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Posts tagged ‘Eileen K. Fry-Bowers’

Dec 13

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The Patient Experience


The current featured article in ANS is titled “The Patient Care Experience as Perceived by Hispanic Patients With Chronic Illness Undergoing Transplant: A Grounded Theory” authored by Silvinia Gamilia González Cuizon, PhD, RN and Eileen K. Fry-Bowers, PhD, JD, RN, CPNP, FAAN. Download this article while it is featured at no cost, and share you comments related to the article here. Dr. Cuizon shared this background about the development of the theory for ANS readers:

In my time as a clinical nurse and through my interactions with patients, I developed an interest in the issues surrounding the patient experience. Cultivating a “good” experience from an unfortunate time was always important to me. Not many people want to be in the hospital, let alone be sick, so making the experience as “good” as possible mattered to me. Along the way, I also found my clinical practice was increasingly influenced by The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This survey was developed to be an objective measurement of patient experience with the aspiration to gauge consumer perspectives about their hospital care.  While I do feel the patient experience matters, I did start to ask myself questions such as: Are we really capturing the patients’ needs? Is this truly a reflection of our care?  

As I transitioned into an administrative role, my perspective on the patient experience broadened to understand its hospital wide impact.  Quarterly, Centers for Medicare & Medicaid Services Hospital Value Based Purchasing (HVBP) Program withholds 2% from this quality indicator domain. If a hospital performs at the national benchmark and or achievement threshold, they gain back the 2% withholdings. If a hospital does not meet the metric, they lose their 2% withholdings1. Additionally, coming from a safety-net hospital, I noted additional challenges in meeting such metrics.  Safety-net hospitals exist to deliver care to individuals who struggle with social determinants of health and live in less-than-ideal locations nationwide. The majority of these patients are uninsured or underinsured, battle more comorbidities, and have poorer health outcomes than their more affluent counterparts because of systemic health inequities plaguing this country2.  I began to ask myself: how do these fiscal implications impact safety-net hospitals? Do they exacerbate health inequities or do they improve them?

My Doctoral program gave me a platform to further discover the complexities of this multi-dimensional phenomena. My examination of existing literature demonstrated substantial evidence to support differences in the patient experience perspective among traditionally underserved populations, including racial and ethnic minorities. Historically, surveys such as HCAHPS were not developed with this particular group in mind.3  This was evidenced by the minority response rate reported in the HCAHPS three state pilot test guiding the development of the HCAHPS survey4.  This was the impetus for my dissertation research. 

 The findings reported in this article focus on the experience of Hispanic transplant patients receiving care at a safety-net healthcare system. The patient interviews allow for an in-depth understanding of their perception of a positive hospital experience.  Four major interdependent and co-occurring concepts were developed:

  • Comfort
  • Communication
  • Connection
  • Care

Ultimately, the study findings confirmed important attributes of a Hispanic patient’s experience, such as communication and care, already measured by the current HCAHPS survey. Additionally, factors such as connectedness and comfort were important and need to be further examined. This study highlights the role culture plays in interpretation of one’s experience as a patient.  Due to the evolving nature of culture and societal norms and the enormous role the patient experience plays in health care, further refinement of this concept can provide already socially marginalized populations, such as the Hispanic population, a voice and the positive health outcomes they deserve. It will also provide clinicians a better understanding of what constitutes an optimal patient experience. With such high stalks it is imperative we get it right.

References:

  1. CMS. (2021). CAHPS® Hospital Survey (HCAHPS) Quality Assurance Guidelines V16. 0.
  2. Kirch, D. G. (2016). In the Search for Measures that Matter, Star Ratings Miss the Mark. Retrieved from https://news.aamc.org/patient-care/article/search-measures-matter-star-ratings-miss-mark/
  3. Stewart, AL., Nápoles‐Springer A, Pérez‐Stable EJ. (1999). Interpersonal processes of care in diverse populations. The Milbank Quarterly, 77(3), 305-339.
  4. Medicare, C. f., Services, M. (2003). HCAHPS three-state pilot study analysis results. Baltimore, MD. Available online at                                                                                      http://www/.cms.hhs.gov/HospitalQualityInits/downloads/Hospital3State_Pilot_Analysis_Final200512. pdf.

Jul 21

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Social Capital


Our latest featured article is titled “Social Capital: A Concept Analysis” authored by Kristi K. Westphaln, PhD, RN, CPNP-PC; Eileen K. Fry-Bowers, PhD, JD, RN, CPNP, FAAN; and Jane M. Georges, PhD, RN. I join the authors to invite you to download this article while it is featured, and return here to share your comments. This is a message from Dr. Westphain giving background about this work:

Kristi Westphaln

Social capital is broadly defined as the resources obtained via social membership and engagement. I first encountered it in the “life lab” during a health care mission in Tachloban City in the Philippines, where I helped care for survivors of Hurricane Yolanda. This was my first experience with international disaster relief and I wasn’t sure what to expect in terms of how the people were coping with such devastating losses. I became friends with a young woman who shared her story of how three tsunami waves unexpectedly swept her out of her home. She told me that the tsunami scene from “The Impossible” was authentic. And, how she was the only person in her family to survive. Another young man recalled how he had to cling to a pole for 4 hours to prevent being washed away by the storm; he vividly remembered bodies floating by as he held on for his life. Almost everyone I met had lost homes, beloved family members, and/or friends to the storm. Despite this, people didn’t want to solely talk about the trauma they experienced. Many of their narratives were centered within the context of how their community came together to take care of each other. They found homes for the homeless, cleaned the debris, attended church, and found ways to make each other laugh. It seemed to extend beyond resilience or coping.

This concept analysis emerged from a desire to better understand how membership and interactions within social networks foster individual and collective capacity. Some of the shared themes across the literature on social capital from multiple disciplines include a socioecological perspective (most frequently at the community level), an asset-based philosophy, structural and functional dimensions, and benefits/rewards for membership and participation within social networks. Given that nurses frequently interact on the front lines of patient care while also navigating the complex connections among individuals, families, and the health care system; this manuscript focuses on the definition and uses of social capital within the discipline of nursing.

The operational definition derived from this analysis was consistent with definitions used within the literature from multiple other disciplines. Dissimilar to the literature from other disciplines, the most common themes at the intersection of social capital and nursing were the nursing workforce and workplace (hospital settings) rather than involving patient- or community-oriented applications. I’m optimistic for further investigation on how nursing and social capital contribute to optimizing public health. Relational aspects of health are often difficult to articulate and measure, however they represent important foundations for growth, development, and sustainability from individual people to entire populations.

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