-reported counselling practices. However, this research needs to be continued, namely in terms of analysing the extent to which the self-reported counselling practices match with the real practices in the consultation, and complemented with further studies about the perceptions, expectations and needs of patients regarding the role of their doctor on counselling them about smoking. On the other hand it will be needed to evaluate the impact of the smoking cessation counselling on the improvement of patient’s health literacy and on long-term success rates. The biomedical model, proposed 100 years ago by the Flexner’ Report, as a paradigm for pre and post-graduate medical training has contributed to the decline of valuing psycho-emotional and social components of health and disease phenomena and to create a gap between curative and preventive care and general medicine and public health. However, in developed countries, the current pattern of disease characterised by the new “pandemics’” of chronic diseases related with social and behavioural determinants, will certainly compel and give impulse to the revision of that paradigm. Moreover, it will impose the need to (re)adopt the Hippocratic principles of understanding health and disease and the role of medicine.

Patient-centred care is the gold standard of health care, yet in practice, problems prevail. The use of the ‘expert patient’ in health professional education is one form of learning patient-centred care. A gap in the literature regarding how the use of ‘expert patient’ in health professional education promotes patient-centred care was acknowledged in current research. With Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board approval, a sample of Queen’s University MScOT students participated in a qualitative study with the following research question: “How does the students’ experience of interacting with the ‘expert patient’ (‘XP’) relate to learning regarding client-centred practice (CCP)?” Three objectives were proposed: 1. Describe the OT students’ experience of interacting with the ‘expert patient’, 2. Describe the students’ learning regarding client-centered practice, 3. Identify the conditions particular to the ‘expert patient’ experience that led to learning regarding client-centered practice. In-depth interviews were conducted with the students subsequent to their ‘expert patient’ experience. Analysis revealed three conditions that together provided the foundation for student experiential learning regarding client-centred practice: interaction with particular persons with stable disability known as ‘expert patients’; students’ requirement to evaluate them and thus ‘experience power’; and explicit opportunities for ‘directed reflection and discussion’. Questions were raised for researchers, health care professional educators and health care professionals regarding the potentially transformative nature of engaging in unfamiliar contexts with openness to learning. The thesis allowed insight into the lived experience of OT students learning with ‘expert patients’; the admiration, discomfort, humility and gratefulness they experienced while gaining a sense of the meaning of collaboration, respect for autonomy and recognition of expertise. Implications of the research impact all stakeholders in health professional education.
Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-04-05 00:18:04.617

Patient-centred care is the gold standard of health care, yet in practice, problems prevail. The use of the ‘expert patient’ in health professional education is one form of learning patient-centred care. A gap in the literature regarding how the use of ‘expert patient’ in health professional education promotes patient-centred care was acknowledged in current research. With Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board approval, a sample of Queen’s University MScOT students participated in a qualitative study with the following research question: “How does the students’ experience of interacting with the ‘expert patient' (‘XP’) relate to learning regarding client-centred practice (CCP)?” Three objectives were proposed: 1. Describe the OT students’ experience of interacting with the ‘expert patient’, 2. Describe the students’ learning regarding client-centered practice, 3. Identify the conditions particular to the ‘expert patient’ experience that led to learning regarding client-centered practice. In-depth interviews were conducted with the students subsequent to their ‘expert patient’ experience. Analysis revealed three conditions that together provided the foundation for student experiential learning regarding client-centred practice: interaction with particular persons with stable disability known as ‘expert patients’; students’ requirement to evaluate them and thus ‘experience power’; and explicit opportunities for ‘directed reflection and discussion’. Questions were raised for researchers, health care professional educators and health care professionals regarding the potentially transformative nature of engaging in unfamiliar contexts with openness to learning. The thesis allowed insight into the lived experience of OT students learning with ‘expert patients’; and the admiration, discomfort, humility and gratefulness they experienced while gaining a sense of the meaning of collaboration, respect for autonomy and recognition of expertise. Implications of the research impact all stakeholders in health professional education.
Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-04-15 08:39:19.094

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Introduction There is growing awareness of the importance of patient centered care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents. However, there is limited research evidence exploring whether perceptions of PCC are equivalent between those delivering (radiographers) and those experiencing (patient) care. This study aimed to address this gap by determining compatibility in perceptions of PCC between those using and those delivering radiography services. This is the first step in developing measurable indicators of PCC in diagnostic radiography. Methods A multi-method two stage approach was undertaken using survey and interview data collection techniques. Ethical approval was granted by University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 1 of the study, the online, cross sectional survey. Participants were asked to indicate their level of agreement to a series of attitudinal statements using a 5-point Likert scale. Statements were paired, but not co-located to increase validity. Participants were invited to provide free text comments to supplement their responses. Stage 2 of the project is reported separately. Results Survey responses were received from all 3 participant subgroups. A minimum response rate of 30 participants per sub-group was set as a target. Response rates varied across subgroups, with only radiography managers failing to meet the expected response threshold. Wide disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident. Conclusion It is evident that there is still work required to ensure parity between expectations of service users and deliverers on what constitutes high quality PCC. Implications for practice Further work is required to identify measurable service delivery outcomes that represent PCC within radiographic practice.

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Introduction There is growing awareness of the importance of patient centred care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents, but there is limited research evidence exploring whether perceptions of PCC are equivalent between those delivering (radiographers) and those experiencing (patient) care. This study aimed to address this gap by determining compatibility in perceptions of PCC between those using and those delivering radiography services in order to develop measurable indicators of PCC. Methods This project was funded by the College of Radiographers Industry Partnership Scheme. Ethical approval was granted by the University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 2 of the project, which was a series of focus groups and telephone interviews to enable deeper discussion and exploration of PCC. Situational vignettes were used to promote discussion and debate and encourage suggestions for PCC approaches. Audit tools to assess engagement with PCC were developed at individual and organisational level. Results Four focus groups and six telephone interviews were carried out in total. Focus groups were held in a variety of locations to promote attendance. Telephone interviews were used to capture participants who could not attend a focus group in person. Disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident. Perceived levels of care and the effectiveness of communication appeared to be the key influences on whether PCC was delivered. Conclusion It is evident from the results of Stage 1 and Stage 2 that we have some way to go before we have parity in how care within diagnostic radiography is perceived, experienced and delivered. Audit tools and an educational toolkit are offered as ways to support increased PCC within diagnostic radiography practice. Implications for practice Several service improvements and audit tools are offered to support the increased delivery of PCC.

Introdução: O exercício e a educação constituem o tratamento não-farmacológico de primeira linha recomendado para a fibromialgia. Objetivo: O objetivo deste estudo foi investigar os efeitos de um programa de 8 semanas que combina educação centrada no utente e exercício versus exercício na intensidade da dor, incapacidade funcional e impacto da fibromialgia e perceção global de mudança na dor e funcionalidade. Metodologia: Sessenta indivíduos com fibromialgia foram aleatoriamente distribuídos pelo grupo experimental (exercício e educação) ou pelo grupo controlo (exercício). A medida de avaliação primária foi a intensidade da dor, avaliada pela Escala Numérica da Dor e a secundária foi a incapacidade, avaliada pela versão portuguesa da Revised Fibromyalgia Impact Questionnaire, assim como a perceção global de mudança, avaliada pela versão Portuguesa da The Patient Global Impression of Change. Os participantes foram avaliados antes da intervenção, 4 semanas após o início e no final das 8 semanas de intervenção. A significância da efetividade das intervenções para a dor e para a incapacidade foi avaliada com uma two-way mixed-model ANOVA, enquanto o chi-square tests of independence foi utilizado para avaliar a relevância clínica dos resultados. Resultados: Trinta participantes em cada grupo foram analisados no final da intervenção. Não se verificou efeito de interação entre grupo e tempo para a intensidade da dor (p=.488) nem para a incapacidade (p=.370). Verificou se que o efeito do tempo foi estatisticamente significativo para a intensidade da dor (p<.001) e para a incapacidade (p<.001). O efeito de grupo foi estatisticamente significativo para a intensidade da dor em favor do grupo de controlo (p=.003). A análise da relevância clínica revelou que não houve diferenças estatisticamente significativas entre os grupos para a intensidade da dor (p=.432), incapacidade (p=.405) e perceção global de mudança da dor (p=.071) e da incapacidade (p=.100). A análise do risco relativo demonstrou que o grupo experimental apresentou 1.3 mais probabilidade de atingir resultados com relevância clínica na intensidade da dor. Conclusão: Ambos os tratamentos foram efetivos na redução da dor e da incapacidade. Um programa de exercício combinado com educação não é mais efetivo do que um programa de exercício isolado para a diminuição da dor e incapacidade em indivíduos com fibromialgia. Proporções semelhantes de indivíduos em ambos os grupos alcançaram melhorias clinicamente significativas para ambas as medidas de resultados, mas o grupo experimental apresentou mais probabilidade de atingir resultados com relevância clínica na intensidade da dor
Background: Non-pharmacological therapeutic interventions are highly recommended for treating fibromyalgia. Objectives: To compare the effectiveness of an 8-week intervention programme who combine patient-centred education and exercise versus exercise alone on pain intensity, disability and patient’s global impression of change for pain and function. Methods: Sixty fibromyalgia patients were randomly allocated to the experimental group (education and exercise programme) or control group (exercise alone). The primary outcome was pain intensity, assessed by the Numeric Pain Scale and the secondary outcome was disability, assessed by the Portuguese Revised Fibromyalgia Impact Questionnaire and the patient’s global impression of change, assessed by the Portuguese version of the Patient Global Impression of Change. The participants were assessed at baseline, week 4 and week 8. Two-way mixed-model Anova was used for pain intensity and disability while the clinical relevance was examined using chi-square tests of independence. Results: Thirty patients each group were analysed at the end of the interventions. No significant group-by-time interactions were found neither for pain intensity (p=.488) nor for disability (p=.370). Significant effects of time were found for pain intensity (p<.001) and disability (p<.001). Significant effects of group were found for the control group on pain intensity (p=.003). Clinical relevance showed no significant differences between groups at the end of the interventions for pain intensity (p=.432), disability (p=.405), and patient global impression of change for pain (p=.071) and function (p=.100). Risk Relative revealed that the experimental group have 1.3 more probability to achieve clinically relevant outcomes for pain intensity. Conclusion: Both treatments were effective for decreasing pain intensity and disability. A combined exercise and education program seems not superior to exercise alone in reducing pain intensity and disability for individuals with fibromyalgia. Similar proportions of patients achieved clinically meaningful improvements for both outcomes, but the experimental group have more probability to achieve clinically relevant outcomes in terms of pain intensity.

Despite the medical advancement in heart failure (HF) management strategies, HF remains a condition that has significant physical, psychological, and social negative impacts on patients. Previous heart failure management programs have produced inconsistent results, and failed to determine an effective intervention that attains clinical stability. While the effectiveness of therapeutic options / elements for HF has been determined, a practice gap exists around how best to structure and deliver the therapeutic options. As a developing country Jordan has a limited health budget and infrastructure, as well as a lack of well-structured health care services for chronic diseases. In addition, there have been dramatic increases in prevalence of ischemic heart disease, diabetes, and hypertension, and other risk factors for heart failure (HF) attributed to sedentary lifestyles and dietary shifts. Therefore, an effective HF management program that is contextualised and feasible is needed. According to the literature, patient-centred care can be effective in improving HF knowledge, adherence to self-care, communication between patients and healthcare provider, and psychological status. Tailoring interventions is an important part of patient empowerment or patient centredness in which the interventions are specifically designed for patients based on careful assessments. This mixed methods study proposes a patient-centred HF management program that is tailored to the Jordanian context and patients’ needs. It involved two studies. The first study was a cross sectional survey. The second study comprised two components: a Delphi study of clinicians and focus groups for patients. The cross sectional study (survey) was conducted with a convenience sample of 300 Jordanian patients with HF. The outcomes that were measured included: (i) heart failure knowledge, (ii) self-care, (iii) treatment adherence, and (iv) quality of life (QOL). The Delphi study utilised seven clinicians and policy makers. The two focus groups included the same seven HF patients recruited from cardiac out-patient clinics. The main purpose for study two was to derive consensus from clinicians (using the Delphi method) and understand the perspectives of patients (using focus groups) on a more patient-centred model of HF management. Study I (quantitative study) showed that Jordanian HF patients had a moderate level of knowledge, a moderate self-care, poor adherence, and moderate quality of life. Males had higher knowledge than females. Only 3% of patients were informed to weigh themselves every day, and to watch the fluid status. Regarding self-care, most patients disagreed that they would contact their doctor or nurse if they gained 2 kg in one week (92%), and 83% disagreed with monitoring their weight every day. Unmarried and illiterate patients had poorer self-care than their counterparts. Activities with the lowest levels of adherence were: reducing or quitting smoking, and self-weighing. The predictors of quality of life were insomnia, marital status, previous hospitalisation, and employment. Regarding patients’ focus groups, eight themes emerged from the first focus group, including emotional impact of HF, Motivation to change lifestyle, Adjustment to treatment, Physical impact of HF, Loss of social interaction, and Impact of religion. Three themes emerged from the second focus group, involving the effectiveness of teaching sessions in cardiac clinic, suggestions for improving the educational program, and appropriateness of educational material. The Delphi study found consensus for the feasibility of different HF components: lifestyle brochure, nutrition card, and follow up phone call program, cardiac rehabilitation program, and group discussion session. The mixed methods study revealed that there were increased HF risk factors and sedentary behaviours for people with HF in Jordan, poor HF education, psychological distress, social isolation, and ineffective communication between patients and healthcare providers. The Jordanian healthcare system will need to implement a patient-centred heart failure management program that is tailored to Jordan context and patient’s needs. The proposed program from this study was determined to be feasible, appropriate, and applicable in Jordan, embracing three main elements that should be delivered to patients across the whole continuum of care process. These were targeted education, psychological support, and social support.
Thesis (Ph.D.) -- University of Adelaide, Adelaide Nursing School, 2020

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Introduction: Awareness is growing of the importance of patient centered care (PCC) in diagnostic radiography. PCC is embedded within professional body publications and guidance documents, but there is limited research evidence exploring the perceptions of student radiographers and radiography academics. Methods: This paper reports Stage 1 and Stage 2 of the project from the perspective of radiography academic and student radiographer participants, and compares these to the perspectives of service users, clinical radiographers and radiography managers reported previously. Stage 1 used an online survey tool to gauge participant agreement with a series of attitudinal statements. Stage 2 used situational vignettes to promote discussion and debate about PCC approaches. Results: Response rates to the Stage 1 survey were above the minimum threshold, with 50 responses from student radiographers and 38 responses from radiography academics. Stage 1 participants were asked to participate in Stage 2 on a voluntary basis. As with service users and service deliverers, care communication, event interactions and control over environment were the key influences on PCC. However, students highlighted differences between reported and observed levels of PCC. Conclusion: There is some way to go to embed PCC in diagnostic radiography practice. As impartial observers of radiography practice, student radiographers highlight the difference between service users and service deliverer's perceptions of PCC. Whilst the focus of clinical radiographers remains on efficiency, it is difficult for student radiographers to challenge the accepted norm. Role models are required to promote PCC behaviours and a holistic approach in radiography practice. Implications for practice: A package of educational support and audit tools will be made available to support both service deliverers and student radiographers to deliver PCC

This thesis investigates a perceived gap between the medical profession’s rhetoric that the welfare of the patient is the medical practitioner’s first priority, and the reality of patient experience. The Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia mandates the duty of medical practitioners to make the care of their patients their first priority. This code also confirms that good medical practice is patient-centred. Patient-centred care should therefore be central to patient experience. However, despite promotion of this goal by medical professional authorities, patient-centred care is not always being achieved as well as it might in practice. This thesis is an attempt to understand the reasons why this divergence between rhetoric and practice is occurring, paying particular attention to the role of the law as a potential and actual promoter of, and barrier to, practices which are recognised components of patient-centred care, and consequently of good medical practice. This aim is developed through two case studies, the way valid advance directives are observed or not, and the responses of medical practitioners to injuries to patients sustained during medical treatment. The methodology used includes analysis of hard law regulatory processes together with the development of and increasing reliance on the soft law documented in codes, guidelines and other regulatory standards which reflect the evolving ideals of medical professionalism. In turn, an examination of disciplinary cases of tribunals and courts shows how conduct is interpreted in accordance with what is or is not professional behaviour. There is evidence that observance by medical practitioners of patient-centred care is often being overwhelmed by the scientific and technical aspects of medical practice and other pressures on medical practitioners, such as concerns about legal liability. The necessity for the observance of respect for the human being who is the patient is discounted to these priorities despite extensive evidence of improved outcomes for patients when patient-centred principles are implemented. The reasons for this discount are complex but a major contributor to the less than optimum observance of patient-centred principles is medical professionalism as fostered by the current methods of socialisation and training of medical practitioners. Bullying and humiliation of medical students in their training leads to desensitisation and a consequent lack of attention by medical practitioners to the necessity for patient-centred approaches to practice. An exploration of the direct and indirect impacts of the law upon the medical profession shows the domination of medical practitioner interests over the interests of their patients. Therefore, this thesis considers whether the existing Australian legislative regime can be applied to achieving the promotion of the observance of quality, patient-centred practices by medical practitioners to the mutual benefit of doctor and patient. It argues that medical disciplinary authorities can use the provisions of the Health Practitioner Regulation National Law together with soft law regulation to more completely embed a patient-centred culture in medical practitioner behaviour.

Patient-centred care has become an important model for health-care delivery, especially in cancer care. The implementation of this model includes patient-centred communication between the clinician and his or her patient. However, most research on patient-centred communication focuses on the clinicians’ initiative: what clinicians should do and what information they should seek to elicit from patients. It is equally important to recognize what each individual patient can contribute about his or her unique perspective on the disease, its treatment, and the effects on what is important to this patient. This thesis reports the development of a system for analyzing over 1500 utterances made by patients in eight video-recorded oncology consultations at the British Columbia Cancer Agency, Vancouver Island Centre. The analysis distinguishes between biomedical information that the patient can provide and patient-centred information, which contributes the individual patient’s unique perspective on any aspect of his or her illness or treatment. The resulting analysis system includes detailed operational definitions with examples, a decision tree, and .eaf files in ELAN software for viewing and for recording decisions. Two psychometric tests demonstrated that the system is replicable: high inter-analyst reliability (90% agreement between independent analysts) on a random sample of the data set and cross-validation to the remainder of the data set. A supplemental idiographic analysis of each consultation illustrates the important role that patient-centred information played in these consultations. This system could be an important tool for teaching clinicians to recognize the individual information that patients can provide and its relevance to their care.
Graduate
0992
0451
0350
shealing@uvic.ca

The thesis presented consists of two parts: a theory and the empirical part. The theory is introduced with a brief survey of the history of the patient centred care followed with current trends in nursing. It is followed with the three key areas determining nursing care. The first one consists of the objective factors - the health care system. The second area is formed by the factors associated with the practical implementation of nursing. The third area is devoted to the role of the patient and his surroundings. Objective of the thesis: The mapping of the factors influencing patient-oriented care by the nursing staff and management in various health care institutions. Research group The research group consisted of 11 female respondents state-registered nurses, aged from 24 to 58 years of age. The respondents varied in their position, level of education, and specialization, and they worked in various health-care institutions. Among them, there were 6 registered nurses, 4 ward nurses, and 1 head nurse. The willingness to cooperate and the saturation of responses were principal in forming the research team in question. The way adopted for achieving of the objective A qualitative research method has been chosen to achieve the goal. The phenomenological focus of the work has led to the selection of the method. The data were collected using semi-structured interviews. The findings were further categorized and confronted with the source material to answer the research questions. Results The research confirms the nursing care is a complex phenomenon. The recently-adopted health care legislation shows a shift from the paternalistic concept of care on behalf of the right of the patient to self-determination. On the other hand, however, the principle of solidarity the basis of the health care system in the Czech Republic retains some paternalismus, and that can negatively affects the relationship of the patient to the nursing staff in some cases. The respondents are in agreement as to the notion of PCC but a single one respondent knows its concept. The possibility of putting the PCC in practice is hampered by a wide range of factors. According to the respondents, the major obstacle is the undernumerousness of the nursing staff, resulting in the omnipresent time stress. The excessive red-tape demands have been seen as the almost equally important factor, together with the lack of continuity of care, but also the fast-and-loose approach of some nurses. The evaluation of the cooperation between staff nurses at the bed and the nurses in senior positions differed. Staff nurses see the problem in cooperation with their superiors, lacking appreciation of their work. Management, i.e. head nurses and ward nurses are often seen as systemic obstacles. The research investigation also shows insufficient cooperation with the patient's family. Permanent changes in the nursing education concept are seen as a hindrance to the problem solution. Regretfully, the actual approach of a nurse often slides down from a vocation to a mere employment. Conclusion The problems identified in the healthcare system indicate a wide range of factors influencing the relations between the nursing staff and patients. Multidimensional patient care concepts and examples from our healthcare system illustrate how clinical, structural, and interpersonal factors can interact in the relations between nursing staff and patient. The PCC concept should enable any health-care provider to set ways to improvement the care rendered and to motivate the caring staff to adopting it.

Paramedicine is a relative newcomer to academia, with paramedic education programs existing in Australian universities since the turn of the century. As such, minimal research exists into the experience of paramedics in general. Gay and Lesbian people are an under researched minority group within the workplace, despite their high participation rates in employment. This research sets out to redress the gap in the literature by investigating the current workplace experience of Gay and Lesbian paramedics in Australia. Using a qualitative approach informed by a bricolage of critical theory and hermeneutic phenomenology, the experiences of inclusion and marginalisation of participants was explored. Experiences of the accounts of the hidden population of 10 Gay and Lesbian paramedic participants provide the first known account of the culture of the paramedic workplace in Australia from a non-heteronormative perspective. Participant experiences also give form to the impacts of practices that exclude and marginalise Gay and Lesbian people in the paramedics’ workplace.

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It is estimated that 820,000 people in the UK have dementia. Dementia costs the UK 17 billion a year and in the next 30 years this will treble to over pound50 billion a year. There is a need to raise competence of staff delivering care to people living with dementia across health, social and voluntary sector provision. Effective education and training will build capacity and improve staff knowledge. However, at present not enough is known about the experiences of staff involved in gaining the skills, knowledge and attitudes required to support provision of high quality care for people with dementia. This study was conducted within a large National Health Service Trust in the UK serving an urban, ethnically mixed population, in collaboration with a local university. The trust responded to government policy by seeking to identify staff training needs. The aim was to explore the experiences of staff working within a specialist mental health service in relation to development of skills for the provision of person-centred care for people with dementia. To achieve this, staff roles, experiences of dementia training and the ways in which staff feel they learn were explored through focus group interviews. Relatives' views of staff competencies necessary for effective care provision were also explored to supplement the data from staff. A total of 70 staff and 16 family carers participated and data were subjected to inductive thematic analysis. Five themes emerged: competency-based skills, beliefs, enablers and barriers and ways of learning. Findings suggested participants felt that skills for person-centred care were innate and could not be taught, while effective ways of learning were identified as learning by doing, learning from each other and learning from experience.