NUR1201 The Patient Experience: Partnering In Care

Introduction

Over the past years, the health quality and performance have improved from the provision of excellent patient care to entail patient experience (PE) as a critical indicator that has been pushed by the constant shifts in public policies aiming to put the patients’ experience at the front(Amsden, Davidson, Fevrier, Goldfien, & Herrinton, 2018). However, among the Aboriginal women aged 40, who suffer from different diseases especially breast cancer. The patient care and experience is something that seems to be much beyond achievable according to the placed standards by the WHO and other responsible agencies.

Patient’s experiences have received different definitions according to Health Leaders Media Patient Experience Leadership Survey (Smimova, Lombarts, Arah, & Vleuten, 2017). Some of the respondents referred PE as patient-centered care, others as an orchestrated set of qualities with meaningful customized for each specific patient while others as the provision of excellent patient service. Generally, combining all the views, PE means the provision of customized service that provides a better healing environment for patients both in hospitals and at home.

Healthcare organizations have considerably applied more effort in establishing quality improvement in the patient’s care and experience. From the 1980s, numerous researchers identified core components that were useful in defining the patient-centered care such as respect for the patient preferences and values; physical comfort; communication and education; coordination of care; emotional support; continuity and transition; involvement of the family and friends and access to care. Patient-Centered was introduced in the 1970s by Balint and the colleagues, however, currently has received various improvements due to the healthcare consumerism (Armstrong, 2017). The other dominant theory applied is the Erickson 8 stages of psychology that entail Trust vs. Mistrust, Autonomy vs. Shame, Initiative vs. Guilt, Industry vs. Inferiority, Identity vs. Role Confusion, Intimacy vs. Isolation, Generativity vs. Stagnation and Ego Integrity vs. Despair. All the stages are quite crucial in enhancing patient-centered care, however, the sixth stage: Intimacy vs. Isolation plays a significant role in the patient’s recovery. These patients always require the family support to facilitate the healing process.

Current frameworks such as patient engagement have been found as the fundamental strategy for achieving effective patient-centered care (Hamilton & Li, 2018). The achievement of this is through engaging the patients’ families, representatives and health organization professionals that are working in active partnership at various levels across the health care system. The engagement can be promoted at three different levels: individual level, organizational level and at the policy level. Engagement promoted at an individual level. The individual-level of engagement entails various activities such as shared decision making. Organizational level-patient engagement takes place at healthcare units through various programs such as patient advisory and inclusion of patients in quality improvements teams. At the hospitals, different programs such as the patient’s guidance and consultation and patient heart failure and other diseased programs have facilitated the drop in mortality rate.

Patient engagement at the policy has been advocated on various bases such as ethical duty, social justice and pragmatic values that aim at achieving better operational management and quality services to the patients. Different advocacy groups across the world such as Mother Care for Children, health activists, and government agencies have reviewed these policies that have seen the health improvement among different genders and communities facing health disparities.  At all these stages communication with the patient is essential as it eliminates the loneliness, depression, and despair, and at the same time promote hope to the recovery. On the same note, the Erickson 8 stages of theory of development are essential in enhancing the patient center care and engagement.

In Australia, breast cancer ranks as the most prevalent cancer diagnosed among women aged 38-60 resulting in numerous deaths (Supramaniam et al., 2014). However, detection of disease at early stages offers better opportunity to treat which eventually leads to reduced mortality rate. The Australian’s government primary objective is to reduce morbidity and mortality from the breast cancer through early cancer detection through screening mammography and to improve the care of the infected individuals to regain the former health status.

According to Kaushik,(2013) breast cancer is common among the Aboriginal Australian women who at the same time experience a high mortality rate of 26.7% than the non-Aboriginal women mortality rate of 23.9 % .The disparity is associated with a higher likelihood of chronic diseases, cultural factors, co-morbidity and inadequate access to health services due to the geographical remoteness.

Therefore, it is imperative for the women to receive improved health services that are satisfactory to both patients and the families and friends, and these can only be achieved through the introduction of the patient-centered care among the Aboriginal population (Thackrah,Thompson & Durey,2015). Numerous advancements such as the installation of Breast Cancer screening services in the region, provision of free transport to individuals that have difficulty in accessing the facilities and home-based advisory among many others. All these initiatives are meant to improve the experience of the Aboriginal women, however, to some extent is not to the required level of the patient’s experience.

Various factors have contributed to the improved patient’s experience among the Aboriginal women, who have been through the cancer screening and treatment. Factors such as influence from others: who had the same problem and had a better experience tend to encourage others to undergo the same process, as has numerous benefits such as treatment, care, and motivation (Jull et al., 2015). However, a good number of the women always fear to go through the process as a result of fear and shame of the experience. Initially, the aboriginal women never attended the pro-active breast screening as they were better off not knowing that they have it. Shame among the women also tends to be a hindrance to the women in participating in such breast cancer screening and programs as they perceive self-examination to be daunting. 

Women who undergo the treatment process: mastectomy, lumpectomy and even radiation in most cases face an emotional imbalance that is brought about by the immense pain (Sofolahan-Oladeinde et al., 2017). Without proper care for these patients, may result in mental disturbance and even deaths since most of the aboriginal women lacked adequate knowledge to make appropriate decisions before, during operation and even after.

Patient-Center care models such as patient coaching programs, the introduction of centers for decision making, self-help groups among the women, and accountable care systems have been developed to enhance the patients experience regarding the services received(Donner-Banzhoff, 2018). However, these practices tend to accept some challenges that hinder the development among the population. Problems such inadequate time for the physicians to offer full information to the patients, patient’s lack of assertiveness and inadequate health literacy, poor communication between the patient and the health provider being affected by the cultural factors are among of the identified challenges.

Conclusion

Most of the healthcare organizations have made more steps towards the patient experience from quality services through various models such as patient-center care that fully entails the engagement of the patients, the health providers, family members, and the policy practices. There is considerable evidence among the Aboriginal women aged 40, who suffer the breast cancer, however different frameworks such as the use of the Erickson 8 stage theory and the patient’s engagement practices have facilitated the healing process of these patients, leading to satisfactory experience.

References

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Hamilton, C. B. & Li, L. C. (2018). An empirically based conceptual framework for fostering meaningful patient engagement in research. Health Expectations, 21(1), 396-406. doi:10.1111/hex.12635

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Kaushik, A. (2013). Developing Vulnerability Scale For The Elderly. Indian Journal Of Gerontology, 27(2), 333-353.

Smirnova, A., Lombarts, K. H., Arah, O. A., & Vleuten, C. M. (2017). Closing the patient experience chasm: A two-level validation of the Consumer Quality Index Inpatient Hospital Care. Health Expectations, 20(5), 1041-1048. doi:10.1111/hex.12545

Sofolahan-Oladeinde, Y., Newhouse, R. P., Lavallee, D. C., Huang, J. C., & Mullins, C. D. (2017). Early assessment of the 10-step patient engagement framework for patient-centred outcomes research studies: the first three steps. Family Practice, 34(3), 272-277. doi:10.1093/fampra/cmx013

Supramaniam, R., Gibberd, A., Dillon, A., Goldsbury, D. E., & O’Connell, D. L. (2014). Increasing rates of surgical treatment and preventing comorbidities may increase breast cancer survival for Aboriginal women. BMC Cancer, 141-9. doi:10.1186/1471-2407-14-163

Thackrah, R. D., Thompson, S. C., & Durey, A. (2015). Promoting women’s health in remote Aboriginal settings: Midwifery students’ insights for practice. Australian Journal Of Rural Health, 23(6), 327-331. doi:10.1111/ajr.12247