Patient Satisfaction and Communication

Patients in hospitals often complain of pain regardless of the diagnosis. Several activities in a patient's life contribute to pain. Some of the activities include amount of sleep, daily chores and quality of life (Alaloul, Williams, Myers, Jones, & Logdson, 2015). While health care expenses have increased significantly over the years, there have been great improvements in increasing both family and patient involvement in medical care. Hourly care is one of the strategies that have worked well in various healthcare settings. Hourly care has been a success in various areas but using it in urgent pediatric settings hasn't been well documented (Emerson, Chumra, & Walker, 2013). Opportunities still exist to look into pediatric family preferences and perspectives as pertains to the use of whiteboards (Cholli, et al., 2016). Several studies have been done in different setups and this paper references many of them. The research projects include in-patient surveys, quasi-experimental design analyses, installation of whiteboards or incorporation of hourly rounding methods and techniques and one-on-one interviews. The study highlights the role of communication in patient satisfaction and pain management. The discussion covers various areas of concern that were aided by:

i. Large quantitative data and sample size that yielded concrete data.

ii. Implementation of whiteboard use was highly specific and this increased knowledge of the level of its effectiveness in postpartum units.

iii. Tracking of hourly rounding metrics which showed that they reduced fall rates, among others.

Ensuring that communication between the interdisciplinary team and the patient together with their family members is one of the key components of Patient Centered Care (PCC). For patients to arrive at informed decisions about the care they want administered, they must have an open line of communication with health care providers serving them. Often times, physicians will meet with a patient to discuss their treatment plan but it is not always the case that the patient understands what's going on and the options that are available to them. Nurses attend to many patients and it is not easy to keep track of a patient's information even with the help of a patient chart. Whiteboards besides patients can be used to bridge the information gap as physicians can update them with any necessary information about the treatment plan and the nurses will update the patient chart as necessary. This can help improve patient safety, better communication needs and significantly improve patient outcomes (Karn, 2016).

PICOT Question

Patient/Problem:

Women going through either caesarean or vaginal delivery

Intervention/ Phenomena of Interest/ Issue:

Making use of white boards and hourly rounding

Comparison/Context:

Compared to no usage of white board and no usage of rounding

Outcome/ Evaluation:

Raise pain management and patient satisfaction

Time: (if applicable otherwise end with PICO)

A trial period of three months

2. Significance of the Problem to Nursing Practice

Most of the metrics used to measure success of post-partum hospital experiences depend on patients' interactions with nurses. The broad goal ought to be managing expectations of post-partum patients and their families as pertains to their stay in the hospital right from the moment they are admitted to the moment they are discharged by using a whiteboard and a postpartum roadmap. Feedback from patients indicate that new families weren't sure of what really to expect of their caregivers and what their responsibilities were as pertains to learning all the new born and postpartum skills required for a discharge to be a success. The whiteboard and postpartum roadmap are very valuable as they allow patients and nurses to communicate effectively during the entire stay of the patient in the facility and manage postpartum care expectations (Horgan, Roe, Yocom-Piatt, & Cohn, 2014).

3. Literature Search Strategy

PICOT Question search terms

i. Emotional, mental, environmental, physical and associated factors linked to labor pain,

ii. Level of relaxation and events are a representation of the delivery experience being perceived positively, iii. Being dissatisfied with equipment, hospital staff, facilities and expenses; and iv. Being aware of one's baby and preparation of the family as pertains to taking the new baby born home, as well as knowing postpartum medical examinations and being ready to be discharged.

Inclusion Criteria

Post-delivery women, no matter their income level, geographies and languages are included in the study.

Exclusion Criteria

Post-delivery women who don't accept the invitation to participate in the study will be excluded.

Search Locations

Google scholar, reputable medical journals, and various research reports that relevant organizations have released will be considered.

Reference Review

Time and quality of publication of the research articles were keenly scrutinized. References of superior quality, as per this research, refer to pieces that are less than 5 years old. Another factor, besides the age, was whether the research articles and citations were written by the same author or not.

The journals or database locations that were searched include:

i. Journal of Nursing Administration,

ii. Various universities' thesis projects, iii. The Journal of Emergency Medicine

iv. Hospital Pediatrics,

v. Pain Management Nursing,

vi. LVHN Scholarly Works -- Research & Neonatal Nursing, vii. Journal of Obstetric, Gynecologic & Neonatal Nursing viii. Journal of Nursing Care Quality, and ix. AWHONN 2013 -- Annual Convention.

Evidence-based Study Types

Qualitative

___Meta-synthesis _X_Generalizable conceptual studies

_X_Descriptive studies __Case Study

Quantitative

_X_Systematic Review _X_Meta-analysis ___Practice Guidelines

_X_Randomized Controlled Trial ___Case-control Study _X_Cohort Study

4. Literature Review

In the paper by (Alaloul, Williams, Myers, Jones, & Lodgson, 2015) the used design was quasi-experimental pretest-posttest, prospective design. The characteristics of the sample were such that all the patients were admitted in two units together with medical-surgical patients and a nurse attended to them between August and December, 2013. The average length of stay for both units was four days and the number of patients in each unit averaged about twenty-two patients at a time. This was done in a health facility based on the grounds of an academic health center in Southern U.S.A. The independent variables that the researchers considered were script-based communication, hourly rounding and whiteboard use. The measurements were patient satisfaction which was evaluated through pain management and effectiveness. There was no quantitative analysis carried out. The researchers' findings were that using whiteboards, and various other communication methods, showed clear and consistent communication with the patients and created a positive effect in realizing better pain management and higher patient satisfaction.

The characteristics and design of the paper done by (Brosey & March, 2015) includes a minimum patient satisfaction score on Hospital Consumer Assessment of Healthcare Providers and Systems (HCANPS) surveys as well as on HAPU and fall rates. These were collected and analyzed before being presented for implementation. There was a seven-day consecutive monitoring rounding compliance that was assessed monthly for the period of the implementation of the project for the eligible 582 students that were discharged. Setting: a 24-bed surgical unit that has both private and semi-private rooms. There was an education session that lasted 20 minutes and nurses provided hourly rounding and this led to an increase in compliance to 69.4% up from 48.6% during the first month of implementation. Nonetheless, this increase wasn't sustained in the months that followed and decreased to 44.3% in the immediate following month and then climbed again to 59.2% the following month.

(Cholli, et al., 2016) look at the pediatric family preferences and perspectives as pertains to the use of whiteboards and also the recommendations made to use whiteboards as tools to ensure patient-centered care and communication. Design: It consisted of semi-structured interviews that involved twenty-nine families. It was set in a pediatric urban academic hospital inpatient surgical service. From the results of the interview, 2/3 of the interviewed respondents reported on using whiteboards while 52% reported having had staff communicate directly with them. Those that had used whiteboards were shown to be 6 times more active using them than those who had been using visual references. A different analysis points to 42% of the group where the parents were the ones who wrote on the whiteboard where 80% of the group had only contact information.

In assessing what impact hourly rounding had on patient satisfaction and communication in pediatric emergency department setting between November and December 2011, (Emerson, Churma, & Walker, 2013) carried out the research with design in observational, prospective study utilizing surveys done between November 2010 and December 2011. The setting was a tertiary care children's hospital. The sample characteristics included 200 discharged families whose opinions were collected and equally divided between post and pre-implementation data. Hourly rounding was the independent variable while call bell activations was the dependent variable. The quantitative analysis that was done wasn't enough. Nevertheless, results show that hourly rounding did not have nor had very small positive effect on call bell activation. The results indicated that accidental call bell activation rose as hourly rounding was introduced.

The goal of (Horgan, Roe, Yocom-Piatt, & Cohn, 2014) was managing expectations of both post-partum patients and their family members regarding their stay in the hospital from the point of their admission to the time they leave after being discharged by using a whiteboard and postpartum roadmap. Design: the design consisted of two interactive tools (whiteboard and written roadmap) that outline every postpartum phase during the hospital stay. Sample characteristics involved all patients and staff in four baby-mother units. Setting: the setting was in four baby-mother units. The use of whiteboards was combined with various dependent variables such as patients and staff members in the postpartum units. The visual appeal of the whiteboard was liked by patients. There was an overall increase of 15.8% in discharge preparedness and patient satisfaction as a result of the use of whiteboards.

Recommendations are made by (Johnston & Fenicle, 2014) through their paper to the HCAHPS scores assigned as relevant to whiteboard use implementation. Design: there were a total 1073 whiteboards installed for the project. They created 12 templates so as to comply with certain needs of particular patients. They constructed boards for critical care, medical-care, transitional skilled unit, labor and delivery, L&D triage, emergency department, prenatal, mom/baby, ED-children, ED-17th street, neo-natal intensive care unit, pediatrics and medical surgery. Sample characteristics: 13 units were involved in the collection of data. They were TTU, TOHU, RHC-M, ICU-M, 7T, 7C, 7BP, 6T, 6K, 6B, 5K, 5CP and 4T. Setting: it was set in Lehigh Valley Health Network. The correctness of the collected data was assessed by auditors. The data, according to the auditors, was correct and satisfactorily complete. The best completion rate was 90% and was recorded by TOHU.

(Karn, 2016) made improvements to the interdisciplinary communication in Ralph H. Johnson VA Medical Center's (RHJ VAMC) inpatient medical-surgical wards by using personalized whiteboards (PWs) at patients' bedsides. Design: Involved a micro-system assessment of the two inpatient RHJ VAMC's inpatient medical-surgical wards. Setting: two RHJ VAMC's inpatient medical-surgical wards. Results demonstrate that there were improvements two months following implementation. After four months, there was a slight decline. Notably, on surveying patients and nurses, it was discovered that PWs increased the satisfaction of the two groups with interdisciplinary communication.

The objective of (Klepper, et al., 2014) was determining if standardized hourly rounding processes (SHaRP) implementation through formal education programs can lead to better efficiency, patient satisfaction, safety and quality metrics when compared with various other processes that aren't as standardized. Design: a two-group quasi experimental design where data was gathered over a six-month period during the study and then six months after the study (from October 2010 to March 2011). Sample characteristics: researchers selected two 32-bed cardiovascular surgery nursing units to take part. Setting: it was set at St. Luke's Episcopal Hospital (SLEH). Efficiency: there were major differences in the use of weekly and daily call lights in the two units over the study period (p= 0.001). Nonetheless, there was no significant variance in the overall number of staff "steps". Also, the differences existing between the two units as pertains to the perception of staff as concerns them having "sufficient time" was not significant (µ = 84.6% vs. 87.5%). Quality of patient care: the differences existing between the two units in 30-day readmission rates and number of patient falls was not significant. The proportion of patients who were satisfied with the explanations given by nurses on the intervention unit saw an increase from 60.4% to 69% over the data gathering period.

(Martin, 2015) tried to take up and implement a relatively good inter-professional initiative that aimed at improving patient perception of care and pain care quality. Design: a committee was formed in April 2014 to serve as unit surveyors, auditors and champions for a project that looked at pain care quality at a community hospital that had a capacity of 110 beds. Sample characteristics: Patients who were in the three inpatient units for adults (telemetry, women's services and medical-surgical). Setting: the facility was a community hospital that had a capacity of 110 beds. Pain care toolkit was the independent variable while patient satisfaction and pain management were the dependent variables.

(Massaro & Murphy, 2013) put in place whiteboards that are unit specific and that can assist in improving patient-centered communication. They briefly summarized findings made during an Association of Women's Health, Obstetric, and Neonatal Nurses convention. Sample characteristics: involved patients in a mother/baby unit. Setting: a hospital. The independent variable was unit-specific whiteboards while the dependent variables were the HCAHPS and Press Ganey surveys. The HCAHPS and the Press Ganey surveys showed that patients in mother/baby units liked the whiteboards and they noted that the communication had improved.

The systematic review (Mitchell, Lavenberg, Trotta, & Umschield, 2014) synthesizes evidence about what effects hourly rounds have on patient satisfaction and discusses what implications nurse administrators have. Design: it was a Synthetic Review. Sample Characteristics: sixteen published studies were used. The independent variable was nursing rounds while the dependent variables were reduction in patient fall and patient satisfaction. They used GRADE analysis to systematically evaluate the consistency, quality and quantity of the evidence as well as the result's effect size so as to rate the entire evidence base for each intervention type's effect on the outcomes under consideration. Moderate-strength shows that hourly rounds help in the improvement of fall intervention through the enhancement of how patients perceive nursing responsiveness. Nonetheless, there wasn't much consistency in how hourly rounding results were measured.

(Olrich, Kalman, & Nigolian, 2012) sought to find out what effects hourly rounding had on patient satisfaction, call light usage and fall rates. Design: it was a quasi-experimental study that replicated another study that was done by Meade, Bursell and Keltelsen (2006) on rounding protocol. Sample characteristics: N=4,418, which was the number of patients discharged from two medical-surgical hospitals over the study period of one year. Setting: two medical-surgical units in a teaching hospital in Northeast U.S. One of the units served as the experimental units while the other one was the control unit. The independent variable was hourly rounding while the dependent variables were patient satisfaction, call-light usage and patient falls. Data on patient satisfaction levels and number of falls were gathered over six months before the intervention and then six months over the period of intervention. They used post-discharge patient satisfaction surveys and occurrence reports to gather data. Call-light data was gathered from the call-light retrieval system over two weeks before the onset of the study and for four weeks over the course of the intervention. Results showed that hourly rounding alone doesn't offer decrease in call light usage, or increases in patient satisfaction. Nonetheless, it helped prevent fall rates by 23%.

In the paper written by (Rondinelli, Ecker, Crawford, Seelinger, & Omery, 2012), the researchers identify the common outcomes, processes and structures that hourly rounding is associated with. The study gets its framework from the Donabedian model of structure, processes and outcomes. Design: fourteen people drawn from eight hospitals in the Southern California Kaiser Permanente integrated healthcare organization and three hospitals from various other hospitals in the area were interviewed. This was done between December 2007 and August 2008. The hospitals ranged from two hundred to four hundred and fifty licensed beds. The period of implementation ranged from a month to a year. Setting: it was done in Southern California Hospitals. The independent variable was hourly rounds while the dependent variables were the participants. The analysis of the qualitative data looked for themes and 15 major themes were found. Structure themes included the use of rounding behaviors while processes included library tools to be used in the incorporation of staff and patient feedback. The two main outcome themes were patient perception and patient satisfaction.

In their study, (Tan, Evans, Braddock & Shieh, 2012) sought to determine if using whiteboards raised patients' satisfaction and understanding of their care. They explored barriers physicians faced when using the whiteboards and how they could overcome them. It also looked at the way physician practices could be impacted if they had knowledge of the information the study yielded. The study is grounded on the Institute for Healthcare Improvement's model of Plan-Do-Study-Act (PDSA) cycle. Design: It was a 3-week pilot that involved white board use across multiple disciplines. Sample characteristics: involved 104 patients at Stanford University Medical Center who were on the general medicine service. A short in-person survey was done with two groups: (1) fifty-six patients on two inpatient units where whiteboards were used and (2) forty-eight patients on two inpatient units where whiteboards were not used. Further, there was a survey of twenty-five internal medicine residents on challenges that came with using whiteboards. Also surveyed were consulting physicians, family members, case managers, occupational therapists and physical therapists (n = 40). Setting: the setting was Stanford University Medical Center's General medicine service. The independent variable was whiteboard use which was assessed on estimated discharge rate, communication and patient satisfaction while the dependent variable was patients. The researchers carried T-tests and one-way ANOVA. The use of whiteboards made patients know their physician's name (p ≤ 0.001), comprehend the goals their admissions sought to achieve (p ≤ 0.0016), and record better satisfaction with their hospital stay (p ≤ 0.0242).

5. Analysis and Synthesis

i. Role of Communication

The studies highlighted how the level of communication affected patient satisfaction and pain management, which was clearly strong (Alaloul, Williams, Myers, Jones, & Logdson, 2015). A majority of patients didn't use whiteboards for the simple reason that the staff didn't request them to. They also thought that physicians used whiteboards less than nurses. Since the study was patient-centered, much insight on how effective the whiteboards are in boosting patient satisfaction was gleaned. Nonetheless, other groups not participating meant the outcome wasn't very comprehensive (Cholli, et al., 2016).

ii. Pain Management

Analysis of similar studies leads to better comprehension of the use of pain care toolkits. Nevertheless, because of time limitations, there wasn't enough information collected to a thorough and comprehensive picture (Martin, 2015). The study done by (Rondinelli, Ecker, Crawford, Seelinger, & Omery, 2012) provides greater comprehension of how improving hourly rounds through ongoing and consistent process assessments of both staff and patient feedback can improve pain management. The data collected wasn't comprehensive as it was limited by phone interviews. The study done by (Tan, Evans, Braddock, & Shieh, 2012) had control groups (the ones that didn't use whiteboards) and so made the results gotten more concrete. There was also a quantitative analysis of the data which is also improved the quality of the results. They proved that using whiteboards is a feasible exercise and can lead to better outcomes for both patients and staff.

iii. Hourly Rounding

The information gathered from other studies points to the possible effectiveness and feasibility of hourly rounds. Nonetheless, systemically reviewing them doesn't yield adequate information (Mitchell, Lavenberg, Trotta & Umschield, 2014). The study done by (Emerson, Chumra, & Walker, 2013) shows no positive correlation between patient satisfaction and hourly rounding. However, the collected information points to the existence of gaps in the research. It appears that hourly rounds increase fall prevention but they don't make nursing responsiveness better. Because of time limitations and the sample size not being sufficient, the study didn't yield concrete evidence (Brosey & March, 2015).