Professionals’ beliefs in patient involvement for hospital safety

a descriptive, exploratory, qualitative study was conducted with 87 health professionals from a teaching hospital. Semi-structured interviews were conducted between December 2019 and January 2020 - data was submitted to content analysis and interpreted in light of Rosenstock’s Model of Beliefs in Health.

Results:

participants included nursing technicians, nurses, doctors, and other professionals. The categories “Professionals’ beliefs about patient involvement in care”, “Practices of patient involvement in care” and “Factors favoring patient involvement in hospital care” emerged. The perception of professionals revealed the influence of patient involvement in care outcomes and benefits for the safety of care.

Final Considerations:

involving the patient in care is associated with the healthcare professional’s belief in the benefits of this practice for reducing incidents.

Descriptors:
Beliefs; Behavior; Patient Safety; Patient Participation; Patient-Centered Care

Signification Units

Representative Statements

Patient protagonist of care
Autonomy for decision making
Patient awareness of care risks
Professional-Patient Interaction and Communication
Trust and empathy relationship

“To have enough empowerment to know what his demand is and the other professionals who are involved in his care, that he is safe in that hospitalization, that he can be cared for, treated in his needs, in a way that is beneficial to him and his overall health status.” (P38)
“Avoiding mistakes. From the moment you include the patient in their own treatment, you have an ally and quality care.” (NT47)
“There have been cases here, for example, where I tried to show the patient that this conduct was better for him, and the patient did not want to receive the conduct. To bandage the patient and say ‘look, this is the most correct way, to guarantee the safety of your treatment, so that you don’t get an infection’. And she wanted me to put contaminated ointment on her finger and take a gauze and tie it instead of using a plaster, to occlude it properly” (N15)
“Involving the patient in the assistance would be like a protective barrier in the assistance. Because the patient... we are looking at several patients, he knows his own things, so there have been cases where he was a barrier, of him saying ‘no, I don’t use this medication’ or ‘no, I don’t know about the exam’, so he himself is a barrier to prevent errors from happening.” (N02)
“Talking about him, showing him where he is going to stay, which bathroom he is going to use; the bed, that he can get up, get down, that he always needs to be careful when he gets up, call someone if he doesn’t have a companion. This is a means of safety so he doesn’t fall; if the floor is wet, he doesn’t walk.” (NT31)
“There is a lot of interaction, interaction of the patient with the whole process that is happening around him. We leave it very open for any questioning, any doubt.” (PT48)
“It is important for him to be involved. It makes it easier for the professional to interact with the patient, to adhere to treatment. The patient needs to know what is being performed on him.” (NU35)
“It means looking the patient in the eye, understanding what the patient is expecting from me at that moment and what I can do best for them at that moment.” (NT22)
“I treat it the way I would like people to treat me. For me, it’s important to know everything that’s happening to me when I’m hospitalized; for them, it is too.” (N03)

Signification Units

Representative Statements

Creation of patient-professional bond
Partnership Attitude
Co-responsibility for care
Transition of care
Respect for the patient’s right
Patient as a barrier to error

“The first way I use to engage the patient is to create the bond with that patient, to establish a bond.” (OT27)
“Creating a bond, making him realize that you are there as a multiprofessional team to provide quality care, that we are concerned with his recovery, with the prevention of new hospitalizations.” (SW43)
“So, if it is a social factor, I seek to share with the social service, with the social worker. If it’s a clinical factor, I seek to discuss it with the doctor, or with nursing. And if it’s an emotional factor, I seek to be working on those resources so that he can be more involved in his care.” (P32)
“Focus on multi work: each professional acting according to his or her specificity, with that patient as the center of attention.” (SW43)
“[...] you have to involve the patient, inform him as much as possible, so that he knows everything that is going on around him, that he understands what a hospital environment is, what has been done in it, what risks this can cause, so that he also has certain care that sometimes, in our absence, he will have to take care of himself.” (NT13)
“I think it is very important that we provide emergency care, so that the patient can leave with an idea of when to go back to the hospital, how much improvement is expected, and how long it will take”. (D62)
“There are professionals who have that level of commitment, of awareness, a more humanized view of care and perceive the patient as a citizen with rights.” (SW43)
“First of all, clarify, inform, orient. First of all, what institution is this, what kind of care is being offered to him here, the social service point of view, we do a whole approach to health rights.” (SW42)
“It helps to protect oneself, it helps the safety culture, because what the professional sometimes overlooks, he can say ‘look, you didn’t do this, you didn’t take my medication on time, or you didn’t wash your hands before touching me’. Since the demand is great, it helps the professional to pay attention to these things.” (N23)
“Because all health professionals are involved, mainly, the patient [...], for example, if it’s a medicine for him to take, and he doesn’t recognize it, by the color, by the characteristic, he can say: ‘No, I don’t use, I don’t use this medicine, I can’t use this medicine’. So, it’s fundamental for his safety.” (ST55)

Signification Units

Representative Statements

Organizational support
(in-service education and physical structure)
Experience as a learning opportunity
Orientation/activation of the patient regarding his/her involvement in care

“The hospital offers training through continuing education, mini-courses, and lectures. This assures the professional in his self-learning, so that he provides quality care, the institution involves the patient with more quality, and this the institution has favored.” (N01)
“For example, we didn’t have a shower chair [...] our management went after it and provided it. So when we have some obstacle like that, in terms of infrastructure, the management is very ready to support us.” (N57)
“There was a change. In the rooms, there was only the name of the patient. Today there is a little place where you put the name of the patient, the date of admission, and there are some little red and green balls that have some indications, and now they put ‘patient with risk of falling’ or not. This didn’t exist before.” (NT22)
“I feel able to engage, because it’s already 18 years old. What I didn’t learn in a classroom, I learned in everyday life, in day to day life.” (NT22)
“I have been living this for 13 years. I consider myself every day better prepared to deal with the need of people, to involve them in the care, to call the person, the responsibility with their own body, with the changes that the disease is putting.” (N57)
“The more the patient is aware of his need to be participating in his health, the length of hospitalization is shorter, he has a better ability to recover. The main point is this, he has the ability to discern that he is important for his safety, that no one but himself has to guarantee that.” (NT12)
“This issue of identification of the bracelet, of the bed, he already has some notion of it. The food, in the food plans, everything is identified with his name. It’s happened sometimes that the label has the wrong name and the patient doesn’t accept it, but it depends a lot on the patient’s conscience.” (NU28)
“Patient aware of what is happening, when he participates in the care during hospitalization, he becomes more aware of everything that is happening and even helps to speed up the whole process, helps us consummate the discharge faster, when he collaborates with everything that the team is guiding.” (D71)

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Cristiane Chagas Teixeira, E-mail: cc-teixeira@hotmail.com