Questionnaire measuring patient participation in health care: Scale development and psychometric evaluation.

BACKGROUND: Patient participation in treatment and care is often encouraged and is desirable because of its proven positive impact on treatment, quality of care and patient safety. AIMS: To develop an instrument to measure patient participation in health care and to investigate the measurement properties of the Patient Participation Questionnaire (PPQ). METHODS: A literature review was conducted to develop a model of patient participation. The PPQ was constructed consisting of 17 items organized into four subscales. Psychometric evaluation of factor structure, convergent construct validity by hypothesis testing and analyses of internal consistency using Cronbach's alpha were performed on data from a hospitalised mixed group of patients with cardiac disease, pulmonary disease and cancer (N=378 patients). RESULTS: Confirmatory factor analysis did not show a clear model fit, which is why an exploratory factor analysis was performed, suggesting a different four subscale structure consisting of a total of 16 items. The four subscales were labelled Shared decision power, Adapted and individualized knowledge, Collaboration and Human approach. There were strong ceiling effects on all items. Analysis of convergent construct validity showed a moderate correlation (0.59) between the PPQ and another instrument measuring patient participation. Internal consistency for the total PPQ score was high: 0.89. CONCLUSION: In a mixed group of patients with cardiac disease, pulmonary disease and cancer, the PPQ showed promising psychometric properties in terms of factor structure, convergent construct validity and internal consistency. The PPQ may be used to shed light on the experience of patient participation and guide quality improvements.

Exercise intervention for patients diagnosed with operable non-small cell lung cancer: a qualitative longitudinal feasibility study.

PURPOSE: The purpose was to explore operable lung cancer patient experiences with an exercise intervention from a longitudinal perspective according to patient motivation and patient perceived benefits and barriers of exercise. METHODS: Nineteen patients enrolled in an exercise intervention 2 weeks post-surgery participated in qualitative interviews at three time points. A criteria sampling strategy was applied. Ricoeur's phenomenological hermeneutical philosophy inspired the analysis. RESULTS: Patients initiated exercising median 15 days postoperative. Eight patients included in the interview study dropped out of the intervention due to side effects of chemotherapy (n = 3) and external circumstances (n = 5). The mean attendance rate for the eleven participants who completed the intervention was 82 %. No patients experienced severe adverse events. Motivation for participation included patients' expectations of physical benefits and the security of having professionals present. Patients experienced physical and emotional benefits and affirmed their social identity. Barriers were primarily related to side effects of chemotherapy. CONCLUSION: The exercise intervention was undertaken safely by operable lung cancer patients initiated 2 weeks after surgery. The intervention put the patients on track to a healthier lifestyle regarding physical activity and smoking. The study indicates that exercise initiated early in the treatment trajectory is beneficial for operable lung cancer patients and especially for those who were physically active and motivated pre-illness and who did not experience side effect of treatment.

Diagnosis as the First Critical Point in the Treatment Trajectory: An Exploration of Operable Lung Cancer Patients' Lived Experiences.

BACKGROUND: Significant advances have been made in the surgical treatment of lung cancer while patient experiences with diagnosis, treatment, and rehabilitation remain only sparsely researched. OBJECTIVE: The objective of this study was to investigate how the diagnosis affects the daily lives of patients with operable lung cancer in order to identify their needs for care interventions from the point of diagnosis to hospitalization. METHODS: We investigated patients' lived experiences from a longitudinal perspective at 4 critical time points during the treatment trajectory; we present here the findings from the first time point, diagnosis. Data were collected through interviews conducted 7 to 10 days following diagnosis of lung cancer. Data from 19 patients are included, and the analysis is based on Ricoeur's interpretation theory. The study framework is inspired by Schutz's phenomenological sociology. RESULTS: The findings are presented as themes that summarize and express the ways in which a diagnosis affects patients' daily lives: the cancer diagnosis comes as a shock, it changes everyday awareness; it presents the patient with an unfamiliar body, disturbs social relationships, forces the patient to face a new life situation, and demands one-on-one supportive care. CONCLUSIONS: Diagnosis is the first critical point for patients with operable lung cancer and disrupts their daily life. Patients need psychosocial support during the period from diagnosis to surgical intervention and patient-tailored one-on-one information. IMPLICATIONS FOR PRACTICE: This article contributes to the knowledge base of support needs of lung cancer patients. Interventions aimed at supportive care during the period between diagnosis and surgical intervention should be researched.

Annual cross-sectional study of nurse-sensitive problems: how to keep a finger on the pulse.

A cross-sectional evaluation of nurse-sensitive problems in hospitalized patients is conducted once per year to monitor patient problems identified by nurses, whether nurses implement interventions to overcome the problems, and if the problems are solved. This article describes a systematic method of data collection and illustrates how the data can be used to improve the quality and documentation of the nursing care. The annual cross-sectional evaluation allows us to identify relevant target areas of future nursing interventions and research.

Perioperative nursing in public university hospitals: an ethnography.

BACKGROUND: In recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of perioperative nursing and how do nurses facilitate the interaction between nursing care and technology in highly specialized operating rooms in public university hospitals? METHODS: An ethnography involving participant observations and interviews was conducted during a 9-month study period. The participants comprised 24 nurses from 9 different operating wards at 2 university hospitals in different regions of Denmark. RESULTS: Patients were addressed as either human beings or objects. Likewise, the participants' technical skills were observed and described as either technical flair or a lack of technical skills/technophobia. The different ways in which the technical skills were handled and the different ways in which the patients were viewed contributed to the development of three levels of interaction between technology and nursing care: the interaction, declining interaction, and failing interaction levels. CONCLUSION: Nursing practice at the interaction level is characterized by flexibility and excellence, while practice at the declining interaction level is characterized by inflexibility and rigidity. Nursing practice at the failing interaction level is characterized by staff members working in isolation with limited collaboration with other staff members in operating rooms. Considering that the declining and failing interaction levels are characterized by inflexibility, rigidity, and isolation in nursing practice, nurses at these two levels must develop and improve their qualifications to reach a level of flexible, excellent interaction. Nurse leaders must therefore refocus their skills on proficiency in perioperative nursing.

A longitudinal exploration of 'Four Critical Moments' during treatment trajectory in patients with operable lung cancer and the feasibility of an exercise intervention: a research protocol.

AIM: This article described a research protocol for a study exploring the lived experiences of patients with operable lung cancer in daily life at 'Four Critical Moments' during the disease and treatment trajectory. BACKGROUND: Patients with lung cancer may experience complex problems during the disease and treatment trajectory, and studies conclude this population to be at higher risk in developing emotional distress than other cancer populations. It is required to explore the supportive needs of patients with lung cancer through the treatment trajectory. DESIGN: A longitudinal design with a method of multiple data collection. The study is performed at four time points 'Four Critical Moments'. METHODS: The study contained three samples. Sample I and sample II explored the expected four critical moments for patients with operable lung cancer within the first 4 months following diagnosis and surgery. Sample III explored the patients' participation and the feasibility of an exercise intervention targeting patients with operable lung cancer. For all three samples, interviews will be performed: (1) 5 days following diagnosis; (2) the day after surgery; (3) 7 weeks; and (4) 4 months following surgery. Data from questionnaires for all three samples will be collected at baseline and 4 months following surgery. DISCUSSION: The study will add new perspectives on the lived experiences of patients with lung cancer along the treatment trajectory based on empirical and theoretical findings for both the general lung cancer population and patients participating in an exercise intervention. This will provide a basis for optimizing and developing interventions for patients with lung cancer starting in the surgical context.

Implementing nutritional guidelines -- the effect of systematic training for nurse nutrition practitioners.

INTRODUCTION: Approximately 40% of patients admitted to hospitals are undernourished. Implementing nutritional guidelines might reduce the incidence of malnutrition, and it requires education and training for the hospital staff. AIM: It was hypothesised that a training programme focusing on the staff behaviour would increase the identification of eating difficulties, improve patients' knowledge about appropriate food choices and increase the number of snacks eaten between meals and thereby to reduce the risk of undernutrition. METHODS: A pre- and post-test design was used to evaluate the effect of the training programme for nurses. The training was conducted in five modules over 1 year and combined nutritional issues with issues on implementation and theories of planned change. The programme was based on experimental learning theories and the steps of look, think and act. The effect on the patients was measured by a patient questionnaire. RESULTS: After implementing the guidelines, more patients discussed their eating difficulties with the staff, received relevant assistance during the meal and were served the type of food they had ordered and could chew. The patients' knowledge of appropriate food choices from the menu increased, suggesting that the nutritional intake of the patients had improved. CONCLUSION: Our findings suggest that a strategy based on the principles of experimental learning theory and the phases in the look, think and act model facilitated the implementation of nutritional guidelines in a hospital setting.

Nurses' self-reported knowledge about and attitude to nutrition -- before and after a training programme.

BACKGROUND: It is well known that appropriate nutrition is vital for inpatientrecovery. Traditionally, nutrition is part of nurses' area of responsibility and as it affects mortality and morbidity, it is important that nurses feel responsible for, and accomplish adequate nutrition care during the patients' hospital stay. But putting evidence of nutritional topics into practice is challenging and nutrition care seems to be a low priority nursing task. AIMS: To investigate the impact of training programme targeted nurses with special responsibilities for nutrition on the nurses' knowledge of nutrition, and whether it enhanced their attitude to their responsibility for nutrition care in relation to assessment and management. METHODS: An intervention study was conducted with 16 nurses from either medical or surgical wards who participated in a 12-month training programme. These nurses were divided into two groups and interviewed twice before and after the intervention. Focus group interviews were used to gather data about their daily clinical work in relation to nutrition. Deductive content analysis was used to analyse the described data. RESULTS: The training programme did have an impact on the nurses' knowledge of nutrition. It made them feel more secure and strengthened their ability to take responsibility for more nutrition management and as the results indicate, improved their awareness of nurse-specific treatment and their responsibility for nutrition assessment. We also found that nurses still have difficulty expressing their knowledge of nutrition using academic concepts, as they mainly use general phrases. CONCLUSION: The findings suggest that a short-duration training programme enhances nurses' awareness of nutrition care, but it is not enough to achieve the nurses' full understanding of their responsibility for nutrition care.