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PubMedDate not supplied

Improving the patient experience with information technology.

It has been proven in many different studies that information technology solutions can improve information transfer, workflow, and communication, resulting in marked improvements in patient safety and overall quality of care. However, equally important but not often emphasized is the potential for information technology to improve the patient experience by making a positive impact on the care that matters most to patients and their families.

Humans↗
PubMed2003

Commentary on hormesis and public risk communication: is there a basis for public discussions?

Research on radiation exposure is now focusing on microbiology and the impact of low dose exposures on cells and cell components. Eventually, this research may provide evidence to support changes in the models used to regulate human and environmental exposures. Currently, three models using older research results are subjects of interest and comparison. The linear no-threshold model, the most restrictive on behalf of public health values, dominates regulatory decision making. Alternative models (i.e., the threshold model and the hormesis model) could reduce costs of radiation management, depending upon new research results and public acceptance. Enacting a new public exposure model is a daunting task for risk communication given existing public risk perceptions and the established public decision-making processes. Each of the three prominent models must answer the question, 'what social good requires the use of this model in contrast to the others?'

Animals↗
PubMed1992

Political and interpersonal aspects of ethics consultation.

Previous papers on ethics consultation in medicine have taken a positivistic approach and lack critical scrutiny of the psychosocial, political, and moral contexts in which consultations occur. This paper discusses some of the contextual factors that require more careful research. We need to know more about what prompts and inhibits consultation, especially what factors effectively prevent house officers and nonphysicians from requesting consultation despite perceived moral conflict in cases. The attitudes and institutional power of attending medical staff seem important, especially where innovative interventions raise ethical questions. Ethics consultants also need to address the thorny problems of the origin(s) of the consultant's authority, whistleblowing, conflicts of interest that affect the consultant, persistently poor communications in hospitals, systemic inequity in the availability or quality of services for some, and the standing of the consultant's recommendations, including their appearance in the patient's medical record.

Bioethical Issues↗
PubMedDate not supplied

Interpersonal skills. What they are, how to improve them, and how to apply them.

Interpersonal skills are those essential skills involved in dealing with and relating to other people largely on a one-on-one basis. The interpersonal communication behavior of many people suggests they assume to have the ability to communicate effectively, which they do not possess and which they take for granted. One must work conscientiously to develop interpersonal competence by doing the right things at all times and doing them repeatedly until they become ingrained. As with any human skills, interpersonal skills can be improved through conscious effort. Successful interpersonal communication involves shaping the behavior of others, often while countering their shaping behavior. To have a chance of being successful, every interpersonal contact must have an objective and every effort must be made to avoid creating win-lose transactions whenever possible.

Competency-Based Education↗
PubMed2003

Communication with general practitioners after accident and emergency attendance: computer generated letters are often deficient.

OBJECTIVES: Accident and emergency departments see large numbers of patients, and computerised administration systems are a useful tool for producing discharge communication. The purpose of this study was to determine the quality of such correspondence. METHODS: Retrospective review of 300 discharge letters and case notes. RESULTS: 29% of all computer generated discharge information was incomplete or misleading. Twenty five per cent of all correspondence was lacking or unacceptable overall. The principal reasons for substandard correspondence were inaccurate coding of diagnoses and procedures, and failure to include specific information relevant to patients' follow up. CONCLUSIONS: Computer generated discharge communication is often deficient. Staff using such systems should be made aware of the importance of accurate coding, and use added explanatory text to clarify diagnoses, management, and follow up as required.

Continuity of Patient Care↗
PubMed2003

The role of the primary clinician in the multidisciplinary team.

This article explores the role of the primary clinician as an integral member of the modern inpatient psychiatric treatment team, as it is practiced on the Professionals in Crisis program at The Menninger Clinic. The modern inpatient team consists of individuals from multiple disciplines and acts as an embodiment of the neo-biopsychosocial model, with each team member providing not only a unique perspective on viewing the patient but also offering unique opportunities to aid in creating an environment that is conducive to change. The role of the primary clinician as the conduit of communication between various treaters and as the individual who provides oversight of the patient's treatment is described. The unique therapeutic elements that this role brings to treatment, with particular respect to the four cornerstones of psychotherapeutic success (alliance, activity, focus, and expectation) are defined.

Humans↗
PubMed2003

Seeking evidence from medical research consumers as part of the medical research process could improve the uptake of research evidence.

Concerns have been expressed about gaps between available medical research evidence and current medical practice. These gaps have been attributed to process problems with the implementation of evidence previously judged to be appropriate, rather than to problems with the appropriateness of the evidence provided for implementation. Two such 'appropriateness' problems are the applicability of research evidence to an individual patient, and the acceptability to an individual patient of a proposed treatment. Part of both these problems is due to the pre-eminence of the scientific paradigm within the medical research domain, and of the randomized controlled clinical trial within that domain. However, there is an opportunity beneficially to address both these problems by supporting reciprocal communication between medical research 'producers' and medical research 'consumers'--both practising clinicians and patients' representatives--in the setting of research priorities, selection of topics for research, development of research questions and study designs, in-progress reviewing, and final reporting of medical research projects. Such communication could allow researchers to understand, and respond to, clinicians' and patients' inputs concerning the applicability, utility and acceptability issues that will ultimately affect whether, and how, medical research findings can be applied. Such communication could also assist with some post-research implementation issues: integration of appropriate evidence into everyday practice; access to appropriate information sources; and a critical lack of necessary time.

Australia↗
PubMedDate not supplied

Communication for high-performance teams.

How many times have you been on a team where you felt that you weren't all on the same page or that the team wasn't performing up to the level it could or should be. And yet you know that your team members are bright and highly capable?

Cooperative Behavior↗
PubMed1992

Medical humanities in nursing: thought provoking?

Medical humanities is an innovative way of learning. Discussing literary texts of nursing practice has been used to help students analyse attitudes, values and ethics; it has also been used to help practitioners review and reflect on their own experience and philosophy of nursing. In nursing education, it has been used to explore difficult issues in a safe environment. The value of this approach in nursing education and practice is that it can encourage reflection, promote self-awareness and stimulate debate on difficult issues: for example, death and dying, power and institutionalization (of patients and staff) and pain. This paper gives a detailed worked example of how a literary text can be used in this way, the aim being to provide a resource which readers can then use with a group of students or colleagues. Finally, the authors explore the question of where medical humanities might have a place in the curriculum: as a lecture/tutorial in a course (e.g. Ethics), as a module in the curriculum, as a method of teaching nursing subjects (e.g. communication skills), as a discussion group (outside the curriculum), as a study guide, using literary texts alongside nursing text books. Any of these strategies can be a powerful vehicle for preserving the 'human factor' in both nursing education and continuing professional development.

Attitude↗
PubMed2003

Using qualitative methods to distill the active ingredients of a multifaceted intervention.

Mental health studies frequently involve multifaceted psychosocial interventions. It may be difficult to isolate the active ingredients that make these interventions successful. This study examined the use of qualitative methods to better understand the content of one of these interventions and to help elucidate the links between the care process and health outcomes. A series of five focus groups were convened at a site remote from a model primary care clinic for veterans. Transcripts of the focus groups were analyzed to identify themes and categorize results for patients with serious mental disorders. Three themes emerged from the groups: the difficulty patients had previously faced in obtaining medical care, the flexibility and availability of resources that defined the clinic culture, and organizational restructuring that allowed enhanced communication. Qualitative methods can be a useful means of "unpacking" multifaceted mental health services interventions. These methods may make it possible to refine and disseminate these models more widely.

Adult↗
PubMed1989

An analysis of ethics consultation in the clinical setting.

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults.

Ethicists↗
PubMed2003

Can we see more outpatients without more doctors?

A reduction in the number of return patients attending general cardiology clinics, if achievable without harm, would improve access for newly referred patients. Outpatient clinic letters (525) sent to general practitioners over a three-month period were reviewed. Simultaneously, physicians' opinions were collected by questionnaire. A subset of 30 clinic patients who attended three local general practitioners were studied to identify how many were assessed in primary care, and how often, in a six-month period. The hospital records of these patients were reviewed to determine whether information about these visits to the general practitioner was documented in the hospital notes. From the outpatient clinics the discharge rates were only 26% and the reason for further clinic review was often not clear. The fact that many patients had no intervention or treatment change performed at the clinic (42%) indicates that patients are reviewed to assess symptom change rather than to receive further interventions. The use of fixed times for review appointment (six months or 1 year) suggests that the intervals are determined by habit rather than clinical indication. A high proportion of patients (28/30) were reviewed at least once in primary care by general practitioners between hospital clinic visits and 20/30 were seen three or more times. There was poor documentation of these consultations in the hospital case notes, and so hospital physicians may be unaware that symptoms are under regular review in primary care. This study suggests that a substantial proportion of current cardiology return outpatients do not require regular outpatient review. However, alternative management demands good communication and exchange of information between secondary and primary care, development of formal written discharge planning in outpatient letters and other forms of follow-up.

Aged↗
PubMed1996

Discharge planning: the need for effective communication.

This article emphasises the need for effective interdisciplinary and interagency communication to ensure a satisfactory transfer of care between hospital and the community. The author highlights some of the policies and guidelines which inform current practice, and examines some of the reasons why care is often fragmented in this important area for patients and their relatives.

Communication↗
PubMedDate not supplied

Community assessment: an innovative approach.

Conducting a community health assessment and analysis is an essential skill for baccalaureate nursing students. Repetitive assignments in the same locale can negatively affect the community, students, and instructors. The authors discuss how a distant community can be successfully used for skill development by utilizing the Internet, communicating with key informants via telephone, and reading resource materials collected from the area. Key elements are prior visitation to the community by the instructor and collaboration with the university reference librarian.

California↗
PubMed2004

Identifying the palliative care role of the nurse working in community hospitals: an exploratory study.

AIM: to ascertain registered nurses' and GPs' perceptions of and influences on the nurse's role in providing palliative care in community hospitals. DESIGN: qualitative exploratory/descriptive study. SETTING: two community hospital sites within Perth and Kinross, Scotland. METHOD: taped semi-structured interviews with four registered nurses and two GPs. Participants' perceptions were sought on the roles of nursing and medical professionals and of factors facilitating and hindering the provision of palliative care within the community hospital setting. FINDINGS: six key themes were identified through thematic analysis of the information: communication, teamwork and relationships, holistic care, resources, culture, professional role. CONCLUSION: the themes were inter-related and gave valuable insight into the multidimensional nature and significance of the nurse's role in palliative care in the community hospital setting.

Attitude of Health Personnel↗
PubMed2006

Untangling the web: the need to clarify care co-ordinating models for people with chronic and complex conditions.

OBJECTIVE: In order to clarify the expanding care co-ordinating field and stimulate debate, a descriptive typology is developed suitable for a range of stakeholders and purposes. METHODS: The strategy for development of the typology involved a literature review of the most commonly used care coordinating models and the utilisation of select government publications that verified diverse ways of classifying care co-ordinating needs. A descriptive typology is proposed to better communicate similarities and differences. RESULTS: The typology delineates similarities and differences among care co-ordinating models that stakeholders can use as a step towards determining the most effective model to meet the varied needs of individuals and populations. CONCLUSIONS AND IMPLICATIONS: Stakeholders can more informatively communicate about care co-ordinating models and their place in the service delivery system. The typology may be used in comparing the effectiveness of the models. A clearer understanding of the field is both timely and warranted.

Chronic Disease↗
PubMed2005

Dentist-assistant communication style: perceived gender differences in The Netherlands and Northern Ireland.

OBJECTIVES: To assess communication style differences with the (female) dental assistant, as perceived by male and female dentists. METHODS: Data were collected from 216 Dutch (male: 99; female: 117) and 261 Northern Irish (male: 135; female: 126) dentists (overall response rate: 60%). Respondents filled in a self-report questionnaire (one follow-up mailing), with 22 items on staff communication style. Using principal component analysis, four distinguishable factors could be extracted: businesslike leadership style (seven items, Cronbach's alpha = 0.87), friendly leadership style (seven items, alpha = 0.87), professional interacting style (four items, alpha = 0.83) and gender interacting style (four items, alpha = 0.83). RESULTS: manova indicated a main effect for gender [F(8,946) = 10.905, P < 0.001] and for country [F(4,474) =4.197, P = 0.002] on the communication style scales. Male dentists, compared with female colleagues, showed higher mean scores on businesslike leadership style and gender interacting style, whereas female dentists showed higher mean scores on friendly leadership style and professional interacting style. Dutch dentists showed higher mean scores on friendly leadership style and professional interacting style than their Northern Irish colleagues. No interaction effect between gender and country was found. Dentist's age and length of assistant's employment (in years) partly explained differences in means. CONCLUSION: Male and female dentists perceive their communication with the assistant differently; male dentists tend to be influenced by the gender differences, female dentists by striving for friendliness. Some country differences were found. Increasing influx of young female dentists underlines the relevance of this topic in dental education and for future research.

Adult↗
PubMed1998

[Virtual workshop for hospital management].

Due to a survey of the CKM insufficient communication among different professional groups is one of the main causes for unused quality reserves and neglected potentials of efficiency in German hospitals. An essential reason for this insufficiency lies in the traditional concepts of education which are designed for the specialties of the different professional groups. With this these concepts only impart key qualifications such as social authority, ability for communication and ability for problem-solving in a small amount. The goal of the virtual workshop is to train students and trainees in communication and interdisciplinary problem-solving early by working together on a practical case in a Virtual Workshop team. On the other hand all relevant persons to talk to are involved in order to support a qualified preparation of decisions: employees of the project hospital, partners from industry and members of universities.

Education, Medical↗