ABSTRACT
Non-adherence in patients with chronic liver disease is a problem resulting in various consequences ranging from disease deterioration to death. Insufficient medication adherence leads to enormous health care costs. Family caregivers can essentially contribute to improving adherence. The aim of this project was to develop a work instruction specifically dedicated to optimize adherence in this patient group and their family caregivers. The project team utilized the principles of participatory action research. A systematic literature research aimed at identifying interventions for improving medication adherence in patients with chronic liver disease. Findings of patient experiences from literature as well as clinical experience of nurses were evaluated for their practicability in the local context. Research revealed that information for patients and family caregivers, supportive relationships with health care professionals, helpful communication, the use of memory aids and integration of medication intake into everyday life were the most helpful adherence-enhancing interventions. The work instruction serves to integrate these interventions into clinical practice in order to ensure optimal medication adherence.
Subject(s)
Caregivers/education , End Stage Liver Disease/drug therapy , End Stage Liver Disease/nursing , Medication Adherence , Patient Education as Topic , Adult , Aged , Attention , Communication , Humans , Middle Aged , Nurse-Patient Relations , Reminder Systems , SwitzerlandABSTRACT
BACKGROUND: Anticipating nursing shortages, the Swiss healthcare system recently introduced the position of allied healthcare assistant (AHA). However, indicators of AHAs' integration and stability, particularly their perceptions of their work environment quality and related outcomes (i.e., burnout, job satisfaction, and intention to leave), remain unclear. AIMS: (a) To describe AHAs' ratings of the quality of the nurse work environment, job satisfaction, burnout, and intention to leave their workplaces; (b) to compare AHAs' and registered nurses' (RNs') work environment quality ratings and related outcomes; and (c) to assess links between AHAs' work environment quality ratings and related workforce outcomes. DESIGN: A secondary analysis of RN4CAST data (October 2009 to June 2010) on 61 AHAs and 466 RNs in 13 Swiss acute care hospitals. METHODS: We used descriptive statistics to summarize data of AHAs and RNs on their units and hospitals. Via binary logistic regression models, we compared AHAs and RNs and identified associations between work environment ratings and workforce outcomes. FINDINGS: AHAs' work environment quality ratings were significantly higher than those of RNs, and were associated with lower odds of burnout and intention to leave their current job and higher odds of reported job satisfaction. CONCLUSIONS: This study provides primary evidence linking AHAs' work environment quality ratings to burnout, job satisfaction, and intention to leave in acute care hospitals. CLINICAL RELEVANCE: Given the increasing importance of AHAs for nursing care provision, hospitals should assess the quality of nurse work environment and nurse outcomes from the perspective of all nurses.
