Relationship-based Care in Kwong Wah Hospital
With the ever-growing technology in medicine, health care has shifted its focus to treating patients with the quickest and latest advancements in medicine and technology. This trend has created a disconnect between the nurses and patients because this healthcare model focuses on completing tasks and moving on to the next patient as fast as possible. This phenomenon is particularly prevalent in the emergency department because it is constantly busy. Because of the fast-paced, high turnover of patients in the ED, it creates a chaotic atmosphere which might leave the patients feeling like they are not cared for (Rogers, 2015). As a result, the patient-centred care delivery model has created the need for implementing relationship-based care (RBC) in the emergency department (ED).
Health organizations are driven by the sole goal of improving the patient’s health for better patient and organization outcomes. However, the patients have expectations on how the goal should be met, which do not align with the organizations. While the organization aims to move the patient through the system smoothly, the patient, on the other hand, wants to feel cared for, form a therapeutic relationship with the nurses and connect with the caregivers. Additionally, RBC extends to relationships between coworkers because they are instrumental in caring for patients and their families. Implementing RBC in the emergency room is expected to enhance the nurse-patient interaction, improve patient-caregiver interaction and strengthen the relationship between coworkers (Will, Johnson, & Lamb, 2019).
This paper will analyze relationship-based care between patients and nurses in emergencies to improve patient satisfaction in Kwong Wah Hospital, Hong Kong. It is a 1,141-bed capacity public hospital in Yau Ma Tei (Rogers, 2015). The hospital provides West Kowloon and Wong Tai Sin residents with a comprehensive range of medical services. It serves as West Kowloon’s major acute teaching hospital and a referral centre for antenatal and Neurosurgical Diagnosis. The hospital has further established respiratory care unit, a Community-based Geriatric Centre, renal memorial centre, nuclear medicine, acute stroke unit and a TWGHs BOCHK diabetes centre. The hospital maintains a unique that attests to its charitable origin. The staff show loyalty to the hospital and treat their jobs as a vocation. The institution is committed to Traditional Chinese Medicine which reflects its historical development.
On a typical day, the hospital hosts 1800 to 2000 patients attending family, general outpatient and specialist clinics. The Accident and Emergency Department caters to around 300t to 400 patients daily, out of which a quarter are admitted. This makes up for 45% of the total daily admissions. In 2009, the hospital was looking to change its care delivery model (Rogers, 2015). Hence a consultant recommended an ambulatory care component for the emergency department. The service enhancements included introducing an emergency medicine ward, 24 hours Computed Tomography, fast-tracking the system for minor injuries and enhancing isolation facilities. Of all the recommendations made, they aimed at fastening the treatment process instead of cultivating a patient-nurse relationship essential for patients in the ED.
Methodology
Academic research is based on building ones’ study and relating it to existing knowledge regardless of the academic discipline. All fields should ensure to do so accurately. However, with the increasing pool of knowledge, research is becoming complex because research in different areas is advancing rapidly while remaining fragmented across various disciplines. (Snyder, 2019) This makes it challenging to keep up with all the research advancements and assess all the available evidence in a given area. This is why researchers have adopted literature review as a research method. It is a less systematic way of collecting and synthesizing available research on a particular topic.
For this paper, research will take a systematic literature review approach. Systematic reviews are primarily used in medical science to systematically synthesize research findings with transparency and how they can be reproduced. In some instances, it is used to collect data from existing research and critically appraise it. Systematic review identifies all the empirical evidence that aligns with the inclusion criteria to prove a given hypothesis or answer a research question. In this study, a systematic review will be conducted on previous research about implementing relationship-based care between nurses and patients to increase patient satisfaction (Eckhardt, Leiras, & Thomé, 2019). It will also include earlier studies around the Kwong Wah Hospital informing customer satisfaction. Evidence from these studies will then be analyzed to a conclusion.
In every study, the literature review is used to map the scope of the research and assess the research area to justify the research question or hypothesis. However, it has to be trustworthy, precise, and accurate for it to pass as a research methodology. Reviews are excellent when the researcher wants to evaluate a theory against competing theories or examine evidence in a given area of research for accuracy and validity. The study can be as narrow as evaluating two variables or as broad as reviewing collective evidence in a given line of research.
Search Strategy
For this study, information will be searched from online libraries that provide medical and nursing articles. The first database is PubMed, an online service of the National Library of Medicine with over 12 million MEDLINE citations dating back to the mid- 1960s and articles from life science journals. It also provides links to different sites with other related resources and full-text articles. Secondly is the Cumulative Index to Nursing and Allied Health (CINAHL), which offers authoritative literature in nursing and allied health. It will be beneficial for this study for articles evaluating the success of RBC concerning the nurse-patient relationship. The third database is Cochrane Library which is famous for systematic reviews. It is among the 53 groups worldwide that ensure systematic reviews that are published maintain a high quality and are evidence-based. Its main advantage is that articles are regularly updated to capture new research. It also offers links to related articles for further investigation. Lastly, the study will rely on UpToDate, an online library that provides detailed reviews of clinical topics. Like Cochrane Library, the articles are regularly updated for relevance (Cowie et al., 2017). The search terms in this research include relationship-based care, nurse-patient relationship, patient-centered care, patient satisfaction.
Inclusion and Exclusion Criteria
The inclusion and exclusion criteria set the scope for systematic review. They adhere to different factors that limit the study to the appropriate material. For this study, the articles used must have been published in the last five years or updated within that same period. This will ensure that the data obtained from them is relevant to the current study and will be helpful in impacting current decisions. Secondly, the studies must have taken place in a public hospital of a similar bed capacity or close to that of Kwong Wah Hospital. Therefore, the sample size will be in the same range allowing for adopting their results for the study (Patino, & Ferreira, 2018). The sources included will be limited to studies carried out in hospitals within Asia due to a similarity in demographics.
On the other hand, this stud will exclude all the articles on the topic that are not written in English. This will ease the burden of translation and the risk of losing the meaning of the results in translation. Secondly, the systemic review will exclude all studies that do not take place in a public hospital setting. Thirdly, the study will exclude non-peer-reviewed articles except for grey literature like technical reports and web-based guidelines (Patino, & Ferreira, 2018). Lastly, the systematic review will only use original studies hence excluding editorials and reviews.
Critical Appraisal Strategy
It is a process of identifying the strengths and weaknesses of a research paper to examine the validity of the research findings and their usefulness for a systematic review (Quigley, Thompson, Halfpenny, & Scott, 2019). It is mainly used for evaluating whether the study design is appropriate for the research question and an assessment of the methodological features of the design. The critical appraisal also considers the suitability of statistical methods, their interpretation, possible conflict of interest and how the research relevant to the practice in question. The process assesses the relevance, trustworthiness and value of the evidence found (Al-Jundi, & Sakka, 2017). For this study, the evidence reviewed should be from reputable sources and up to date.
The critical appraisal tool for this study will be the Critical Appraisals Skills Programme (CASP) which equips one with skills to systematically assess the relevance and trustworthiness of results from published papers. It helps in making sense of research evidence for application in evidence-based practice (Buccheri, & Sharifi, 2017). This will be used in collaboration with Joanna Briggs, which ensures that research evidence that is synthesized and shared for implementation within universities and hospitals is culturally inclusive and relevant across all cultures worldwide (Purssell, 2020).
Data analysis
Data analysis will be carried out using meta-analysis, a statistical method used to integrate results from the different studies in a systematic review. It combines results from various studies to identify patterns, relationships and disagreements in the different studies for the same topic. The primary studies are abstracted and coded, and the findings changed into a regular metric to calculate the overall effect size. However, to use meta-analysis, the primary studies must use a similar study design to compare results. Therefore, it is not easy to employ this analytic design for studies using different methodological approaches. Outcomes from this analysis give a more precise estimate of the effect of a given outcome than any of the studies pooled for the literature review. It should be conducted when the studies are adequately homogenous and produce a meaningful summary. The most significant advantage of using meta-analysis is the ability to examine heterogeneity among the present studies (Pigott, & Polanin, 2020). The presence of heterogeneity means that results must be cautiously interpreted, and even further caution should be exercised in generalizing the results. Heterogeneity gives rise to more effective treatments, interventions and practices.
Because systematic reviews do not collect personal or confidential information from participants like in primary studies, confidentiality is not a concern. They use publicly available information hence are not required to seek institutional ethics approval. Generally, no guidelines exist from the Institutional Review Boards for the ethical requirements of a systematic literature review. However, the study will use scientific methodologies, analytic designs and appraisal tools to reduce bias from subjectivity and reflexivity. Reflexivity is evaluating one’s belief’s practices, and judgments and how they impact the study. On the other hand, subjectivity affects the topic of study, the research question, and the methodologies employed in the study (Suri, 2020).
