Hearing the patient voice: The importance of caring in care
Background: Much has been written about the need to change the design of health services to meet current and future challenges. Challenges include increased health care service costs; difficulty meeting rising demand; concern about health service quality; workforce capability shortcomings; and nuances specific to New Zealand’s local context. Increased health service costs are driven by health sector wage pressures; new and expensive medications and technologies; higher expectations of patients; the growing burden of chronic conditions; multimorbidity; and an aging population coupled with increasing life expectancy. The Transitional Care Nursing service, on which this study of patient experience is based, was developed as a general practice’s response to some of these challenges. It aims to meet national health sector goals of improved patient experiences through enhanced person-centred care practices, and greater integration between primary, secondary and community health care services. Aim: Using the patient voice, this study explores whether additional support in the form of the Transitional Care Nursing service influenced the overall experience of patients who received assistance from the Transitional Care Nurse during the vulnerable period of hospitalisation and transition to home. Method: Qualitative, semi-structured, face-to-face interviews were conducted with twelve patients who were purposively sampled to achieve maximum variation of patient characteristics within the sample size. Interviews were audio-recorded, and transcribed verbatim before analysing the data using a thematic analysis supported by a general inductive approach. Results: Based on the patient’s reported experiences, their interactions with the Transitional Care Nurse had the ability to significantly and positively influence both patient experience as well as create tangible improvements in their outcomes and quality of life following hospitalisation. Self-reported benefits included improvements to the patients’ experience of hospitalisation and transition to home; increased health literacy and confidence in self-managing their conditions and ongoing recovery following discharge; appropriate medications usage; improvements to the whānau and family experience of the patients’ episode of care; and improvements to patients’ sense of control, wellbeing, and perceptions of their overall quality of care. Characteristics of care that patients identified as being particular to the Transitional Care Nurse as compared to other care team members included perceived superior kindness and empathy; accessibility and responsiveness; and communication skills. It was clear that the patients viewed their care, and the team members who delivered their care, synonymously. The perceived perception of individual team members’ abilities to display these identified characteristics factored significantly in patients’ view of their overall care and experience. Conclusion: The patients of this study have demonstrated how greatly the practice of person-centred care, by just one provider within their care teams, can be seen to make a positive impact on experience and outcomes during the vulnerable period of hospitalisation and transition to home. In comparing the Transitional Care Nurse to her care team colleagues, these results presented through the patients’ eyes acknowledge the difficulties facing health professionals in delivering care that reflects principles of person-centred care within current service delivery environments. This study reinforces the need to place kindness, compassion and respect at the heart of the care we deliver to patients as health professionals. It is an essential factor in improving the patient experience, which has long been viewed as one of the most important outcomes of any effective health care system. This study gives the patient voice a much-needed place in this field of literature.
Advisor: Dowell, Tony; Morris, Caroline
Degree Name: Master of Primary Health Care
Degree Discipline: Department of General Practice and Primary Health Care
Publisher: University of Otago
Keywords: transitional care; integrated care; primary health care; person centred care; patient experience
Research Type: Thesis