Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience

In settings where antenatal ultrasound is not offered routinely, ultrasound use when a woman first presents to the maternity ward for labour (i.e., triage) may be beneficial. This study investigated patients’ perceptions of care and providers’ experience with ultrasound implementation during labour triage at a district referral hospital (DH) and three primary health centers (HC) in eastern Uganda. This was a mixed methods study comprising questionnaires administered to women and key informant interviews among midwives pre- and post-ultrasound introduction. Bivariate analyses were conducted using chi-square tests. Qualitative themes were categorized as (1) workflow integration; (2) impact on clinical processes; (3) patient response to ultrasound; and (4) implementation barriers. A total of 731 and 815 women completed questionnaires from the HCs and DH, respectively. At the HC-level, triage quality of care, satisfaction and recommendation ratings increased with implementation of ultrasound. In contrast, satisfaction and recommendation ratings did not differ upon ultrasound introduction at the DH, whereas perceived triage quality of care increased. Most participants noted a perceived improvement in midwives’ experience and knowledge upon introduction of ultrasound. Women who underwent a scan also reported diverse feelings, such as fear or worry about their delivery, fear of harm due to the ultrasound, or relief after knowing the baby’s condition. For the midwives’ perspective (n = 14), respondents noted that ultrasound led to more accurate diagnoses (e.g., fetal position, heart rate, multiple gestation) and improved decision-making. However, they noted health system barriers to ultrasound implementation, such as increased workload, not enough ultrasound-trained providers, and irregular electricity. While triage ultrasound in this context was seen as beneficial to mothers and useful in providers’ clinical assessments, further investigation around provider-patient communication, system-level challenges, and fears or misconceptions among women are needed.

Physician Attire Influences Patient and Family Perceptions of Care in the Palliative Care Unit in Japan

Background: Physician attire influences perceptions of care. This study was conducted to evaluate the impact of physician attire on perceptions of care by patients and families in a Japanese palliative care unit. Methods: From November 2018 to February 2020, patients and family members admitted to the Palliative Care Unit at Jichi Medical University Hospital were recruited and completed a survey consisting of 4 demographic questions and 15 questions regarding perceptions of care. A 7-point Likert scale (1 = strongly agree, 4 = neutral, 7 = strongly disagree) was used to judge attire (name tag, long sleeve white coat, short sleeve white coat, scrubs, scrub color, jeans, sneakers) addressing patient and overall impact on perception of care. Results: Of 203 patients admitted, 79 were enrolled. Surveys were received from 23 patients and 52 family members. Patients and families want physicians to wear name tags (median, interquartile range) (2, 1-2) and white coats (3, 2-4). Patients want to be addressed by surnames (2, 1.5-4). Patients and family members have neutral opinions about short sleeve white coats (4, 4-4) and scrubs (4, 4-4). Jeans were not liked (4, 4-6) while sneakers are acceptable (3, 2-4). The impact of attire on perceptions of care is significantly (p = .04) greater for patients (3, 2-4) than family members (4, 3-4). Conclusion: Patients and family members prefer their physicians to wear name tags and white coats and address patients by surnames. Physician attire has a significantly greater impact on perceptions of care for patients than family members in a palliative care unit.

Perception of Caring Behavior of Nurses and Patients

ABSTRACT Introduction: Nurses have several tasks but one of the most crucial for them is to provide quality patient care. However, patients’ perception of care might differ with what nurses think. Patients perceive caring as a developed interpersonal relationship between themselves and their nurses. Contrarily, nurses perceive caring as providing quality care through being knowledgeable and compliant in the prescribed orders through the course of treatment. Aims: This study aims to develop a distinct comparison between the perception of care of patients and nurses. Methodology: A descriptive-comparative design was utilized. Survey data were collected from 200 nurses and 160 patients in the general nursing units of a private, tertiary-level general hospital in the Philippines. The Caring Behaviors Inventory-24 (CBI-24) was used to obtain perceptions of care between nurses and patients. Data was analyzed using t-test to compare care perceptions between nurses and patients. Statistical significance was based on p < .05. Results: The results showed no statistical difference between nurses’ and patients’ CBI-24 scores. Among CBI-24 items, only seven had significant statistical difference. Specifically, staff nurses reported higher scores for ‘spending time with the patient’ and ‘demonstrating professional knowledge and skill’ while patients reported higher scores for ‘giving instructions or teaching the patient,’ ‘supporting the patient,’ ‘being patient or tireless with the patient,’ ‘including the patient in planning his or her care,’ and ‘giving the patient’s treatments and medications on time.’ Conclusions: In general, the perceptions of care between nurses and patients is at the same level. However, there are specific caring behaviors where nurses over- or underestimate themselves. Overall, the results can be used to develop strategies to further improve the quality of care provided to patients. Keywords: Nurses, Patients, Philippines, Nursing Care Management, Caring