Simon Malfait

Feasibility, appropriateness, meaningfulness and effectiveness of patient participation at bedside shift reporting: mixed‐method research protocol

AIM To evaluate the feasibility, appropriateness, meaningfulness and effectiveness of bedside shift reporting in a minimum of five interventions and five control wards. BACKGROUND Hospitals continually improve their quality of care. Next to improvements in clinical performance, more patient participation is stimulated through different methods. Methods to enhance patient participation such as bedside shift reporting lack rigorously performed research to determine their feasibility, appropriateness, meaningfulness and effectiveness. Small-scale research and a previous pilot study indicate that bedside shift reporting improves patient participation, nurse-nurse communication and nurse-patient communication. DESIGN The development, implementation and evaluation of bedside shift report are based on the Medical Research Council framework for complex interventions in health care. A matched, controlled, mixed-method, longitudinal study design will be used. The Feasibility-Appropriateness-Meaningfulness-Effectiveness framework will be applied for the quantitative and qualitative evaluation of bedside shift report. METHODS A tailored intervention and implementation process for bedside shift report will be developed using diagnostic interviews, co-design and acceptability testing. The intervention will be evaluated before implementation and three times after implementation. Individual and focus group interviews will be performed. Questionnaires, observations and analysis of the medical records and administrative databases will be completed. This study was funded in October 2015. Research Ethics Committee approval was granted in March 2016. DISCUSSION There is a pressing need for rigorous research into the effects of interventions for improving patient participation. This study addresses the significance of bedside shift report as an intervention to improve quality of care, communication and patient participation within a large-scale, matched, controlled research design.

The Patient Participation Culture Tool for healthcare workers (PaCT-HCW) on general hospital wards: A development and psychometric validation study

BACKGROUND Patient participation is an important subject for modern healthcare. In order to improve patient participation on a ward, the wards culture regarding patient participation should first be measured. In this study a measurement tool for patient participation culture from the healthcare workers perspective, the Patient Participation Culture Tool for healthcare workers (PaCT-HCW), was developed and psychometrically evaluated. OBJECTIVES The aim of this study was to develop and validate a tool that measures the healthcare worker-related factors of patient participation and information sharing and dialogue in patient participation from the healthcare workers perspective in order to represent the patient participation culture on general and university hospital wards. DESIGN A four-phased validation study was conducted: (1) defining the construct of the PaCT-HCW, (2) development of the PaCT-HCW, (3) content validation, and (4) psychometric evaluation. SETTINGS The Belgian Federal Government invited all Flemish general and university hospitals by e-mail to distribute the PaCT-HCW in their organization. Fifteen general hospitals took part in the study. PARTICIPANTS Units for surgery, general medicine, medical rehabilitation, geriatric and maternal care were included. Intensive care-units, emergency room-units, psychiatric units and units with no admitted patients (e.g. radiology) were excluded. The respondents had to be caregivers, with hands-on patient contact, who worked on the same ward for more than six months. Nursing students and other healthcare workers with short-time internship on the ward were excluded. The tool was completed by 1329 respondents on 163 wards. METHODS The PaCT-HCW was psychometrically evaluated by use of an exploratory factor analysis and calculation of the internal consistency. RESULTS A model containing eight components was developed through a literature review, individual interviews, and focus interviews. The developed model showed high sampling adequacy and the Bartletts test of sphericity was significant. An exploratory factor analysis identified eight components, explaining 49.88% of the variances. The eight original included components were retained. The PaCT-HCW also showed high internal consistency. CONCLUSION The PaCT-HCW offers an in-depth and differentiated perspective of the healthcare worker-related factors of patient participation and information sharing and dialogue in patient participation. The PaCT-HCW has been developed thoroughly, resulting in a strong, psychometric evaluated tool and is a valuable measure for both scientists and clinicians to measure these two aspects in general and university hospitals. By using the PaCT-HCW, the opportunity is created to develop specific actions to improve patient participation.

Nursing staff and their team: Impact on intention to leave

AIM The aim was to examine the relationship between the quality of team-member exchange experienced by nursing staff and their intention to leave. Job satisfaction and affective organizational commitment are considered as mediators. BACKGROUND While the shortage of nurses is a management and policy priority, few studies have studied the relationships between nursing staff and their team, key organizational attitudes, and intentions to leave the organization. METHOD A questionnaire was administered to 217 registered nurses and nurse assistants in Belgium. Data were collected in 2012. To analyse the data, descriptive statistics, correlation, regression and path analyses were conducted. FINDINGS Team-member exchange has a positive impact on nursing staff satisfaction and affective commitment. Job satisfaction and affective organizational commitment fully mediated the impact of team-member exchange on nursing staffs intention to leave. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY This study illustrates the potential benefits of the positive influence of team-member exchange on key organizational attitudes of nursing staff, and the negative influence on intention to leave through affective commitment and job satisfaction.

Co-design for implementing patient participation in hospital services : A discussion paper

Patient participation is increasingly recognized as a key component in healthcare. Patients’ experiences and knowledge are considered as complementary and equal in importance to professionals’ knowledge [1], both in individual care contexts and in healthcare organization [2,3]. Direct patient participation methods have been proven to lead to patient-centeredness and better care [4], but developing and implementing such methods is often a complex matter [5,6]. The use of the co-design methodology could offer a solution for designing and implementing these complex interventions. “Experience-Based Co-Design” is a specific form of co-design in healthcare. “Experience-based” refers to how patients feel about the used healthcare services and how well they serve their needs. “Co-design” indicates that both patients and healthcare professionals act as designers of the healthcare services. Also, it can be seen as an implementation strategy as it has the potential to counter reluctance within healthcare teams [7]. Overall, EBCD is a rigorous participatory approach that enables both staff and patients to (re)design services together by sharing experiences, identifying priorities, implementing and evaluating improvements in care and service provision [8].

Compliance with a structured bedside handover protocol: An observational, multicentred study

BACKGROUND Bedside handover is the delivery of the nurse-to-nurse shift handover at the patients bedside. The method is increasingly used in nursing, but the evidence concerning the implementation process and compliance to the method is limited. OBJECTIVES To determine the compliance with a structured bedside handover protocol following ISBARR and if there were differences in compliance between wards. DESIGN A multicentred observational study with unannounced and non-participatory observations (n = 638) one month after the implementation of a structured bedside handover protocol. SETTINGS AND PARTICIPANTS Observations of individual patient handovers between nurses from the morning shift and the afternoon shift in 12 nursing wards in seven hospitals in Flanders, Belgium. METHODS A tailored and structured bedside handover protocol following ISBARR was developed, and nurses were trained accordingly. One month after implementation, a minimum of 50 observations were performed with a checklist, in each participating ward. To enhance reliability, 20% of the observations were conducted by two researchers, and inter-rater agreement was calculated. Data were analysed using descriptive statistics, one-way ANOVAs and multilevel analysis. RESULTS Average compliance rates to the structured content protocol during bedside handovers were high (83.63%; SD 11.44%), and length of stay, the type of ward and the nursing care model were influencing contextual factors. Items that were most often omitted included identification of the patient (46.27%), the introduction of nurses (36.51%), hand hygiene (35.89%), actively involving the patient (34.44%), and using the call light (21.37%). Items concerning the exchange of clinical information (e.g., test results, reason for admittance, diagnoses) were omitted less (8.09%-1.45%). Absence of the patients (27.29%) and staffing issues (26.70%) accounted for more than half of the non-executed bedside handovers. On average, a bedside handover took 146 s per patient. CONCLUSIONS When the bedside handover was delivered, compliance to the structured content was high, indicating that the execution of a bedside handover is a feasible step for nurses. The compliance rate was influenced by the patients length of stay, the nursing care model and the type of ward, but their influence was limited. Future implementation projects on bedside handover should focus sufficiently on standard hospital procedures and patient involvement. According to the nurses, there was however a high number of situations where bedside handovers could not be delivered, perhaps indicating a reluctance in practice to use bedside handovers.

Patient and public involvement in hospital policy-making: Identifying key elements for effective participation

The involvement of patients and the public in healthcare decisions becomes increasingly important. Although patient involvement on the level of the individual patient-healthcare worker relationship is well studied, insight in the process of patient and public involvement on a more strategic level is limited. This study examines the involvement of patient and public (PPI) in decision-making concerning policy in six Flemish hospitals. The hospitals organized a stakeholder committee which advised the hospital on strategic policy planning. A three-phased mixed- methods study design with individual questionnaires (n = 69), observations (n = 10) and focus groups (n = 4) was used to analyze, summarize and integrate the findings. The results of this study indicate that: (1) PPI on hospital level should include the possibility to choose topics, like operational issues; (2) PPI-stakeholders should be able to have proper preparation; (3) PPI-stakeholders should be externally supported by a patient organization; (4) more autonomy should be provided for the stakeholder committee. Additionally, the study indicates that the influence of national legislation on stakeholder initiatives in different countries is limited. In combination with the growing importance of PPI and the fact that the recommendations presented are not claimed to be exhaustive, more transnational and conceptual research is needed in the future.

The impact of stakeholder involvement in hospital policy decision-making : a study of the hospital’s business processes

Introduction: In many health care systems, strategies are currently deployed to engage patients and other stakeholders in decisions affecting hospital services. In this paper, a model for stakeholder involvement is presented and evaluated in three Flemish hospitals. In the model, a stakeholder committee advises the hospital’s board of directors on themes of strategic importance. Objectives: To study the internal hospital’s decision processes in order to identify the impact of a stakeholder involvement committee on strategic themes in the hospital decision processes. Methods: A retrospective analysis of the decision processes was conducted in three hospitals that implemented a stakeholder committee. The analysis consisted of process and outcome evaluation. Results: Fifteen themes were discussed in the stakeholder committees, whereof 11 resulted in a considerable change. None of these were on a strategic level. The theoretical model was not applied as initially developed, but was altered by each hospital. Consequentially, the decision processes differed between the hospitals. Despite alternation of the model, the stakeholder committee showed a meaningful impact in all hospitals on the operational level. As a result of the differences in decision processes, three factors could be identified as facilitators for success: (1) a close interaction with the board of executives, (2) the inclusion of themes with a more practical and patient-oriented nature, and (3) the elaboration of decisions on lower echelons of the organization. Conclusion: To effectively influence the organization’s public accountability, hospitals should involve stakeholders in the decision-making process of the organization. The model of a stakeholder committee was not applied as initially developed and did not affect the strategic decision-making processes in the involved hospitals. Results show only impact at the operational level in the participating hospitals. More research is needed connecting stakeholder involvement with hospital governance.

The Development and Validation of the Patient Participation Culture Tool for Inpatient Psychiatric Wards (PaCT-PSY)

ABSTRACT Patient participation is an important topic in mental health and receives increased attention along with deinstitutionalization. No tool exists to measure healthcare worker‐related factors that influence patient participation. A three‐staged study was conducted to develop and validate the ‘Patient Participation Culture Tool for inpatient PSYchiatric wards’ (PaCT‐PSY), and to analyse its psychometric properties (n = 603). The 60‐items tool, comprising thirteen components, showed content validity, strong psychometric properties, and a high internal consistency. The PaCT‐PSY measures the patient participation culture on psychiatric wards by exploring healthcare workers factors influencing patient participation. It enables researchers, practitioners and administrators to develop tailored actions.

The influence of healthcare worker-related determinants on a ward's patient participation culture

Background: Cancer is considered as chronic condition, especially in the older people. Prevalence of cancer is especially high in the Nordic countries and Mediterranean countries. People with cance ...Background: To measure the attitudes towards older people and perceptions of working with older people of undergraduate health and social care students in 5 European countries. Questionnaires are one of the most widely used data collection methods. The use of questionnaires constructed and validated in a setting to other setting is an essential aspect in international studies, which have as main objective to compare and deduce similarities and differences within different contexts. There are three main aspects in validation, the linguistic, the cultural and statistic validation,all these three aspects are essential during theprocess. Materials: Two questionnaires were used: Attitudes towards Older People Scale (Kogan1966) and Students’ Perception of Working with Older People Scale (Nolan et al, 2006). Methods: Five Countries were involved in the study namely Ireland, Finland, Germany, Latvia, and Italy. Back translation methodology was used in order to translate questionnaire (Linguistic and cultural validation) while a Cronbach was calculate to assess internal validity (statistic validation). Results: Students (n = 955) completed the two questionnaires. Students’ Perception of Working with Older People Scale, shows a 0.81 a Cronbach for all sample, for Ireland 0.84, Germany, 0.79, Italy 0.79, Finland 0.84 and Latvia 0.59, Attitudes towards Older People Scale shows a 0.83 a Cronbach for all sample,for Ireland 0.85, Germany, 0.83, Italy 0.62, Finland 0.86 and Latvia 0.74. Respondents were generally positive towards older people with few differences between countries. Those with least experience with older people displayed more negative attitudes. Significant relationships were found between positive 50

Reporting of \"dialysis adequacy\" as an outcome in randomised trials conducted in adults on haemodialysis: a systematic review

Background Clinical trials are most informative for evidence-based decision-making when they consistently measure and report outcomes of relevance to stakeholders, especially patients, clinicians, and policy makers. However, sometimes terminology used is interpreted differently by different stakeholders, which might lead to confusion during shared decision making. The construct dialysis adequacy is frequently used, suggesting it is an important outcome both for health care professionals as for patients. Objective To assess the scope and consistency of the construct dialysis adequacy as reported in randomised controlled trials in hemodialysis, and evaluate whether these align to the insights and understanding of this construct by patients. Methods To assess scope and consistency of dialysis adequacy by professionals, we performed a systematic review searching the Cochrane Central Register of Controlled Trials (CENTRAL) up to July 2017. We identified all randomised controlled trails (RCT) including patients on hemodialysis and reporting dialysis adequacy, adequacy or adequacy of dialysis and extracted and classified all reported outcomes. To explore interpretation and meaning of the construct of adequacy by patients, we conducted 10 semi-structured interviews with HD patients using thematic analysis. Belgian registration number B670201731001. Findings From the 31 included trials, we extracted and classified 98 outcome measures defined by the authors as adequacy of dialysis, of which 94 (95%) were biochemical, 3 (3%) non-biochemical surrogate and 2 (2%) patient-relevant. The three most commonly reported measures were all biochemical. None of the studies defined adequacy of dialysis as a patient relevant outcome such as survival or quality of life. Patients had a substantially different understanding of the construct dialysis adequacy than the biochemical interpretation reported in the literature. Being alive, time spent while being on dialysis, fatigue and friendliness of staff were the most prominent themes that patients linked to the construct of dialysis adequacy. Conclusion Adequacy of dialysis as reported in the literature refers to biochemical outcome measures, most of which are not related with patient relevant outcomes. For patients, adequate dialysis is a dialysis that enables them to spend as much quality time in their life as possible.