EXECUTIVE SUMMARY

A recent study of nurses’ thoughts after being a patient or a caregiver revealed better care coordination is needed.

  • Overall, nurses were satisfied with their care. But 96% of respondents believed they needed to intervene in their care.
  • Better communication and greater access to medical records is necessary, especially when creating a treatment plan.
  • Potential solutions include facilitating more staffing, spending more time with the patient, and improving communication on most levels.

Nurses who were patients or caregivers overwhelmingly said they felt the need to intervene in care, a new study revealed.1

More than 82% of nurses surveyed said they had been either a patient or a caregiver to a patient with a serious medical condition. Ninety-six percent said they felt the need to intervene based on their medical knowledge.

“It would be fair to say that, overall, they were satisfied with the care, but were able to identify specific things that gave them pause,” says Marian A. O. Cohen, PhD, director of the Center for Social Research at Framingham (MA) State University.

Most patient satisfaction data related to hospital and healthcare services come from patients who are not clinicians and who do not possess the background to fully evaluate their care.

“For the most part, patients evaluate their care based on whether the provider was nice to them, but that is not the same thing as technical competence,” she says.

The researchers asked nurses questions about the care they or their family member received. They completed a questionnaire that measured their assessment of the health system and described their experiences.

“Some of the questions were close-ended, such as ‘Have you had this experience, yes or no?’” Cohen says. “Others were ‘If you’ve had this experience, tell us about it,’ or ‘If you have identified the need for better care coordination, what specifically should be coordinated?’”

Care coordination issues included teamwork and whether teams would be established on paper but not necessarily practiced in reality.

“The nurses felt that better communication was needed, including greater access to medical records,” Cohen explains. “Some of them recognized that this might require changing the culture of the healthcare system, but the coordination had to do with the fact that providing healthcare doesn’t rest on the shoulders of a single person; it requires teamwork and coordination so that everyone is on board and everyone has the same information.”

The goal is to prevent situations where one clinician is providing treatment for a patient and the next person does not know what that was, she adds.

More than 63% of the time, the nurses believed their intervention improved safety and prevented significant complications. These issues included errors related to provider carelessness, inappropriate treatment regimens, problems with therapeutic management, and inadequate postoperative care.

Communication issues often were cited as a problem. “They didn’t think there was adequate communication among the providers of services and, frankly, between the patients and clinicians,” Cohen says. “Sometimes, you might get a situation where the teams would be working together and wouldn’t necessarily be telling the patients what was going on, or they would be getting different information from different providers.”

For instance, patients with nonmedical backgrounds might not know what to do with an offhand comment by their provider. “While the nurses understood what was being communicated to them, the patient/non-caregiver did not understand,” Cohen explains. “The healthcare team was not being clear and not providing adequate information. They were answering questions without a thorough explanation and just ignoring some things.”

The nurses who responded to the survey said they intervened when they believed there was carelessness, inadequate postoperative care, or failure to consider underlying conditions.

“It wasn’t just that the provider didn’t communicate to the patient — it was that the provider failed to ask the right questions of the patient,” Cohen says. “Sometimes, the respondents were able to say there was a treatment plan put together, but it failed to acknowledge another condition or home-life situation that could affect the care or efficacy of post-hospital care.”

It turned out it was important for the care team to know that additional information. The nurse, as the patient’s caregiver, intervened and provided the context.

Solutions could include following a checklist, or simply acknowledging it is important to ask questions about patients’ lives and home situations.

“It comes back to that notion of coordinated care, of people working together,” she says. “That is certainly more true now than it has been historically in healthcare delivery, but I guess what these nurses were saying is ‘we can still do better.’”

When asked if their interventions were well-received by other medical personnel, 48.5% of respondents said they received negative reactions, such as the personnel becoming annoyed and the interventions perceived as interfering. About 40% said they received positive reactions, and personnel were appreciative and respectful of the respondent’s contribution.

When nurses intervened on behalf of family members, they sometimes requested specific types of care or additional information. “They felt they had to advocate for themselves and their family,” Cohen adds. “Some nurses said their intervention helped to reduce the pain and anxiety for the person they were providing care for, some said it allowed the patient to be transferred to a more appropriate facility, and a few even said it managed to save lives.”

For example, nurses would intervene if a patient was given a new medication regimen and providers were unaware of the patient’s current medications, or that the patient experienced an adverse reaction to a specific medication on the new regimen. In these situations, intervention could prevent adverse reactions or a worsening medical condition.

Researchers also wanted to identify ways to improve care coordination. “When we asked nurses what they thought would make situations better and [facilitate] high-quality care, respondents said there needed to be high-quality communication, and also suggested more staffing,” Cohen says. “They said to improve interactions with patients, there would need to be more time spent with each patient.”

To improve coordination, care teams need better communication, more effective teamwork, and access to medical records.

“For accessibility of care, they talked about more care options in remote areas so people who don’t live around a lot of hospitals can still receive care,” Cohen says. “People also need [more] transportation options so they can get to the care that is available and access more primary care providers.”

Cohen became interested in this area of research after a dinner with her physician husband and his physician friends. They talked about their experiences with their elderly parents.

“All the physicians in the group felt that being a physician made a difference in the kind of care that was being provided for the elderly parent,” Cohen explains.

Cohen and colleagues found it is not uncommon for healthcare professionals to help improve their loved ones’ care.

Physicians and nurses know what should or should not be happening, and they can step in to provide relevant information or ask the right questions.

“The bottom line is we’re doing a good job overall, but as is with all things, we could do better,” Cohen says.

REFERENCE

  1. Cohen MAO, McQuaid J, Remington R. Need to intervene: An exploratory study of nurses’ experiences with patienthood. J Patient Exp 2021;8:2374373521998846.