How do patients view continuity of care in a rural hospital with significant medical staff turnover?
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Other Title
Authors
Brebner, Tracy
Author ORCID Profiles (clickable)
Degree
Master of Nursing
Grantor
Eastern Institute of Technology
Date
2015
Supervisors
Marshall, Bob
Isaacs, Dorothy
Isaacs, Dorothy
Type
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
Keyword
New Zealand
patients
rural
continuity of care
turnover
perspectives
interviews
patients
rural
continuity of care
turnover
perspectives
interviews
ANZSRC Field of Research Code (2020)
Citation
Brebner, T. (2015). How do patients view continuity of care in a rural hospital with significant medical staff turnover? (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Nursing). Eastern Institute of Technology (EIT), New Zealand.
Abstract
BACKGROUND
Continuity of care is connected, coherent, and consistent care in relation to the patients’ health care needs and personal circumstances (Haggerty, Roberge, Freeman and Beaulieu, 2013). Continuity has been associated with improved health care, and is greatest when the patient establishes an ongoing relationship with a health care provider (Nies and McEwan, 2007). It is the key component to quality of care, and is becoming increasingly important for complex and vulnerable patients who transition through the greater health system (Price and Lau, 2013). Three major categories of continuity of care have been identified as: informational; management; and relational (Kristjansson et al., 2013). Small rural hospitals in New Zealand are hard to staff with medical physicians and this poses a challenge to the health sector. Eighty percent of registered physicians practice in urban centres, raising a significant concern to rural areas being able to retain medical professionals (Garces-Ozanne, Yow and Audas, 2011). This constant change in medical staff in rural areas can affect continuity of care for the patients, as the development of an ongoing therapeutic relationship is hindered (Wong and Regan, 2008).
OBJECTIVES
The aim of this research was to explore and establish patients’ perspectives on what continuity of care means to them, when utilizing a rural hospital in a hard to staff rural geographical area, to ascertain if this indeed impedes their continuity of care.
METHOD
Background to the research question was provided by completing a literature review on continuity of care, rural hospitals, and medical staff turnover. Eight semi-structured interviews were then conducted to gain the patients’ perspectives on continuity of care. Each person was asked the same set of questions, and these were set out in the three main dimensions of continuity - informational, relational, and management. The narrative data were then organised into themes, providing insight into their views and beliefs on what continuity of care was for them.
SELECTION CRITERIA
The environment of focus was an acute care unit (ACU) that provided care for high dependency patients. The recruitment of patients was done through purposive sampling from this unit. Patients were over 18 years of age, had English as a first language, had four admissions to the acute care unit over a five year period, and were cared for by different doctors with each admission.
DATA COLLECTION AND ANALYSIS
The data from the semi-structured interviews were analysed thematically, to reveal themes of what continuity of care was to the patient.
FINDINGS
Regarding informational continuity the participants in this research revealed they appreciated honest open communication, providing information about their illness, and information exchange was reciprocated between the patient and the ACU team. Relational continuity was made evident through the therapeutic relationship that allowed the effective information exchange. This was fostered by familiar faces in the hospital environment to provide a supportive environment enhancing their continuity of care. The consistency of nursing staff helped provide coherent and linked health care. Management continuity was highlighted as the participants having easy access to the ACU health care team to clarify their questions. Individualised care was given to participants through the inclusion of multidisciplinary health providers in their treatment plan.
DISCUSSION
This thesis has shown that consistency of nursing staff gave the patient’s relational continuity, and provided information continuity. Improvements need to be made to the transfer of information between health care facilities. The consistent availability and communication by the hospital staff implemented and fostered management continuity.
CONCLUSIONS AND RECOMMENDATIONS
The achievement of overall continuity was discussed by participants in a positive way. However, doctor’s knowledge of patients requires optimisation, and transfer of this knowledge to other health care facilities needs improvement. A national information exchange document online would provide a universal format to provide this. The introduction of an Acute Care Nurse Practitioner (ACNP) would also facilitate a coordinated and coherent health care approach to patient continuity.
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Eastern Institute of Technology