Patients’ experiences of acute deterioration and Medical Emergency Team (MET) encounter : a grounded theory study
- Authors: Chung, Catherine
- Date: 2021
- Type: Text , Thesis , PhD
- Full Text:
- Description: Globally, considerable effort has been made to ensure hospital patients whose clinical condition deteriorates receive timely and appropriate care. Research suggests that hospitals have increasing numbers of patients who are more likely to become seriously ill during their admission due to complex problems. Recently, patient experience has been recognised as a means of assessing healthcare delivery with healthcare services across the world gathering patient experience or satisfaction data. Acute deterioration is unique and complex for all involved. However, little is known about this experience from the patient’s perspective. The purpose of this study was to generate theory about processes patients engage in when experiencing acute deterioration and MET encounter. Also, the research aimed to recognise and explain the factors that mediate patients’ experiences. The findings of this study contribute to a growing body of knowledge that will improve patient care and practice guidelines for healthcare professionals. Underpinned by the theoretical framework of symbolic interactionism, grounded theory was employed for this study. From it ontological, epistemological, and methodological underpinnings, constructivist grounded theory was considered the most suitable approach. Using purposive sampling, in-depth semi-structured interviews were conducted with 27 patients across three Australian healthcare services. Data were collected over a 12-month period, between May 2018 – May 2019 and analysed using constant comparative analysis. The theoretical model ‘Unravelling a complex experience: contextualising patients’ experiences of acute clinical deterioration and Medical Emergency Team (MET) encounter’ emerged, offering a possible explanation of patients’ actions and processes. Most patients began their journeys feeling something was wrong which triggered emotional changes (experiencing changes-before the encounter). Patient experience was influenced by a combination of physical and psychological changes and a MET response (perceiving the reality - the encounter). After the MET encounter, some patients searched for deeper understandings about their illnesses and the events that occurred, whereas others managed without further reflection (reflecting on the event-after the encounter). Contextual conditions emerged influencing patients’ experiences with three broad mediating factors identified. Some participants identified that their acute deterioration and subsequent MET encounter was unexpected, and they perceived the nature of their illness (before their acute deterioration) as stable, based on what they had been told by medical staff (expectations and illness perception). Many participants acknowledged that their experience was dependent on the health care professionals who were caring for them at the time (relationship with the MET). Past experiences of illness and hospitalisation played an important role in participants’ abilities to conceptualise their experiences of acute deterioration and MET encounter (past experiences). These factors exerted a significant influence on participants’ experiences and helps to explain the differences between them. Unravelling a complex experience: Conceptualising patients’ experiences of acute deterioration and MET encounter offers a possible explanation of patients’ meanings, actions and processes when experiencing acute deterioration and MET encounter. The theory leads to recommendations that healthcare organisations gather data about patients’ experiences of acute deterioration and MET encounters, as these provide insights and opportunity to identify challenges that can be addressed.. Findings provide an explanatory framework for similar phenomena and increase awareness of patients’ experiences to ultimately inform health policy and improve patient care. The findings highlight the need for healthcare services to instigate strategies that support patients who have experienced acute deterioration. Further research could evaluate the effectiveness of implemented strategies.
- Description: Doctor of Philosophy
- Authors: Chung, Catherine
- Date: 2021
- Type: Text , Thesis , PhD
- Full Text:
- Description: Globally, considerable effort has been made to ensure hospital patients whose clinical condition deteriorates receive timely and appropriate care. Research suggests that hospitals have increasing numbers of patients who are more likely to become seriously ill during their admission due to complex problems. Recently, patient experience has been recognised as a means of assessing healthcare delivery with healthcare services across the world gathering patient experience or satisfaction data. Acute deterioration is unique and complex for all involved. However, little is known about this experience from the patient’s perspective. The purpose of this study was to generate theory about processes patients engage in when experiencing acute deterioration and MET encounter. Also, the research aimed to recognise and explain the factors that mediate patients’ experiences. The findings of this study contribute to a growing body of knowledge that will improve patient care and practice guidelines for healthcare professionals. Underpinned by the theoretical framework of symbolic interactionism, grounded theory was employed for this study. From it ontological, epistemological, and methodological underpinnings, constructivist grounded theory was considered the most suitable approach. Using purposive sampling, in-depth semi-structured interviews were conducted with 27 patients across three Australian healthcare services. Data were collected over a 12-month period, between May 2018 – May 2019 and analysed using constant comparative analysis. The theoretical model ‘Unravelling a complex experience: contextualising patients’ experiences of acute clinical deterioration and Medical Emergency Team (MET) encounter’ emerged, offering a possible explanation of patients’ actions and processes. Most patients began their journeys feeling something was wrong which triggered emotional changes (experiencing changes-before the encounter). Patient experience was influenced by a combination of physical and psychological changes and a MET response (perceiving the reality - the encounter). After the MET encounter, some patients searched for deeper understandings about their illnesses and the events that occurred, whereas others managed without further reflection (reflecting on the event-after the encounter). Contextual conditions emerged influencing patients’ experiences with three broad mediating factors identified. Some participants identified that their acute deterioration and subsequent MET encounter was unexpected, and they perceived the nature of their illness (before their acute deterioration) as stable, based on what they had been told by medical staff (expectations and illness perception). Many participants acknowledged that their experience was dependent on the health care professionals who were caring for them at the time (relationship with the MET). Past experiences of illness and hospitalisation played an important role in participants’ abilities to conceptualise their experiences of acute deterioration and MET encounter (past experiences). These factors exerted a significant influence on participants’ experiences and helps to explain the differences between them. Unravelling a complex experience: Conceptualising patients’ experiences of acute deterioration and MET encounter offers a possible explanation of patients’ meanings, actions and processes when experiencing acute deterioration and MET encounter. The theory leads to recommendations that healthcare organisations gather data about patients’ experiences of acute deterioration and MET encounters, as these provide insights and opportunity to identify challenges that can be addressed.. Findings provide an explanatory framework for similar phenomena and increase awareness of patients’ experiences to ultimately inform health policy and improve patient care. The findings highlight the need for healthcare services to instigate strategies that support patients who have experienced acute deterioration. Further research could evaluate the effectiveness of implemented strategies.
- Description: Doctor of Philosophy
Patients’ experiences of acute deterioration : A scoping review
- Chung, Catherine, McKenna, Lisa, Cooper, Simon J.
- Authors: Chung, Catherine , McKenna, Lisa , Cooper, Simon J.
- Date: 2020
- Type: Text , Journal article
- Relation: International Journal of Nursing Studies Vol. 101, no. (2020), p.
- Full Text: false
- Reviewed:
- Description: Background: Patient experience is recognised as a means of assessing healthcare delivery with organisations in many countries now gathering patient experience or satisfaction data. It is well documented that the benefits of improving a patients' experience include increased satisfaction, reduced length of stay, improved patient outcomes and reduction of costs. The experience of acute clinical deterioration is unique, extensive and complex as well as being a difficult experience for all involved. However, little is known about this experience from the patient's perspective. Aim: To explore what is known about the experiences of acute deterioration from the perspective of the patient. Design: A scoping review of international, peer-reviewed research studies and grey literature published between the years of 2000 and 2018. This review was guided by the three-step search strategy recommended by the Joanna Briggs Institute (JBI). Data sources: A range of databases were searched, including CINAHL, Medline, Health Source, Joanna Briggs Institute, PsycINFO, Embase via Ovid, Cochrane library, Ovid Emcare, Scopus as well as grey literature, reference lists and the search engine Google Scholar. Review methods: Joanna Briggs Institute (JBI) scoping review framework was utilised to identify patients' experiences of acute deterioration. Ten databases were searched, and 249 articles were retrieved. After screening the titles and abstracts, 102 articles were assessed in full text for eligibility, and finally 23 articles were further analysed and synthesised using inductive thematic analysis. Results: 19 qualitative studies, three quantitative and one mixed methods study met the inclusion criteria. Seven key themes emerged related to patients' experience of acute deterioration: (1) transformation of perception: memories of factual events; (2) psychological transformation: emotional distress and well-being; (3) physiological transformation: physical distress; (4) facing death; (5) the severity of acute deterioration: from the perspective of the patient; (6) relationship with healthcare professionals and the clinical environment; and (7) the value of relationships: the support of family and friends. Conclusions: Participants had considerable recall of their experiences and hospital admissions. The themes highlight the important issues patients face during their own acute physiological deterioration. This review has highlighted that further research is needed to specifically explore the patients' experience of acute deterioration and the emergency management they receive, for example from a hospital's rapid response team (RRT) or medical emergency team (MET). © 2019
Contextual factors influencing patients' experiences of acute deterioration and medical emergency team (MET) encounter : a grounded theory study
- Chung, Catherine, McKenna, Lisa, Cooper, Simon
- Authors: Chung, Catherine , McKenna, Lisa , Cooper, Simon
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 78, no. 12 (2022), p. 4062-4070
- Full Text:
- Reviewed:
- Description: Aim: This paper explores the personal, social and structural factors that influence patients' experiences of acute deterioration and medical emergency team (MET) encounter. Background: Patient experience is recognized as a means of assessing healthcare delivery with a positive experience being linked to high-quality healthcare, improved patient safety and reduced length of stay. The experience of acute deterioration is unique, extensive and complex. However, little is known about this experience from the patient's perspective. Design: Constructivist grounded theory, informed by Kathy Charmaz, was used to explore the personal, social and structural factors that influence patients' experiences of acute deterioration and MET encounter. Methods: Using a semi-structured interview guide, in-depth individual interviews were conducted with 27 patients from three healthcare services in Victoria, Australia. Data were collected over a 12-month period from 2018 to 2019. Interview data were analysed using grounded theory processes. Findings: Contextual factors exert a powerful influence on patients' experiences of acute deterioration and MET encounter. The most significant factors identified include patients' expectations and illness perception, relationship with healthcare professionals during MET call and past experiences of acute illness. The expectations and perceptions patients had about their disease can condition their overall experience. Healthcare professional–patient interactions can significantly impact quality of care, patient experience and recovery. Patients' experiences of illness and healthcare can impact a person's future health-seeking behaviour and health status. Conclusion: Patients' actions and processes about their experiences of acute deterioration and MET encounter are the result of the complex interface of contextual factors. Impact: The findings from this study have highlighted the need for revised protocols for screening and management of patients who experience acute deterioration. © 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
- Authors: Chung, Catherine , McKenna, Lisa , Cooper, Simon
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 78, no. 12 (2022), p. 4062-4070
- Full Text:
- Reviewed:
- Description: Aim: This paper explores the personal, social and structural factors that influence patients' experiences of acute deterioration and medical emergency team (MET) encounter. Background: Patient experience is recognized as a means of assessing healthcare delivery with a positive experience being linked to high-quality healthcare, improved patient safety and reduced length of stay. The experience of acute deterioration is unique, extensive and complex. However, little is known about this experience from the patient's perspective. Design: Constructivist grounded theory, informed by Kathy Charmaz, was used to explore the personal, social and structural factors that influence patients' experiences of acute deterioration and MET encounter. Methods: Using a semi-structured interview guide, in-depth individual interviews were conducted with 27 patients from three healthcare services in Victoria, Australia. Data were collected over a 12-month period from 2018 to 2019. Interview data were analysed using grounded theory processes. Findings: Contextual factors exert a powerful influence on patients' experiences of acute deterioration and MET encounter. The most significant factors identified include patients' expectations and illness perception, relationship with healthcare professionals during MET call and past experiences of acute illness. The expectations and perceptions patients had about their disease can condition their overall experience. Healthcare professional–patient interactions can significantly impact quality of care, patient experience and recovery. Patients' experiences of illness and healthcare can impact a person's future health-seeking behaviour and health status. Conclusion: Patients' actions and processes about their experiences of acute deterioration and MET encounter are the result of the complex interface of contextual factors. Impact: The findings from this study have highlighted the need for revised protocols for screening and management of patients who experience acute deterioration. © 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
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