in Healthcare Environment in Oncology Care
Study Summary: Factors in the
Healthcare Environment in Oncology Care
This study by Browall, Koinberg, Falk, and Wijk aims to characterize the factors that are important to oncology patients within the healthcare environment (2013). The characteristics of the environment during treatment, particularly long-term care for patients with likely incurable and life-threatening illnesses, has emerged as a crucial factor in the development of person-centered medical care (McCormack and McCance, 2006). Because of foundations in holistic human values, person-centered care is regarded as the equivalent to best quality care (Mead and Bower, 2000). The role of the nurse in providing key aspects of person-centered care is crucial and provides the link between the results of this study and the nursing profession.
The purpose of the Browall et al. study is to determine in a rigorous way what environmental factors in the clinic environment are important and valued to cancer patients (2013). Care is taken within the work to specifically place the various factors into concrete categories and subcategories to focus the results and interpretation. As the clinics within the study had been recently reconstructed, both physically and organizationally, a corollary question was to determine if the alternations made had achieved the goal of improving the environment for the patients. The study also sought to determine the importance of first impressions of the patients to their ultimate perception of the quality of care they received. Finally, the results were to provide specific information so that resources can be invested in the environmental aspects that are important to the patients (Browell et al., 2013).
Browall et al. utilize a qualitative method to gather information concerning the factors within the healthcare environment and their relative importance (2013). Using this method, the collected, detailed expressions of the patient perceptions are filtered through content analysis. The research design was that of a small focus group in order to utilize group interaction to more easily explore knowledge and experience (Kitzinger, 1994). The sample size was eleven patients and three focus group interviews were set up, comprising subsets of the eleven participants. In particular, two of the interviews included three patients, one man and two women, while one interview included five patients, three men and two women. The patients had a variety of oncology diagnoses and had all received chemotherapy and/or radiotherapy at the clinic prior to the study (Browell et al., 2013).
Data was collected through recorded focus groups surrounding three primary questions: “1. What meaning do you attach to the concept of healthcare environment?
2. Can you give some examples of positive and/or negative aspects of the healthcare environment at the ward, and provide arguments to support your opinion?
3. What do you consider to be important factors in healthcare environments in general, and why?” (Browell et al., 2013). The discussions were verbatim transcribed and analyzed by three different researchers using a reiterative review and categorization procedure. The statements were all placed into three categories which represent the three most important factors of the environment for the patients based on their statements. The three categories were subdivided into more narrow categories representing specific areas of the primary factors that were commented upon.
Specifically, Browall et al. study found factors related to safety, the partnership with the staff, and the physical space were important to the patients (2013). Even more particularly, in relation to the safety category, having continuity of and accessibility to staff was important, as was understanding and accommodation of the need for both privacy and community during treatment. In relation to the partnership with the staff category, being a person, having participation and responsibility in their care, and good communication were all aspects of the environment found central to a positive experience. Finally, in the physical space category, care surrounding food and smells, bright and fresh visual impressions, and the need for quiet and calm surrounding sounds were emphasized. The comments within the study also indicated that first impressions did not particularly influence the final impression of the quality of care received (Browall et al, 2013). The primary implications to nursing of these results are its support of the impact of the health care environment upon the patient and the clear role nurses in oncology practice can have in keeping the environmental factors as preferred by the patients, as indicated by their comments, whenever possible.
Ethically, this study was approved by the Regional Ethics Committee in Gothenberg (Browell et al., 2013). Because of the study design using voluntary focus groups, the patient privacy concerns are minimal. There are also no considerations related to treatment because no treatment was administered as a direct result of this study.
The study by Browall et al. provides qualitative support for oncology patients’ issues with the environment where they receive their care. These factors were all related to broad categories of safety, partnership with the staff, and physical space and therefore had implications with both physical and psychosocial environments. Some limitations of the study were the very small sample size (n=11) and the breadth of the questions asked. Nevertheless, this study does provide support for the true impact of environment on the oncology patient. It also provides suggested areas for nursing staff and other medical personnel to focus their attention in relation to healthcare environments in order to provide the most positive support for an oncology patient as possible.
References
Browall, M., Koinberg, I., Falk, H., and Wijk, H. (2013). Patients’ experience of important factors in the healthcare environment in oncology care. International Journal of Qualitative Studies of Health and Well-being. 8, 20870-80.
Kitzinger, J. (1994). The methodology of focus groups: The importance of interaction between research participants. Sociology of Health and Illness. 16: 103-21.
Mead, N., and Bower, P. (2000). Patient-centeredness: A conceptual framework and review of the empirical literature. Social Science & Medicine. 51: 472-79.
McCormack, B., and McCance, T. V., (2006). Development of a framework for person-centered nursing. Journal of Advanced Nursing. 56, 472-79.
