METHODS: A qualitative study with four focus-group discussions was conducted with 20 registered nurses from general wards in a Malaysian public hospital. Semi-structured interviews were used to elicit participants' opinions. NVivo 10 software was used for data management and content analysis was used to analyze the data.
RESULTS: Several participants used inconsistent methods to involve patients in bedside handovers and others did not involve the patients at all. The participants' interpretations of the concept of patient-centered care were ambiguous; they claimed that patient involvement during bedside handovers was impractical and, therefore, not reflective of patient-centered care. Some nurses' subjective views of patient involvement as impractical during bedside handovers were manifested in their deliberate exclusion of patients from the handover process.
CONCLUSIONS: Changes in patient involvement and nursing practices congruent with patient-centered care require that nurse educators in hospital settings reform nursing education to focus on fostering of communication skills needed to function in nurse-patient partnerships. Guidelines for patient involvement consistent with patient-centered values should be developed using ward nurses' subjective views and introduced to all registered nurses in practice.
DESIGN/METHODOLOGY/APPROACH: The topic was selected for reasons guided by the Institute of Healthcare Improvement virtual breakthrough series collaborative (VBSC). Subject matter experts came from existing global quality development in collaboration with sales and marketing, and talent management agencies/departments. Patient satisfaction (PS) was measured using the SH Customer Feedback Form. Data were analysed using Friedman's test.
FINDINGS: The in-patient (IP) department PSI repeated measures comparison during VBSC, performed using Friedman's test, showed a statistically significant increase in the PSI, χ2 = 44.00, p<0.001. Post hoc analysis with Wilcoxon signed-rank test was conducted with a Bonferroni correction applied, which resulted in a significant increase between the baseline and action phases ( Z=3.317, p=0.003) between the baseline and continuous improvement phases ( Z=6.633, p<0.001), and between the action and continuous improvement phases ( Z=3.317, p=0.003), suggesting that IP PSI was continuously increasing during all VBSC phases. Like IP PSI, the out-patient department PSI was also continuously increasing during all VBSC phases.
RESEARCH LIMITATIONS/IMPLICATIONS: The VBSC was not implemented using a control group. Factors other than the VBSC may have contributed to increased PS.
PRACTICAL IMPLICATIONS: The VBSC was conducted using virtual telecommunication. Although conventional breakthrough series might result in better cohesiveness and commitment, Indonesian geographical barriers forced an alternative strategy, which is much more cost-effective.
ORIGINALITY/VALUE: The VBSC, designed to improve PS, has never been implemented in any Indonesian private hospital group. Other hospital groups might also appreciate knowing about the VBSC to improve their PSI.
METHODS: A cross-sectional study (n = 230) was conducted using the Pressure Management Inventory on several female dominated health professions within a large public hospital. Analysis of variance was used to show relationship between sources and outcome of pressure. Linear regressions were used to predict which sources of pressure (IV) was linked to the outcomes of occupational pressure (DV).
RESULTS: The number one source of occupational pressure is relationships at work (i.e. with supervisors), and not workload. 'Relationship' is also the key predictor of several negative outcomes of pressure at work. Analysis of variance showed significant differences in two sources of pressures, i.e. Workload (P = 0.04) and Home-work balance (P = 0.03).
CONCLUSION: This paper provides insights into the occupational pressure of women health professionals by highlighting the organisational sources of pressure and the implications for preventing occupational dysfunction secondary to stress at work.
METHODS: Through the Association of Southeast Asian Nations Costs in Oncology study, 1,294 newly diagnosed patients with cancer (Ministry of Health [MOH] hospitals [n = 577], a public university hospital [n = 642], private hospitals [n = 75]) were observed in Malaysia. Cost diaries and questionnaires were used to measure incidence of financial toxicity, encompassing financial catastrophe (FC; out-of-pocket costs ≥ 30% of annual household income), medical impoverishment (decrease in household income from above the national poverty line to below that line after subtraction of cancer-related costs), and economic hardship (inability to make necessary household payments). Predictors of financial toxicity were determined using multivariable analyses.
RESULTS: One fifth of patients had private health insurance. Incidence of FC at 1 year was 51% (MOH hospitals, 33%; public university hospital, 65%; private hospitals, 72%). Thirty-three percent of households were impoverished at 1 year. Economic hardship was reported by 47% of families. Risk of FC attributed to conventional medical care alone was 18% (MOH hospitals, 5%; public university hospital, 24%; private hospitals, 67%). Inclusion of expenditures on nonmedical goods and services inflated the risk of financial toxicity in public hospitals. Low-income status, type of hospital, and lack of health insurance were strong predictors of FC.
CONCLUSION: Patients with cancer may not be fully protected against financial hardships, even in settings with universal health coverage. Nonmedical costs also contribute as important drivers of financial toxicity in these settings.