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- Krevers, Barbro, 1955-
(author)
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Patient and relative perspective regarding quality in hospital care for older people : Theory and Methods
- 2003
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Doctoral thesis (other academic/artistic)abstract
- Although the elderly population consumes a relatively large proportion of health care, international research has focused little attention on older people and their perception of health care and its outcome. Information is also scanty concerning relatives in hospital care and their actions and the circumstances related to relatives' participation in the care process.The overall aim of this thesis is to contribute to a better knowledge and understanding of the perspectives of older patients and relatives regarding hospital care and how this knowledge can be used in measurements of quality of hospital care from the patient perspective.This thesis uses both qualitative and quantitative methods. Study I and II are based on semistructured interviews. In study I a midrange theory and a theoretical model of patients' evaluation process regarding the care was derived. In study II relatives' actions and the circumstances related to their participation in the care process were described. In study III the knowledge obtained in study I was used as a base for development of an instrument 'Patients perspectives on care and rehabilitation process' (POCR) containing structured questions for measuring patients' perceptions regarding the care process. The instrument was used in telephone-interviews for the data collection in study III and IV. In study IV analyses were conducted regarding the interrelation between some of the concepts in the model of patients' evaluation process.The patient and relative perspectives on hospital care, are based on complex processes that involve their past experiences, present situation and expectations of the of future regarding care and illness/health. The encounters patients and relatives have with staff and the organisation lay the foundations for their future expectations and experiences regarding a potential forthcoming care process. Relatives carry out a variety of actions and engagements based on their own knowledge and ability. Patients and relatives have disparate realities and needs. The three-part interaction between patient, relative and staff is an important factor in patients' and relatives' actions and participation in the care process and in how their needs are met.Patient perceived needs differ during the different phases of the care process. Patients' perception of needs and care are associated with patients' previous experiences with illness and care, their perception of themselves and the situation, and their expectations regarding health and care.Patient-perceived results of the care process include how needs were met as well as health outcome. Patients' evaluation of the hospital care is shown to be associated with their previous experiences of the care unit, perceived health outcome including their overall lifesituation post-discharge, as well as patients' expectations regarding their future health postdischarge. These aspects ought to be focused in measures regarding quality of care from patients' perspective.The POCR instrument was found to have adequate validity and reliability. The instrument reflects patients' different needs during the care process and measure patients' perceptions regarding fulfilment of needs and their importance. Using the telephone interview technique makes it possible for data collectors to learn more about the patient perspective and it resulted in high response rate.
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- Nilsson, Gunilla, et al.
(author)
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Patients' experiences of illness, operation and outcome with reference to gastro-oesophageal reflux disease.
- 2002
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 40:3, s. 307-15
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Journal article (peer-reviewed)abstract
- BACKGROUND: Describing the illness-story from a patient perspective could increase understanding of living with a chronic disease for health professionals and others, facilitate decision-making about treatment and enhance information about the outcome from a patient perspective. AIM: To illuminate patients' illness experiences of having a gastro-oesophageal reflux disease (GORD), going through surgery and the outcome. METHODS: Twelve patients were interviewed 5 years after having had the operation; six patients had had fundoplication via laparoscopy and six via open surgery. Each patient was asked to talk openly about their experiences, thoughts, feelings and consequences of living with the illness, going through surgery and the period from surgery to the day of interview. A qualitative content analysis was performed concerning the context of the data and its meaning. FINDINGS: Three central categories were identified and nine subcategories: living with GORD- symptoms of the disease affecting daily living, taking medicines, work, family and social life; concerns related to surgery- decision-making about the operation, influence by physicians; life after the operation- outcomes and consequences, side-effects and complications of the operation, sick leave, information and sharing experiences with future patients. All patients were free from symptoms of the illness after surgery independent of type of surgery, but side-effects from surgical treatment varied individually. Interviewees would have liked information concerning side-effects after surgery from previous patients. CONCLUSIONS: This study contributes to knowledge about patients' long-term suffering, their control of symptoms and how they have tried to cure themselves, but also about their concerns about surgery and the importance of surgical treatment to their quality of life. They wanted information about treatment, outcome and consequences, not only from a health care perspective but also from previous patients having had the same treatment.
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