Introducing multidisciplinary ward rounds in Malawi: a best practice implementation project.

INTRODUCTION: The Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) in the United Kingdom advocate the use of structured multidisciplinary team (MDT) ward rounds since they can enable safe, effective, improved care and enhanced staff satisfaction. OBJECTIVES: This project sought to implement best practices for MDT ward rounds in a male medical ward in a hospital in Malawi. METHODS: The project was conducted in line with the JBI Evidence Implementation Framework. A baseline audit of MDT ward rounds was conducted with six staff members. Audit criteria consisted of ten best practices, as recommended by JBI, the RCP, and the RCN. Stakeholder meetings were held to review the baseline audit results and highlight areas of non-compliance. JBI's Getting Research into Practice (GRiP) tool was used to identify barriers to compliance with best practices, and a follow-up audit was conducted to determine changes in practice. RESULTS: The results only showed improvement for one criterion, which rose from 33% to 100% (n=6) where nurses attended the ward round. CONCLUSIONS: This study demonstrated some challenges in evidence implementation projects and how these can, in part, be overcome. While the results only demonstrated improvement for one criterion, this paper shows how audits can be used to promote best practice, which in this case resulted in nurses being more involved in ward rounds, improvements in MDT communication, enhanced nurse inclusion in decision-making and, consequently, patient care. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A233.

Reinforcing the essential role of families through first impressions of the physical environment.

The physical environment in all of its aspects of space, structure, millwork, furniture, materials, flow, signage, and art has great potential to set a positive tone and invitation for families to be partners in the care of their infants. This article describes design strategies that create a series of positive welcoming first impressions throughout a NICU to support family caregiving and participation as parents of their infant and essential members of the care team.

A Narrative Review of Patient and Family Engagement: The "Foundation" of the Medical "Home".

BACKGROUND: Patient and family engagement (PFE) is vital to the spirit of the medical home. This article reflects the efforts of an expert consensus panel, the Patient and Family Engagement Workgroup, as part of the Society of General Internal Medicine's 2013 Research Conference. OBJECTIVE: To review extant literature on PFE in pediatric and adult medicine and quality improvement, highlight emerging best practices and models, suggest questions for future research, and provide references to tools and resources to facilitate implementation of PFE strategies. METHODS: We conducted a narrative review of relevant articles published from 2000 to 2015. Additional information was retrieved from personal contact with experts and recommended sources from workgroup members. RESULTS: Despite the theoretical importance of PFE and policy recommendations that PFE occurs at all levels across the health care system, evidence of effectiveness is limited, particularly for quality improvement. There is some evidence that PFE is effective, mostly related to engagement in the care of individual patients, but the evidence is mixed and few studies have assessed the effect of PFE on health outcomes. Measurement issues and the lack of a single comprehensive conceptual model pose challenges to progress in this field. Recommendations for future research and a list of practical tools and resources to facilitate PFE are provided. CONCLUSIONS: Although PFE appeals to patients, families, providers, and policy-makers, research is needed to assess outcomes beyond satisfaction, address implementation barriers, and support engagement in practice redesign and quality improvement. Partnering with patients and families has great potential to support high-quality health care and optimize outcomes.

A critical narrative analysis of shared decision-making in acute inpatient mental health care.

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients' care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

Promoting Patient- and Family-Centered Care Through Personal Stories.

Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among patients, their families, and health care professionals. It redefines the relationships in health care by placing an emphasis on collaborating with patients of all ages, and their families, at all levels of care, in all health care settings, and in organizational change and improvement. This collaboration ensures that health care is responsive to an individual's priorities, preferences, and values. In patient- and family-centered care, patients define their "family" and determine how they and their family will participate in care and decision making. While patient- and family-centered care can improve the experience of care, safety, and quality, it also can improve the learning environment for students and trainees. The author shares personal stories to illustrate the core concepts of patient- and family-centered care, when they are present in health care interactions, and when they are not. Drawing from these stories and the author's experience in working with academic medical centers and other health care organizations over many decades, recommendations for changes in medical education are suggested that can contribute to the development of a health care workforce with the skills and commitment to partner respectfully, effectively, and authentically with patients and families. The implementation of the Affordable Care Act gives new impetus for building a health care delivery system and related educational programs to support patient- and family-centered practice.

Partnering With Patients, Families, and Communities.

BACKGROUND AND OBJECTIVES: Collaborating with patients, families, and communities is a core principle of family medicine. However, the health care system in the United States has grown increasingly complex, fragmented, and difficult to navigate. This system, focused on disease-specific care delivered by specialists, often treats patients as the objects of care rather than as partners in care. Family Medicine for America's Health (FMAHealth) offers an opportunity to challenge the status quo in collaborative care through enhanced patient outreach and community engagement. With a central focus on improving health and achieving the Triple Aim, the FMAHealth initiative recognizes that successful transformation of the US health care system requires collaborative partnerships between clinicians, patients, families, and communities. Patient and population-level outcomes can be improved through shared decision making; application of new technology; and authentic partnerships with patient, families, and communities. Broader collaboration in practice transformation, research, and policymaking can lead to identification of common goals and mutually embraced transformation. The discipline of family medicine aspires to encourage patients, families, and communities to demand change as consumers, as citizens, and as voters.

Challenges having conversations about sexuality in ambulatory settings: part II--health care provider perspectives.

Cancer treatment can have a significant impact on an individual's quality of life. In particular, body image and sexuality can be compromised. There is increasing evidence that conversations about these specific consequences are not happening often between cancer patients and health care providers, especially in busy ambulatory settings. This study was undertaken to explore the perspectives of cancer care providers regarding the conversations about sexuality that happen following a cancer diagnosis. There was a desire to understand more about the barriers that exist with regards to having this conversation in daily practice. Thirty-four cancer care professionals (nurses, physicians, social workers and radiation therapists) were interviewed to explore their experiences in having conversations about sexuality. Transcripts were subjected to a standard qualitative content and theme analysis. Six themes emerged from the analysis. Overall, participants acknowledged treatment can have an impact on a patient's sexuality. For the most part, any conversations about sexuality topics occurred during informed consent processes before treatment began or when a patient raised a question about a side effect. However, these conversations rarely covered more than the physical side effects and did not focus on the impact of those side effects on emotional and personal relationships or intimacy. Most providers waited for patients to raise any concerns and expressed their own personal discomfort and lack of training in holding these types of conversations. They perceived the conversations as difficult for themselves and for patients. The findings support the need to clarify role expectations for cancer nurses, as well as other members of the cancer care team, about patient care regarding sexuality, and the provision of education to support the expected role.

Challenges having conversations about sexuality in ambulatory settings: Part I--patient perspectives.

INTRODUCTION: A cancer diagnosis and treatment can have a significant impact on an individual's quality of life. In particular, body image and sexuality can be compromised. However, there is increasing evidence that conversations about these consequences are not happening often between cancer patients and their health care providers. This is especially the case in busy ambulatory settings. PURPOSE: This study was undertaken to explore the perspectives of cancer patients concerning the conversations that happen about sexuality following a cancer diagnosis in daily practice. There was a desire to understand more about the barriers that exist with regards to having this type of conversation. METHODS: Thirty-two cancer patients participated in interviews that explored their experiences with having conversations about sexuality. Transcripts of the interviews were subjected to a standard qualitative content and theme analysis. FINDINGS: Patients described many changes in their bodies following cancer treatment that had the potential to impact on sexuality, but actual concerns or problems about sexuality were highly individualized. Few had had conversations about sexuality with their health care providers. Most thought it was the responsibility of the cancer care team to "open the door" to the topic area. CONCLUSION: The results support the idea that few conversations are taking place between cancer patients and their providers about sexuality. Innovative approaches are required to better meet patient needs.

Expressive writing for high-risk drug dependent patients in a primary care clinic: a pilot study.

BACKGROUND: Previous research has shown that expressive writing is beneficial in terms of both physical and emotional health outcomes. This study aimed to investigate the effectiveness and acceptability of a brief expressive writing intervention for high-risk drug dependent patients in a primary care clinic, and to determine the relationship between linguistic features of writing and health outcomes. METHODS: Participants completed four 15-minute expressive writing tasks over a week, in which they described their thoughts and feelings about a recent stressful event. Self-report measures of physical (SF-12) and psychological health (DASS-21) were administered at baseline and at a two-week follow-up. Fifty-three participants were recruited and 14 (26%) completed all measures. RESULTS: No statistically significant benefits in physical or psychological health were found, although all outcomes changed in the direction of improvement. The intervention was well-received and was rated as beneficial by participants. The use of more positive emotion words in writing was associated with improvements in depression and stress, and flexibility in first person pronoun use was associated with improvements in anxiety. Increasing use of cognitive process words was associated with worsening depressive mood. CONCLUSION: Although no significant benefits in physical and psychological health were found, improvements in psychological wellbeing were associated with certain writing styles and expressive writing was deemed acceptable by high-risk drug dependent patients. Given the difficulties in implementing psychosocial interventions in this population, further research using a larger sample is warranted.

Patient- and family-centered perinatal care: partnerships with childbearing women and families.

Providing patient- and family-centered care is not a simple endeavor. It requires a transformation in organizational culture that is reflected in a myriad of details at the departmental, clinical, and individual provider and patient levels. Patient- and family-centered practitioners know that it is not a recipe or formula of specific practices, but an evolving approach that guides policy and program development, facility design, decision making, and daily interactions throughout the healthcare system. Today, momentum for patient- and family-centered care continues to build. It is supported by a growing body of research and by prestigious organizations that are committed to involve patients and families in care and in the redesign of healthcare for the 21st century to meet the recommendations of the IOM report. This article outlines the concepts of patient- and family-centered care and describes how they link with and differ from traditional concepts of family-centered maternity care. Partnerships with childbearing women and their families in clinical settings and in healthcare redesign that enhance quality, safety, and experience of care are described.

Designing the neonatal intensive care unit for optimal family involvement.

The design of a new neonatal intensive care unit provides an opportunity to ensure that the new facility best meets the needs of the infants and families whom the unit serves. In design planning,administrators, staff, family members, and the architect must work together in a self-education process that entails examining current design standards, exploring exemplary facilities at other institutions,defining the priorities and needs of infants, families, and staff, and deciding how to respond to them. The involvement of family members in this important work can help ensure that the facility is responsive to families and supports the family as the primary caregiver and decision maker for the infant. Such an environment will lead to improved health and developmental outcomes for infants and greater family and staff satisfaction.