1. The concepts of expectation and satisfaction: do they capture the way patients evaluate their care. Staniszewska, S. & Ahmed, L. (1999). Journal of Advanced Nursing 29(2), p. 364-372 2. Privacy or help? The use of curtain positioning strategies within the maternity ward environment as a means of achieving and maintaining privacy, or as a form of signalling to peers and professionals in an attempt to seek information or support. Burden, B (1998). Journal of Advanced Nursing 27(1), p. 15-23
I shall utilise a qualitative research tool Critical Appraisal Skills Programme (www.phru.org.uk/~casp.htm) to assess the two research papers. This tool looks at three areas – rigour, credibility and relevance of the research, in other words the critical appraisal of evidence about effectiveness. For clarity of purpose, I am very pleased to give full credit to both articles. In both papers the purpose of the research is expounded in the introduction.
Burden (1998) the impetus for research was necessitated by the decline in interactions between women within a maternity unit environment. Patients had started spending long periods behind curtains drawn around the bed space. Staniszewska & Ahmed (1999) looked at the issue of patient involvement in the evaluation of care by examining the concepts of expectation and satisfaction. Both articles clearly formatted statements of the research questions and hypotheses into well-organised categories. Both provided an adequate detail of literature review references. The papers are well supported by research data and in-text citations abound.
This is a sign that the research was thorough and credit was given where due. Based on the research needs discovered from the literature review, the authors determined to conduct their work for searching advance information. Therefore, I was convinced that both authors knew what they expected their works to reveal, to describe feedback information acquired systematically from patients as the basis for improving quality services. The authors of the articles are of a high academic and professional calibre, which warrant them to be competent contributors in their subject areas.
Burden (1998) studied social interactions and actions of women within a maternity ward and get their perceptions on privacy and dignity. The author used the ethnography approach “the description and understanding of communicative behaviour in specific cultural settings …..and formulation of concepts and theories upon which to build a global metatheory of human communication” (Coulmas, 2000, p.347). Ethnography was the best research methodology to obtain the most accurate result.
Staniszewska & Ahmed (1999) explored the concepts of expectation and satisfaction doing pre-admission interviews to know patients’ expectations and an evaluation after care. A qualitative research methodology was used on a condition-specific group, cardiac patients. The research articles being qualitative in nature prove that they were appropriate to be used as reference sources for this benchmark. The articles show how patients can be effective contributors in having their needs met by the health sector through patient involvement.
The Essence of Care is a valuable resource to help improve quality, because it involves all the stakeholders -health professionals, patients, service users and their carers and representatives (Ellis, 2000). On reflection, I have learnt that maintaining a patient’s dignity is an essential component of care. Section 2.2 of Nursing and Midwifery Council (NMC) Code of Professional Conduct (2002) addresses a nurse’s accountability to promote and protect patients’ dignity.
There is no evidence of co-coordinated best care practice in my area of practice. Bad practices include asking a patient to use a bedpan without adequate screening; wearing ill-fitting hospital gown that gapes and mixed wards that do not preserve patients’ modesty. To share and compare best practices in the benchmarking process evidence has to be collected on other areas of practice. I have collected the following information that I feel would be beneficial to my area of practice.
Where benchmarking has succeed it is documented in literature that the Trusts have taken a holistic approach, involving all stakeholders, to effect change. Below are examples of such success: i. Rotherham General hospital – in recognition of the need to maintain patients dignity – worked with linen services to design specialist ITU gowns ii. Wirral Hospital – patient feedback led to new gowns being introduced into the Outpatients Department to maintain patients’ dignity
iii. Royal Sussex Hospital – large coloured curtain clips used to hold curtains together so patient’s dignity is maintained. The clips also act as a signal to other staff and visitors not to enter the cubicle. (Picker Institute Europe, 2003) In conclusion, it is evident that the two articles have built a case for improving patient care through involving the patient in formulating best practice clinical care. Benchmarking is a process and should not be considered as a one-off exercise. To be effective, it must become an ongoing, integral part of an ongoing improvement process with the goal of keeping abreast of ever-improving best practice. The fundamental and essential aspects of care can be identified in patient complaints, ombudsmen reports and professional and patient/consumer feedback.