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Issue 180 - 4 May 2011

Articles from Health Expectations, March 2010

1. Enabling consultations: the facilitative significance of relational aspects of interpersonal communication
By Entwistle, Vikki A.
Health Expectations, Mar 2010, Vol. 13 Issue 1: p1-3
The author introduces articles within the issue including one by Judith Hibbard and others about clinician's support of patient participation, one by Roger Ruiz-Moral about medical communication and decision making and one by Livieu Oprea and others about care of chronic illness..

2. Eliciting individual preferences for health care: a case study of perinatal care
By van der Pol, Marjon et al.
Health Expectations, Mar 2010, Vol. 13 Issue 1: p4-12
: To demonstrate how a discrete choice experiment (DCE) can be used to elicit individuals’ preferences for health care and how these preferences can be incorporated into a cost–benefit analysis. Methods A DCE which elicited preferences for three perinatal services: specialist nurse appointments; home visits from a trained lay visitor; and home-help. Cost was included to obtain a monetary measure of the value that individuals place on the services. In total, 292 women who had previously participated in a randomized trial of alternative forms of pre-natal care were interviewed.
Results: The most preferred service configuration consisted of three nurse appointments and two home visits before birth and 4 h of home-help per week for the first 4 weeks after birth. On average, women are willing to pay $371 for this package. A package that excluded home-help was valued at $122 whilst provision of three nurse appointments only was valued at $97. The predicted uptake of the services ranged from 37% to 93% depending on the woman’s experience with the service, whether or not it was her first child and her level of education.
Conclusion: The willingness to pay values were much higher than the costs for nurse appointments, suggesting this service produces a net social benefit. The willingness to pay for the package including both the nurse appointments and home visits only just exceeded the costs of the package, suggesting there is a relatively high chance that this package produces a net social loss. [ABSTRACT FROM AUTHOR].

3. Patient involvement in assessing consultation quality: a quantitative study of the Patient Enablement Instrument in Poland
By Pawlikowska, Teresa al.
Health Expectations, Mar 2010, Vol. 13 Issue 1: p13-23
: Promoting a more patient-responsive service has been the focus of policy initiatives in newer EU states. One measure of success should be the patient’s assessment of their consultation with their doctor.
Objectives: To measure consultation quality in Polish primary care using patient enablement (a patient-driven instrument developed in the UK) and to test its theoretical framework. To compare the patient enablement outcome of different types of doctor delivering primary care in Poland following reform.
Design: Cross-sectional quantitative questionnaire survey. Setting Random sample of primary care doctors practising within a 60-km radius of Gdansk, Poland.
Subjects and outcome measures: Patient Enablement Instrument and correlates were measured in 7924 consecutive adult consultations of 48 doctors, stratified according to training: family medicine specialists (diploma holders), non-diplomates and general medicine doctors (polyclinic internists).
Results: Completion was high (78%). The mean patient enablement score in Poland was 4.0 (SD 3.3) and mean consultation length was 10.3 min (SD 5.4 min). Consultation length and knowing the doctor are independently related to patient enablement in the Polish context. Variation between doctors is significant, but earlier differences in enablement between alternative providers have largely been ameliorated in practice. Conclusion: It is feasible to use patient enablement on a large scale at routine consultation in primary care in Poland: acceptability was good in diverse environments. The internal consistency of enablement and its relationships broadly mirror those found in the UK. The effect of patient expectations shaped by social and cultural issues influencing enablement outcome requires further investigation. [ABSTRACT FROM AUTHOR].

4. Patients’ perceptions of discrimination during hospitalization
By Hudelson, Patricia et al.
Health Expectations, Mar 2010, Vol. 13 Issue 1:p24-32
To identify sources of perceived discrimination during hospitalization and examine the relationship of perceived discrimination to patient and hospital stay characteristics, and to patient ratings of care.
Background: Patient experiences of discrimination within the health-care system are associated with delays in care seeking, non-adherence to medical advice and poorer health status. Most research to date has focused on race and ethnicity-based discrimination, and few studies have included hospitalized patients.
Methods: Questions about patients’ experiences of discrimination were added to a regular patient opinion survey conducted at the Geneva University Hospitals. Participants were 1537 adult residents of Switzerland discharged from the hospital between 15 February and 15 March 2007.
Results: A total of 171 (11.1%) respondents reported at least one source of discrimination. Most (93, 54.4%) reported a single cause of discrimination. The most frequent causes of discrimination were language, age, nationality and having a disease that is viewed negatively by others. Fifteen percentage of non-European respondents reported at least one of the following types of discrimination: language, nationality, religion and skin colour. Reporting discrimination from any cause was associated with higher Picker Patient Experience problem scores, and patients who reported discrimination were less likely to describe their care as very good or excellent and less likely to recommend the hospital to others.
Conclusions: Patient experiences of discrimination during hospitalization are relatively frequent and are associated with lower patient ratings of care. Collection of data on patient experiences of discrimination may contribute to the development of interventions aimed at ensuring respectful, quality care for all patients. [ABSTRACT FROM AUTHOR].

5. The role of physician–patient communication in promoting patient–participatory decision making
By Ruiz-Moral, Roger.
Health Expectations, Mar 2010, Vol. 13 Issue 1: p33-44
: Context Involving patients in decision making (DM) is being advocated in clinical practice. For it to be operational, some behavioural models have been put forward. Yet, their suitability and implementation in primary care are controversial.
Objective: To illustrate: (i) some of the strategies general practitioners use to involve patients in DM and (ii) a type of patient involvement in the context of primary care based on the appropriate use of general communication skills along the physician–patient interaction to promote participation without an extensive exhibition of options.
Strategy: Analysis of two real situations of family medicine practice.
 Conclusion: The quality of the process of involving patients in DM depends mainly on the professional’s communicative effort to achieve understanding and rapport rather than on an extensive discussion of possibilities or their prioritization. [ABSTRACT FROM AUTHOR].

6. Patient factors in the implementation of decision aids in general practice: a qualitative study
By Bhavnani, Vanita & Fisher, Brian.
Health Expectations, Mar 2010, Vol. 13 Issue 1: p45-54
Decision aids (DAs) have been developed to help patients make treatment decisions. Research shows that they are effective in increasing patients’ knowledge of treatment options without raising anxiety or conflict. However, they have not been routinely adopted for use in general practice in the UK and there are few reports addressing strategies to introduce them.
Objective: To examine patients’ views about a variety of DAs for different conditions (heart disease, osteoporosis, osteoarthritis and breast cancer) in order to inform a strategy to introduce them into general practice.
Setting and participants: General practice patients over the age of 18 years being or having been treated for one of the conditions above.
Methods: Qualitative study involving 12 focus groups with 77 patients evaluating decision aids relevant to their conditions. A semi-structured interview guide was used to generate discussions about the applicability of the DAs in routine general practice.
 Results: Patients welcomed DAs for their educational and informational content. Reactions to the DAs were influenced by patients’ own personal desires for involvement. The main concerns were that the use of DAs would potentially shift the onus of decision making responsibility on to the patient and about the practical challenges to implementation.
Conclusions: Clinicians will need to make explicit to patients that DAs are an adjunct to routine care and not a replacement, and therefore do not represent a derogation of responsibility. DAs need to be used as an integral part of the communication and support process for patients who want them. [ABSTRACT FROM AUTHOR].

7. An ethical justification for the Chronic Care Model (CCM)
By Oprea, Liviu et al.
Health Expectations, Mar 2010, Vol. 13 Issue 1: p55-64
Chronic diseases are major causes of morbidity and mortality in developed countries. Their effects can be mitigated by high quality evidence-based care, but this is not the norm in most systems. The Chronic Care Model (CCM) is an evidence-based policy response to this practice gap, which uses multiple strategies to promote the quality of chronic care.
Objective: To review CCM with an ethical lens. Methods: We reviewed the published empirical and non-empirical articles of CCM to analyse the ethical underpinnings of this model.
Results and conclusions: We argue that its principal ethical value lies in the institutional cooperation it builds between the stakeholders involved in health care services. First, we briefly describe CCM and argue that the pathways through which it aims to improve patients’ health outcomes are not made explicit. Second, we argue that the potential of CCM to be more beneficent, compared with traditional health care systems, depends on its capacity to promote mutual trust between health care providers and patients. There is no evidence to date that the implementation of CCM enhances mutual trust between health care professionals and patients. Third, we argue that CCM seeks to enhance human agency, allowing increased expression of individual autonomy and increased respect for individuals thereby expanding human freedom and avoiding social discrimination. However, we review the communication patterns that characterize the model of doctor–patient relationship promoted by this model and argue that these communication patterns raise ethical concerns that may prevent the model from reaching its expected outcomes. [ABSTRACT FROM AUTHOR].

8. The development and testing of a measure assessing clinician beliefs about patient self-management
By Hibbard, Judith al.
Health Expectations, Mar 2010, Vol. 13 Issue 1, p65-72
Clinicians have been slow to embrace support for patient self-management. Objective To explore clinicians’ beliefs about patient self-management and specifically assess which patient competencies clinicians believe are most important for their patients.
Methods: Using items adapted from the Patient Activation Measure (PAM) as a basis, a new measure that assesses clinicians’ beliefs about patient self-management was created using Rasch analysis. The development and testing of the new measure Clinician Support for Patient Activation Measure (CS-PAM) is described here. Primary care clinicians from the UK and the USA were recruited to participate in the survey ( n = 175).
Findings: The CS-PAM reliably measures clinician attitudes about the patient role in the care process. Clinicians strongly endorse that patients should follow medical advice but are less likely to endorse that patients should be able to make independent judgements or take independent actions. Endorsed to a lesser degree was the idea that patients should be able to function as a member of the care team. Least endorsed was the notion that patients should be independent information seekers.
 Discussion: Clinicians’ views appear to be out of step with current policy directions and professional codes. Clinicians need support to transition to understand the need to support patients as independent actors. [ABSTRACT FROM AUTHOR].

9. Patient participation in collective healthcare decision making: the Dutch model
By van de Bovenkamp, Hester al. Health Expectations, Mar 2010, Vol. 13 Issue 1: p73-85
To study whether the Dutch participation model is a good model of participation. Background Patient participation is on the agenda, both on the individual and the collective level. In this study, we focus on the latter by looking at the Dutch model in which patient organizations are involved in many formal decision-making processes. This model can be described as neo-corporatist. Design We did 52 interviews with actors in the healthcare field, 35 of which were interviews with representatives of patient organizations and 17 with actors that involved patient organizations in their decision making.
Results: Dutch patient organizations have many opportunities to participate in formal healthcare decision making and, as a result, have become institutionalized. Although there were several examples identified in which patient organizations were able to influence decision making, patient organizations remain in a dependent position, which they try to overcome through professionalization.
Discussion: Although this model of participation gives patient organizations many opportunities to participate, it also causes important tensions. Many organizations cannot cope with all the participation possibilities attributed to them. This participation abundance can therefore cause redistribution effects. Furthermore, their dependent position leads to the danger of being put to instrumental use. Moreover, professionalization causes tensions concerning empowerment possibilities and representativeness.
Conclusion: Although the Dutch model tries to make patient organizations an equal party in healthcare decision making, this goal is not reached in practice. It is therefore important to study more closely which subjects patients can and should contribute to, and in what way. [ABSTRACT FROM AUTHOR].

10. What is involvement in research and what does it achieve? Reflections on a pilot study of the personal costs of stroke
By McKevitt, Christopher et al.
Health Expectations, Mar 2010, Vol. 13 Issue 1: p86-94
Health researchers are encouraged to involve service users as partners in their research. There is a need to increase the evidence base of involvement, including an accumulation of empirical accounts of involvement practices, demonstrating how involvement influences research and refinement of the concept itself. Aims To report the development of a pilot study by academic researchers and stroke service users belonging to a user research group to investigate costs of stroke to individuals and families; to reflect on what this example of user involvement achieved and implications for what involvement means.
Methods: We conducted a 2-year ethnographic study that included participant observation, formal and informal interviews with professionals and user group members and documentary analysis. Data were systematically recorded to permit description of processes and reflexive analysis.
Results and conclusions: We report on five stages of the research process from service user identification of a research question to interpretation of pilot study findings. Professional researchers led the research process and developed a novel method to involve stroke service users in the development of a questionnaire. Some academic colleagues questioned the value of the proposed investigation as it did not appear to conform to implicit criteria of quality research. We argue that the moral status that user involvement has acquired means that academics’ concerns about quality did not prevent the pilot study from being conducted. We suggest that much of what was undertaken might be considered standard good practice in developing new research studies but also identify additional benefits of user involvement. Implications for conceptual development and evaluation are discussed. [ABSTRACT FROM AUTHOR].

Articles from AANA Journal, August 2010

11. LEGAL BRIEFS. Patient Privacy and Social Media
By Hader, Amy L.& Brown, Evan D. AANA Journal, Aug 2010, Vol. 78 Issue 4: p270-274
Healthcare providers using social media must remain mindful of professional boundaries and patients' privacy rights. Facebook and other online postings must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), applicable facility policy, state law, and AANA's Code of Ethics. [ABSTRACT FROM AUTHOR].

12. GUEST EDITORIAL. Advancing Evidence-Based Nurse Anesthesia Practice
By Thiemann, Lisa al. AANA Journal, Aug 2010, Vol. 78 Issue 4: p279-282
The American Association of Nurse Anesthetists (AANA) is committed to advancing evidence-based nurse anesthesia practice. This determination is evident across multiple activities within the Association. This editorial describes the AANA's evidence-based policy and process for the development of those practice- related documents that require approval from the AANA Board of Directors. Additionally, several of the Association's initiatives geared toward fostering the advancement of evidence-based nurse anesthesia practice are described. [ABSTRACT FROM AUTHOR].

13. THE OPEN MIND. The Normalization of Deviance: Do We (Un)Knowingly Accept Doing the Wrong Thing?
By Prielipp, Richard al. AANA Journal, Aug 2010, Vol. 78 Issue 4: p284-287
A reprint of the article "The Normalization of Deviance: Do We (Un)Knowingly Accept Doing the Wrong Thing?," by Richard C. Prielipp et. al, which appeared in a 2010 issue of "Anesthesia & Analgesia" is presented. It deals with errors committed by anesthesia professionals. It compares the approach of doing more with less in the operation room (OR) with the faster, cheaper, better mantra of the U.S. National Aeronautics and Space Administration (NASA). Safety is cited as the core value shared by anesthesiology with space flight and aviation..

14. Use of Clevidipine for Intraoperative Hypertension Caused by an Undiagnosed Pheochromocytoma: A Case Report
By Kline, Jonathan P. AANA Journal, Aug 2010, Vol. 78 Issue 4: p288-290
The acute intraoperative hypertension and tachycardia caused by an undiagnosed pheochromocytoma is a rare event for the anesthesia provider. If treatment is not prompt and successful, permanent and possibly lethal complications can ensue. This article reports what the author believes to be the first case study in which clevidipine (Cleviprex) was successfully used to treat a suspected, and later diagnosed, pheochromocytoma. [ABSTRACT FROM AUTHOR].

15. Inhalational Anesthesia for Organ Procurement: Potential Indications for Administering Inhalational Anesthesia in the Brain-Dead Organ Donor
By Elkins, Laurie J. AANA Journal, Aug 2010, Vol. 78 Issue 4: p293-299
: Organs needed for transplantation far outweigh their availability. There is minimal research regarding perioperative care of the brain-dead organ donor during the procurement procedure. Current research attributes a great deal of organ damage to autonomic or sympathetic storm that occurs during brain death. Literature searches were performed with the terms brain death, organ donor, organ procurement, anesthesia and organ donor, anesthesia and brain death, anesthesia and organ procurement, inhalational anesthetics and organ procurement, and inhalational anesthetics and brain dead. Additional resources were obtained from reference lists of published articles. The literature review showed there is a lack of published studies researching the use of inhalational anesthetics in organ procurement. No studies have been published evaluating the effect of preconditioning with inhalational agents (administering 1.3 minimal alveolar concentration of an inhalational agent for the 20 minutes before periods of ischemia) in the brain-dead organ donor population. Further studies are required to determine if administration of inhalational anesthetics reduces catecholamine release occurring with surgical stimulation during the organ procurement procedure and whether this technique increases viability of transplanted organs. Anesthetic preconditioning before the ischemic period may reduce ischemia-reperfusion injury in transplanted organs, further increasing viability of transplanted organs. [ABSTRACT FROM AUTHOR].

Journals - Table of Contents

16. From The Journal of Nursing Administration (JONA), April 2011, Volume 41, Number 4
Strategic Leadership for Organizational Change
Establishing a Sense of Urgency for Leading Transformational Change
Spotlight On
Nurse Executives and the National Priorities Partnership: Transforming America's Healthcare
Inspiration Point
16C. Nursing Leadership in Professional Organizations
Leadership Development
. The Emerging Leader: Leadership Development Based on the Magnet® Model
The Impact of Nurses' Health on Productivity and Quality of Care
16F. Assessing Individual Frontline Nurse Critical Thinking
16G. Pursuing Magnet® Designation as a System or as Individual Entities: What Is the Right Decision?
16H. The Role of the Chief Nurse Officer in Ensuring Patient Safety and Quality
16I. Applying the Adams Influence Model in Nurse Executive Practice

17. From The Journal  of Continuing Education in Nursing, April 2011, Volume 42, Number 4
Managers’ Perspectives of New Graduates of Accelerated Nursing Programs
Implications of the Institute of Medicine Report for Continuing Education to “Ensure Full Extent”Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN
. What Is Next? I Wish I Had a Crystal BallLynore D. DeSilets, EdD, RN-BC
Using Evidence to Enhance the Recovery of Patients Undergoing Colorectal Surgery: Part 1Pamela M. Maxson, PhD, RN, ACNS-BC; Jenna K. Lovely, PharmD, RPh, BCPS; Diane M. Wrobleski, PhD, RN, ACNS-BC; Emily Carver Isaacson, BS, RN
. A Model for International Nursing CollaborationJehad O. Halabi, PhD, RN; Sawsan Majali, PhD, RN; Lola Carlsson, RN, NT, BScN; Ingegerd Bergbom, PhD, RN
Incorporating Café Design Principles Into End-of-Life Discussions: An Innovative Method for Continuing EducationMary Louise Kanaskie, MS, RN-BC, AOCN
17G. Effect of a Preceptor Education Workshop: Part 2. Qualitative Results of a Hospital-Wide StudyKristin E. Sandau, PhD, RN; Margo A. Halm, PhD, RN, CNS-BC
17H. Support Programs for New Graduates in Pediatric NursingPatricia R. Messmer, PhD, RN-BC, FAAN; Jane Bragg, RN, MSN, MBA, CPON, NEA-BC; Phoebe D. Williams, PhD, RN, FAAN

News International

18. New health register under-resourced 
Sydney Morning Herald - 4 May 2011
The government's new register of health professionals has made a shaky start because it wasn't properly resourced at the outset, health professionals say. They argue it wasn't given sufficient funding and new staff faced with a large volume of work weren't properly trained. Forum of Australian Health Professions Councils chairman Richard Smallwood says the $19.8 million provided to the Australian Health Practitioner Regulation Agency (AHPRA) to set up the whole exercise was insufficient.

19. Huh? Low-salt diet ups risk of fatal heart attack?
CNN, Health.May 4, 2011
Doctors and public health officials have been telling us for years that eating too much sodium can increase the risk of heart attack or stroke by raising blood pressure to unsafe levels. So how to explain a new study that suggests low salt intake actually increases the risk of dying from those causes? The study, which followed 3,681 healthy European men and women age 60 or younger for about eight years, also found that above-average sodium intake did not appear to up the risk of developing high blood pressure (hypertension) or dying of a heart attack or stroke.

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