Improved patient satisfaction 2 years after introducing person-centred handover in an oncological inpatient care setting.

AIMS AND OBJECTIVES: To investigate patients' satisfaction with care, 2 years after the introduction of person-centred handover (PCH) in an oncological inpatient setting, and to describe patients' perceptions of individualised care. BACKGROUND: To obtain higher levels of patient satisfaction, bedside nursing handovers have been evaluated with positive results. One such model is PCH, which blends aspects of person-centred care with the bedside report and provides the opportunity for nursing staff and patients to perform the handover together. DESIGN: A survey-based design was used with one data collection period. Patient satisfaction scores were compared with baseline data from a previous study that has been conducted in the same wards. METHOD: Patient satisfaction was measured with the EORTC IN-PATSAT32 questionnaire, and individualised care was assessed with the Individualized Care Scale. A total of 120 adult patients with cancer were invited to participate from August 2017-March 2018. Of these, 90 chose to participate. The STROBE checklist for cross-sectional studies was used when preparing the paper. RESULTS: Compared to the previous study, statistically significant improvements in patient satisfaction were observed in the subscales "Exchange of information between caregivers" and "Nurses' information provision" postimplementation of PCH. Regarding patients' perceptions of individualised care, the highest scores were in the ICS-A subscale "Clinical situation" and ICS-B "Decisional control," while "Personal life situation" scored the lowest overall. CONCLUSIONS: Person-centred handover seems to have sustainable positive effects on important outcomes regarding patient satisfaction. A novel finding is the positive impact on nurses' information provision, indicating that PCH can facilitate effective information exchange between patients and nurses. RELEVANCE TO CLINICAL PRACTICE: Person-centred handover seems to improve patients' satisfaction with nurses' provision and exchange of information. Nurses and managers should carefully consider the implementation process of PCH and evaluate its long-term effects. PCH can be recommended in the oncology inpatient setting.

Nurse perceptions of person-centered handovers in the oncological inpatient setting: A qualitative study.

BACKGROUND: Deficient communication during shift change can cause negative patient outcomes and hinder person-centeredness in care. Person-centered handover is performed together with the patient at bedside, with the intention of providing a safe and efficient handover while promoting patient participation. The knowledge about nurse perspectives on handover models that involve patient participation is sparse. OBJECTIVE: To describe registered nurses' perceptions of person-centered handover in an oncological inpatient setting. DESIGN: A qualitative interview study. SETTING: The study was undertaken at two oncological inpatient wards at the Karolinska University Hospital, Stockholm, where person-centered handover was implemented in 2015. PARTICIPANTS: Registered nurses who had worked at the wards for at least six months. We aimed for a full sample investigation. All eligible nurses (n = 13) were approached, and 11 chose to participate. Participants' age ranged from 23 to 60 years, the mean work experience was 10 years, and 4 out of 11 nurses were oncology nurse specialists. METHODS: Semi-structured interviews were performed by an independent researcher. The data was analyzed using content analysis with an inductive approach. RESULTS: Three main themes with ten subsequent subthemes emerged from the data. The main themes were: clinical communication and assessment; opportunity for patient participation; consequences for nursing care. In general, the nurses were positive towards person-centered handover, but they expressed concerns regarding patients' integrity and insecurities regarding bedside communication. All nurses described how they aimed at enhancing patient participation and viewed person-centered handover as an opportunity, but still perceived it difficult to succeed due to drawbacks and factors hindering nursing care. Overall, the nurses were positive regarding the involvement of patients in the handover procedure. Information provision from nurse to patient, as opposed to information exchange, was predominant. CONCLUSIONS: The intentions of person-centered handovers differed from the way it was actually performed, especially in regards to the obtained levels of patient participation, as described by nurses. Professional insecurity in relation to bedside communication with patients and their visitors is a novel finding that should be considered when implementing person-centered handovers. Overall, the perceptions of person-centered handovers, as expressed by the nurses, enhance our understanding of what to consider when implementing the model and why compliance may vary.

Patient satisfaction after implementation of person-centred handover in oncological inpatient care - A cross-sectional study.

Effective nurse shift-to-shift handover is a prerequisite for high-quality inpatient care. Combining person-centeredness with the need for improved handover rituals, we introduced and evaluated person-centered handover (PCH) in an oncological inpatient setting. PCH is the shift-to-shift nursing report performed together with the patient according to a set structure focused on patient participation, relevant clinical information, and patient safety. Non-verbal handover, standard at the department, is conducted via the electronic health record, in absence of the patient, and without a set structure. The aim of the study was to compare person-centered handover with non-verbal handover in an oncological inpatient setting with regard to patient satisfaction. A cross-sectional design featuring two points of measurement at one intervention ward and two control wards was applied. The EORTC IN-PATSAT32 questionnaire was used for measuring patient satisfaction. Baseline measurements were taken during the spring of 2014, when all three wards used a non-verbal handover model, and included responses from 116 patients. Follow-up measurements (comparing PCH and non-verbal handover) involved 209 patients and were on-going from September 2014 to May 2015. After the introduction of PCH, one change in patient satisfaction was detected regarding the subscale measuring exchange of information between caregivers. Patients from the intervention ward scored statistically higher after the implementation of PCH when compared to the control wards (p = .0058). The difference remained after a multivariate regression analysis controlling for clinical variables. In conclusion, PCH is feasible in oncological inpatient care but does not seem to affect patient satisfaction.

Changed nursing scheduling for improved safety culture and working conditions - patients' and nurses' perspectives.

AIM: To evaluate fixed scheduling compared with self-scheduling for nursing staff in oncological inpatient care with regard to patient and staff outcomes. BACKGROUND: Various scheduling models have been tested to attract and retain nursing staff. Little is known about how these schedules affect staff and patients. Fixed scheduling and self-scheduling have been studied to a small extent, solely from a staff perspective. METHOD: We implemented fixed scheduling on two of four oncological inpatient wards. Two wards kept self-scheduling. Through a quasi-experimental design, baseline and follow-up measurements were collected among staff and patients. The Safety Attitudes Questionnaire was used among staff, as well as study-specific questions for patients and staff. RESULTS: Fixed scheduling was associated with less overtime and fewer possibilities to change shifts. Self-scheduling was associated with more requests from management for short notice shift changes. The type of scheduling did not affect patient-reported outcomes. CONCLUSIONS: Fixed scheduling should be considered in order to lower overtime. Further research is necessary and should explore patient outcomes to a greater extent. IMPLICATIONS FOR NURSING MANAGEMENT: Scheduling is a core task for nurse managers. Our study suggests fixed scheduling as a strategy for managers to improve the effective use of resources and safety.

Information exchange in oncological inpatient care--patient satisfaction, participation, and safety.

PURPOSE: This prospective pilot study aimed to investigate patients' perception of information exchange and its associations with patient satisfaction, participation and safety at inpatient oncology wards. METHODS AND SAMPLE: Consecutive patients with cancer who spent ≥3 days at an oncological inpatient ward at the Department of Oncology, Karolinska University Hospital during the study period (March-August 2013) were invited to respond to EORTC-INPATSAT32 measuring patient satisfaction and a study specific questionnaire. Data on changes in medication and fall risk assessments was collected from the patients' electronic health records. KEY RESULTS: A total of 104 patients (58%) participated in the study. Patients rated doctors' and nurses' information provision lower than their technical and interpersonal skills, and 13% considered the information exchange "excellent". Changes in medication were registered for 83% of participating patients, which 56% of the patients were aware of. Fall risk assessment was registered for 73% of responding patients, and 39% reported having discussed risk of falling during the hospital stay. The Downton Fall Risk Index scores were not associated with actual falls or fall prevention actions. CONCLUSIONS: Deficits were found on information exchange and information provision between health care professionals and patients. This might have a negative impact on known patient safety risks such as medication errors and falls. More effective strategies to perform fall risk assessments in an oncological inpatient setting are needed. Further studies evaluating interventions to improve participation and information exchange are necessary to increase patient satisfaction, participation and safety in oncological inpatient care.

'Why is there another person's name on my infusion bag?' Patient safety in chemotherapy care - a review of the literature.

PURPOSE: Approximately 10% of all patients is in some way harmed by the health care system. Risk factors have been identified and patients with cancer are at high risk due to the seriousness of the disease, co-morbidity, often old age, high risk treatments such as chemo and radiotherapy. Therefore, a closer look on safety for patients undergoing chemotherapy is needed. The aim of this study was to identify and evaluate interventions for improved patient safety in chemotherapy care. METHOD: We undertook a review of the available evidence regarding interventions to improve patient safety in relation to chemotherapy care. RESULTS: We found 12 studies describing the following interventions; 1) Computerized Prescription Order Entry (CPOE), 2) Failure Mode and Effect Analysis (FMEA) and Lean Sigma, 3) Error reporting and surveillance systems, 4) Administration Checklist and 5) Education for nurses. Even if all five interventions showed positive effects in patient safety, the evidence level is rather weak due to design, sample size and the difficulties involved measuring patient safety issues. CONCLUSIONS: Three studies with fairly high evidence level showed that computerized chemotherapy prescriptions were significantly safer than manual prescriptions and could therefore be recommended. For the other remaining interventions, more research is needed to assess the effect on improved patient safety in chemotherapy care. There is a need for more rigorous studies with sophisticated design for generating evidence in the field.

Anthroposophic health care in Sweden - a patient evaluation.

This study surveyed patients and their satisfaction with an integrative anthroposophic hospital. The patients were followed up by questionnaires up to six months after a stay in a Swedish clinic. Satisfaction with the care, life satisfaction, and health-related quality of life were measured for 53 patients, 48 women, 5 men, with cancer, pain diseases, and psychosomatic problems. Sampling was consecutive and due to regional reasons. The evaluation of patients' satisfaction from the anthroposophic clinic (AC) was compared to similar questions of patients using conventional hospital care. The stay lasted 7-21 days and was paid by the patients' county councils. Causes for choosing AC were predominantly a positive attitude towards a holistic health view and expectations on being cared for. Less frequently noted was dissatisfaction with conventional care. Satisfaction with health care given after one month by the AC was sample scored more positively than the highest unit in the conventional clinic. This is important because women in conventional clinic report lower satisfaction. The AC sample consisted of 91% women with an average age of 54 years and a higher level of education compared to the sample from the conventional hospital. Health-related quality of life and life satisfaction was, if not significant, moderately increased during the following six months. The AC initiated a new attitude and change in life habits that stimulated the patients into improving their life style habits and hence their overall health. Still challenging is the gender question. Why do middle-aged, well-educated women experience a need for and a satisfaction in complementary and integrative health care?