Patient-Centered care

以患者为中心的护理
  • 文章类型: Journal Article
    慢性护理模式(CCM)是一个支持积极主动、计划,慢性病的协调和以患者为中心的护理。慢性疾病护理患者评估(PACIC)量表是基于CCM评估患者对慢性护理提供观点的有价值的工具。很少有研究探讨其在中国的应用。这项研究评估了中国患者的高血压护理,并探讨了PACIC评分与患者依从性的关系。在杭州进行了一项横断面研究,中国,2021年6月至8月,包括来自5家县级医院和13家基层医疗中心的253名高血压患者。该研究使用PACIC量表评估高血压护理服务,并使用高血压患者依从性量表(CHPS)来衡量患者的依从性。多元线性回归分析用于探索人口学特征与PACIC总分和领域得分之间的关系。以及CHPS与PACIC领域得分之间的关联。总体PACIC评分的平均值为3.12(满分5分)。解决问题/上下文领域的每个项目的平均得分最高,而随访/协调域最低。患者激活对意向有负面影响(β=-.18,P<.05),姿态(β=-.21,P<.05),责任(β=-.17,P<.05),CHPS总分(β=-.24,P<.01)。分娩系统设计/决策支持与生活方式(β=-.21,P<.05)和CHPS总分(β=-.26,P<.01)呈负相关。高血压患者认为,他们有时会在中国初级医疗机构中接受与CCM一致的高血压护理。较高水平的PACIC评分有利于改善高血压患者的依从性。
    The Chronic Care Model (CCM) is a framework that supports the proactive, planned, coordinated and patient-centered care of chronic diseases. The Patient Assessment of Chronic Illness Care (PACIC) scale is a valuable tool for evaluating patients\' perspectives on chronic care delivery based on the CCM. Few studies have examined its application in China. This study assesses hypertension care in Chinese patients and explores how PACIC scores relate to patient compliance. A cross-sectional study was conducted in Hangzhou, China, from June to August 2021, including 253 hypertensive patients from 5 county hospitals and 13 primary healthcare centers. The study used the PACIC scale to assess hypertension care delivery and the Compliance of Hypertensive Patients scale (CHPS) to measure patient compliance. Multiple linear regression analyses were used to explore the relationship between demographic characteristics and the total and domain scores of PACIC, as well as the association between CHPS and the domain scores of PACIC. The mean value of overall the PACIC score was 3.12 (out of 5). Problem solving/contextual domain had the highest average score for each item, while follow up/coordination domain had the lowest. Patient activation had negative effects on intention (β = -.18, P < .05), attitude (β = -.21, P < .05), responsibility (β = -.17, P < .05), and the total score of CHPS (β = -.24, P < .01). Delivery system design/decision support was negatively associated with lifestyle (β = -.21, P < .05) and the total score of CHPS (β = -.26, P < .01). Hypertensive patients perceived that they sometimes received hypertension care consistent with the CCM in Chinese primary healthcare settings. A higher level of PACIC score was beneficial for improving hypertensive patient compliance.
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  • 文章类型: Journal Article
    以患者为中心的护理(PCC),几十年前创造的一个术语,是护理实践的关键但具有挑战性的焦点。历史,发展,以及当前关于PCC的对话以及圣经对护理的观点,智慧,和洞察力帮助跟随基督的护士提供富有同情心的PCC。提出了有意义地参与患者和家庭作为医疗保健的积极参与者的策略。基督教护士最好提供一致的,通过保持以基督为中心的有效PCC。
    UNASSIGNED: Patient-centered care (PCC), a term coined decades ago, is a key but challenging focus of nursing practice. The history, development, and current dialogue about PCC along with biblical perspectives on caregiving, wisdom, and discernment help nurses who follow Christ to offer compassionate PCC. Strategies are proposed for meaningfully engaging patients and families as active participants in healthcare. The Christian nurse can best provide consistent, effective PCC by remaining Christ-centered.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    背景:鉴于进行研究以解决严重疾病患者的姑息治疗和临终关怀需求的许多挑战,从研究概念化和设计开始的利益相关者参与对于确保成功招募参与者至关重要,数据收集,干预交付,数据分析,和传播。
    方法:以患者为中心的结果研究所(PCORI)发布的概念模型为指导,“衡量什么对推进参与的科学和实践至关重要”14,并在PCORI参与官员的支持下,来自9个由PCORI资助的研究小组的代表组成了一个工作组,对调查小组成员进行调查和审查,大纲,并描述促进利益相关者参与姑息治疗研究的关键经验教训和最佳实践。
    结果:几乎所有的研究团队都与患者/护理人员合作,临床医生,研究人员,和医疗保健系统专家作为利益相关者的合作伙伴。大约一半的团队还包括付款人和培训机构,作为其利益相关者顾问以及一系列内容专家的一部分。研究团队依靠各种支持结构和资源,他们采用了10种不同的方法来保持参与。使用该方法的团队通常认为所有参与方法都是有效的,尽管每种方法的团队评估参与质量都有一些差异。在9项研究中,确定了9项利益相关者参与的障碍,以及克服这些障碍的9项策略(或促进者)。我们分享了利益相关者参与如何影响所有阶段研究的例子,包括准备阶段,研究开始阶段,执行阶段,和数据分析/传播阶段。
    结论:团队利用各种资源和支持结构,并利用多种参与方法来促进利益相关者的参与,导致高水平的协作和集成。
    BACKGROUND: Given the many challenges of conducting research that addresses the palliative and end-of-life care needs of patients with serious illnesses, stakeholder engagement starting from the moment of study conceptualization and design is critical to ensure successful participant recruitment, data collection, intervention delivery, data analysis, and dissemination.
    METHODS: Guided by a conceptual model published by the Patient-Centered Outcomes Research Institute (PCORI) entitled, \"Measuring What Matters for Advancing the Science and Practice of Engagement\"14 and with the support of a PCORI Engagement Officer, representatives from 9 PCORI-funded study teams formed a working group to survey team members and review, outline, and describe key lessons learned and best practices for promoting stakeholder engagement in palliative care research.
    RESULTS: Almost all study teams engaged with patients/caregivers, clinicians, researchers, and health care system experts as stakeholder partners. About half the teams also included payers and training institutions as part of their stakeholder advisors as well as a range of content experts. Study teams relied on a variety of support structures and resources, and they employed 10 distinct methods for maintaining engagement. All engagement methods were generally considered to be effective by teams who used the method, though there was some variability in team-rated engagement quality of each method. Nine barriers to stakeholder engagement were identified across the 9 studies as well as 9 strategies (or facilitators) to overcome these barriers. We share examples of how stakeholder engagement impacted studies in all phases, including the preparatory phase, study initiation phase, execution phase, and data analysis/dissemination phase.
    CONCLUSIONS: Teams utilized a variety of resources and support structures as well as capitalized on multiple engagement methods for fostering stakeholder engagement, resulting in a high level of collaboration and integration.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    目的:直肠癌治疗期间和之后的标准化患者报告结局(PRO)监测提供了对患者经历的治疗相关毒性的洞察,并改善了健康相关的生活质量以及总生存率。我们旨在选择PRO版本的不良事件通用术语标准(PRO-CTCAE)的子集,以标准化监测直肠癌中与治疗相关的症状毒性。
    方法:我们使用了混合方法方法,包括文献综述,与参与直肠癌护理和直肠癌患者的医疗保健提供者(HCP)进行半结构化访谈。总结了文献和访谈的结果,并将其用于改良的Delphi程序中,以选择针对直肠癌的PRO-CTCAE子集。
    结果:从文献中确定了26个PRO-CTCAE症状毒性。来自多个学科的15个HCP(医学,放射和外科肿瘤学),和一组由15名接受化疗和/或放疗和/或手术治疗的直肠癌患者组成的异质组,参加半结构化面试。10名HCP(67%)和9名患者(90%)参加了第一轮Delphi。最终选择的PRO-CTCAE核心子集包含16种症状毒性:\'腹泻\',\'大便失禁\',\'便秘\',\'腹部腹胀\',\'腹部疼痛\',\'呕吐\',\'性欲下降\',\'阴道性交时疼痛\',“实现和保持勃起的能力”,\'疲劳\',\'焦虑\',\'感觉没有什么能让你振作起来\',\'尿失禁\',\'排尿疼痛\',\'一般疼痛\',和“手足综合症”。
    结论:基于综合混合方法研究,本研究确定了用于直肠癌标准化治疗相关症状毒性监测的PRO-CTCAE子集.建议使用该子集评估症状毒性监测的有效性和依从性。
    OBJECTIVE: Standardized patient-reported outcomes (PRO) monitoring during and after rectal cancer treatment provides insight into treatment-related toxicities patients experience and improves health-related quality-of-life as well as overall survival. We aimed to select a subset of the PRO version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) for standardized monitoring of treatment-related symptomatic toxicities in rectal cancer.
    METHODS: We used a mixed methods approach including a literature review, and semi-structured interviews with health care providers (HCPs) involved in rectal cancer care and rectal cancer patients. Results from literature and interviews were summarized and used in a modified Delphi procedure to select a PRO-CTCAE subset specific for rectal cancer.
    RESULTS: Twenty-six PRO-CTCAE symptomatic toxicities were identified from literature. Fifteen HCPs from multiple disciplines (medical, radiation and surgical oncology), and a heterogeneous group of fifteen rectal cancer patients treated with chemotherapy and/or radiotherapy and/or surgery, participated in semi-structured interviews. Ten HCPs (67%) and nine patients (90%) participated in the first Delphi round. The final selected PRO-CTCAE core-subset contained 16 symptomatic toxicities: \'diarrhea\', \'fecal incontinence\', \'constipation\',\'bloating of the abdomen\', \'pain in the abdomen\', \'vomiting\', \'decreased libido\', \'pain during vaginal sex\', \'ability to achieve and maintain erection\', \'fatigue\', \'anxiety\', \'feeling that nothing could cheer you up\', \'urinary incontinence\', \'painful urination\', \'general pain\', and \'hand-foot syndrome\'.
    CONCLUSIONS: Based on a comprehensive mixed methods study, a PRO-CTCAE subset for standardized treatment-related symptomatic toxicity monitoring in rectal cancer was identified. Assessment of the effectiveness and compliance of symptomatic toxicity monitoring using this subset is recommended.
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  • 文章类型: Journal Article
    背景:患有持续性危重病的患者会经历长时间的多系统发病率,功能障碍,和慢性病。因此,这些患者长期入院重症监护病房.如果出院,他们带着长期的医疗依赖返回家园。护理伙伴承担各种身体,心理健康,认知,和社会角色,以支持为这些患者提供护理。证据有限,然而,在住院期间成为该患者人群的护理伙伴的影响。
    方法:进行了一项定性描述性研究,以探讨护理伙伴对持续性危重病患者的影响。患有或曾经患有持续性重症疾病和护理伙伴的患者是从多伦多一家社区学术医院的两个住院单位中招募的。加拿大参加半结构化面试。使用基于团队的归纳内容分析来分析数据。
    结果:7名(43.8%)参与者为患者幸存者,9名(56.3%)是护理伙伴。患者和护理伙伴报告身体,社会情感,和社会压力作为持续危重病住院期间护理提供的影响。护理合作伙伴确定了几种保护策略,用于减轻护理对他们的影响,例如寻求外部心理健康支持和边界设置。还确定了正式和护理伙伴计划的特征,并建议这些计划可以保护护理伙伴的价值观,减轻无助和压力的感觉,并可能改善处于护理伙伴角色的家庭成员与医疗团队之间的关系。
    结论:这项研究确定了身体,社会情感,以及与社会压力相关的护理服务对住院期间持续性危重症患者的护理伙伴的影响。此外,这项研究确定了由护理伙伴发起的保护因素,以减轻报告的角色压力,以及护理伙伴计划的保护功能。结果提供了更好地理解护理伙伴计划的支持功能,这些支持功能特定于持续严重疾病的经历和需求,并增加了关于如何在住院期间和住院后公平获得护理的越来越多的证据。
    BACKGROUND: Patients with persistent critical illness experience prolonged multi-system morbidity, functional impairments, and chronic conditions. As a result, these patients have prolonged intensive care unit admissions. If discharged, they return home with long-term medical dependencies. Care partners take on a variety of physical, mental health, cognitive, and social roles to support the provision of care for these patients. There is limited evidence, however, of the impact of being a care partner for this patient population during hospitalization.
    METHODS: A qualitative descriptive study was conducted to explore the impact care provision on care partners for patients experiencing persistent critical illness. Patients who have or have had persistent critical illness and care partners were recruited from two inpatient units in a single community academic hospital in Toronto, Canada to participate in semi-structured interviews. Data was analyzed using a team-based inductive content analysis.
    RESULTS: Seven (43.8%) participants were patient survivors, and nine (56.3%) were care partners. Patients and care partners reported physical, socio-emotional, and social stress as impacts of care provision during persistent critical illness hospitalization. Care partners identified several protective strategies that they used to mitigate the impacts of care provision on them such as seeking external mental health support and boundary setting. Features of formalized and care partner programs were also identified and suggest that these programs can be protective of care partner values, mitigate feelings of helplessness and stress, and may improve relationships between the family members who are in the care partner role and the healthcare team.
    CONCLUSIONS: This study identified physical, socio-emotional, and social stress related impacts of care provision on care partners of patients with persistent critical illness during hospitalization. Additionally, this study identified protective factors initiated by care partners to mitigate the reported stresses of the role, as well as protective features of a care partner program. The results provide a better understanding supportive features of care partner programs that are specific to the experiences and needs of persistent critical illness and add to the growing body of evidence about how to provide equitable access to care during and post hospitalization.
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  • 文章类型: Journal Article
    患者体验被认为是高质量护理的支柱,以患者为中心的护理不可或缺,但是,尽管政策重点关注患者报告的经验措施(PREM),很少发表关于他们的发展,使用,或对临床实践的影响。在肾脏病学中,PREM越来越多地用于研究,以捕获和量化患者对他们在医疗保健服务方面的经历的看法。研究表明,负面的患者体验会影响患者的身心健康,在选择的环境中,一小部分但很大一部分患者报告他们的医疗保健体验较差或欠佳。PREM是否在临床环境中提高护理质量或支持以人为本的护理的证据在很大程度上仍是理论上的。已经投入了广泛的努力来开发用于肾脏服务的各种PREM。尽管目前几乎没有证据将PREM收集与护理交付的有意义变化联系起来,工作正在进行中。早期迹象表明,有了合适的调解人,在常规实践中实施PREM可以帮助提供商认识到需要改变的地方并激励转型。了解PREM数据和可修改的提供程序特征之间的联系以定位和启用更改的旅程已经开始,但还需要进一步的证据.本文概述了PREM在肾脏病学中的历史,并详细介绍了它们当前的使用以及实施挑战。在考虑其对肾脏保健影响的证据基础之前,将讨论PREM的使用和益处。建议了PREM可能的下一步步骤,并强调了最佳做法。
    Patient experience is considered a pillar of high-quality care, integral to patient-centered care, but despite significant policy focus on patient-reported experience measures (PREMs), little is published regarding their development, use, or impact on clinical practice. In nephrology, PREMs are increasingly used in research to capture and quantify patients\' perceptions of their experiences with health care services. It has been shown that a negative patient experience impacts patients\' physical and psychological health, and a small but significant proportion of patients across a selection of settings report their experiences of health care as poor or suboptimal. Evidence of whether PREMs improve quality of care or support person-centered care in the clinical setting remains largely theoretical. Extensive effort has been invested to develop various PREMs for kidney services. Although little evidence linking PREM collection to meaningful change in delivery of care currently exists, work is underway. Early indications are that with the right facilitators, implementing PREMs in routine practice can help providers recognize where change is needed and galvanize transformation. The journey toward understanding the connection between PREM data and modifiable provider characteristics to target and enable change has started, but further evidence is needed. This article outlines the history of PREMs in nephrology and details their current use alongside implementation challenges. The use and benefits of PREMs are discussed before considering the evidence base for their impact on renal health care. Possible next steps for PREMs are suggested and best practices highlighted.
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
    本文探讨了旨在改善患者体验的手疗法的变革策略-这是与改善临床结果和提高患者和治疗师满意度相关的关键因素。重点是三个关键领域:个性化互动、移情沟通,和感官参与。个性化的互动确保治疗是针对每个患者的独特需求,培养个人关注和关心的意识。移情沟通包括理解和有效地回应患者的口头和非语言线索,创造一个患者感到真正听到的支持性环境。感官参与利用治疗环境的视觉,嗅觉,和听觉元素来创造平静,欢迎空间有利于愈合和放松。整合这些策略旨在通过促进令人满意且压力较小的工作环境来提高治疗效果并改善治疗师的健康状况。通过对现有证据的全面审查,当前的做法和创新的方法,本文主张整体,以患者为中心的手治疗模式,显着改善治疗结果并增强整体治疗体验,确保它既实用又富有同情心。
    This paper explores transformative strategies in hand therapy aimed at improving the patient experience - a critical factor linked to improved clinical outcomes and increased satisfaction for patients and therapists. The focus is on three key areas: personalized interactions, empathic communication, and sensory engagement. Personalized interactions ensure therapy is uniquely tailored to each patient\'s needs, fostering a sense of individual attention and care. Empathic communication involves understanding and responding effectively to patients\' verbal and nonverbal cues, creating a supportive environment where patients feel genuinely heard. Sensory engagement utilizes the therapeutic environment\'s visual, olfactory, and auditory elements to create a calming, welcoming space conducive to healing and relaxation. Integrating these strategies aims to increase treatment effectiveness and improve therapist well-being by promoting a fulfilling and less stressful work environment. Through a comprehensive review of existing evidence, current practices and innovative approaches, this paper advocates for a holistic, patient-centered model of hand therapy that significantly improves treatment outcomes and enhances the overall therapeutic experience, ensuring it is both practical and compassionate.
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