This essay laid out the development of a nurse's identity from clinical practitioner to developing researcher, with a focus on the importance of patient-centered and nurse-centered care as the cornerstone pillars of nursing research. Through narrative and application of qualitative and participatory research approaches, the author showed the intersection of everyday experience, philosophical inquiry, and scholarly pursuit along the path toward becoming a nurse researcher. The article examined how emotional experiences within the perioperative environment have instigated research questions aimed at improving patient and nurse well-being. Through the incorporation of academic models and theoretical perspectives, the author presented an emerging investment in health equity, social determinants of health, and collective inquiry, framing this individual path within the greater nursing science mission.

BACKGROUND

In Family and Community Medicine (FCM) residency training, the biopsychosocial approach to care was translated to a teaching strategy and cognitive framework called patient-centered, family-focused, and communityoriented (PFC) lens. However, the PFC lens documented in a matrix has no evidence of its implementation acceptability and appropriateness for the users in the FCM training program.

To determine the acceptability and appropriateness of the integration of the PFC lens in the Ortho- Geriatrics Fracture Liaison Service (OG-FLS) in applying the family medicine principles and achieving family practice required competencies of the residents in a tertiary hospital FCM training program.

A cross-sectional survey was conducted using a 15-item self-administered pre-tested online questionnaire to gather feedback and experiences on the PFC lens integration. Answers to open-ended questions were coded and analyzed with MaxQDA and synthesized into themes while numerical rating scales were analyzed with Microsoft Excel into means and standard deviation.

Nineteen residents answered the questionnaire. There were 47 OG-FLS patients referred to the service. Overall, the acceptability of the approach among FCM residents had an average score of 9.26 (SD ± 0.99) while appropriateness was rated 9.26 (SD ± 1.09) with 10 points as the highest score. The competencies achieved reported by residents were communicating effectively, collaborating with interprofessional teams, demonstrating clinical competence, and practice of biopsychosocial approach.

The PFC lens integration in OG-FLS is acceptable and appropriate in the practice of multidisciplinary care in the in-patient setting among FCM residents. Its integration is aligned with the expected competencies of a family physician that trainees can apply in future practice.

Client feedback is an integral part of the health care system’s quality and effectiveness. In health care operations, it is paramount as it serves as a vital tool for continuous improvement, ensuring patient-centric care delivery, and fostering trust and accountability within the health care system. Client feedback helps shape up new and existing policies and is, therefore, highly valued, considered, and acted upon. In health care institutions such as the Southern Philippines Medical Center (SPMC), incorporating client feedback into policy-making enhances health care operations and aligns services with patient needs and institutional goals. In SPMC, the Hospital Client Experience Survey is the primary feedback mechanism by which clients, both internal and external, can voice their opinions, concerns, and suggestions regarding its personnel, processes, and structure. Through directives from the Anti-Red Tape Authority (ARTA)1 and the Department of Health (DOH),2 SPMC uses the Hospital Client Experience Survey Tool (HCES) to enhance service delivery. Public Assistance and Complaints Desk (PACD) Officers conduct monthly surveys across 200 hospital areas. Each area expects 5 to 30 responses, based on a calculation by the HCES Online Report Generator (ORG). PACD officers actively engage staff within their designated areas, encouraging their participation in survey distribution per transaction and motivating clients to provide feedback during specified survey days. Highlighting the significance of these surveys, PACD Officers emphasize the invaluable insights gained from diverse client responses, which ultimately shape and validate the impact of service delivery initiatives within the hospital. At the end of each quarter, PACD officers analyze data using the HCES-ORG, collate comments and commendations, verify the accuracy of HCES results, and then post them for viewing by the different departments within the institution. Exceptional staff commendations are documented in the quarterly HCES results publication, prominently displayed within the hospital. These commendations contribute to individual performance evaluations. If a staff member receives negative feedback on the HCES form, their unit manager receives a photocopy of the form and may implement disciplinary action or enroll the staff in customer service seminars hosted by the Professional Education and Training Department (PETD). Consistent negative feedback over three consecutive months may trigger appropriate improvement plans or corrective actions among individual staff or even entire departments. The infographic displays the reports from the HCES for the first to the fourth quarters of 2023. Clients’ feedback comprises three domains: personnel, processes, and structures. Personnel covers attitude and character, processes involve system and organization, and structures include facilities and equipment. The feedback includes both positive and negative comments, with recommendations also identified. The HCES consists of statements rated on a scale from 1 (strongly disagree) to 5 (strongly agree). For this infographic, we computed the mean satisfaction scores for each domain and the proportion of clients who reported satisfaction with the service and timeliness of service they received. To summarize the recommendations from the HCES, we utilized the artificial intelligence (AI) chatbot-powered search engine Perplexity AI. We uploaded the recommendations in spreadsheet format and prompted Perplexity AI to "Summarize, in bullets, the recommendations into three categories: personnel, process, and structure," and then to "Count the times each of those summarized comments were mentioned in the file." We used the response of Perplexity AI to illustrate the results as a word cloud, with the sizes of the words in the cloud proportional to the frequency of mentions. In the HCES, the most frequently mentioned suggestion was to provide additional staff. Other suggestions included maintaining clean and functional restrooms, and improving overall cleanliness and sanitation. Infrastructure-related suggestions focused on better ventilation, air conditioning or fans, expanding wards and watchers’ areas, adding more hospital beds and chairs, ensuring a consistent water supply, and providing necessary diagnostic and therapeutic equipment and medicines. Process-related recommendations focused on reducing service delivery turnaround time, prioritizing senior citizens, PWD, and pregnant patients, improving billing and laboratory services, optimizing operation scheduling, and enhancing staff communication and coordination between and among offices. Personnel-related suggestions included improving staff interaction with patients, providing staff training, ensuring staff safety, and performing diligent patient checks. Client feedback helps SPMC retain positive responses, optimize health care delivery, and serve clients better through ongoing renovations, reorganizations, and transformations, affirming its vision of quality service.
Feedback ; Patient-Centered Care

Background: Dementia is a chronic progressive disease that ultimately affects the patient’s quality of life. It is therefore important to manage and treat patients with the disease holistically, addressing other factors such as the patient’s lifestyle, family problems and even economic strains. Objective: This meta-analysis was conducted to determine the effectiveness of a patient-centered intervention among patients with dementia as the primary objective. Methods: A meta-analysis of studies was done on elderly patients diagnosed with dementia undergoing usual care or patientcentered care. Eligible studies for the meta-analysis were searched on electronic databases of Pubmed, Cochrane, Grey Literature and by cross referencing. Three review authors independently carried out all aspects of study selection, ‘risk of bias’ assessment and data extraction. RevMan 5 software was used in the analysis of gathered data. Results: Results in favor of patient centered care interventions were seen in the studies. In the analyses of 3 studies pertaining to the improvement of quality of life as measured by QUALID, QOD AD and EURO QL scale, the combined results were noted to favor the intervention over the control. Pooled results showed effectiveness favoring PCC intervention as compared to usual care (mean difference: 0.26, 95% CI: -1.31, 0.80), though not statistically significant. Conclusion Patient-centered care intervention is effective in improving the quality of life of patients with dementia. PCC should be initiated whenever possible from the time of dementia diagnosis and through the stages of the diseas
Patient-centered care ; dementia

Humans ; Sleep Apnea, Obstructive/therapy* ; Patient-Centered Care

INTRODUCTION: The Patient-Centred Medical Home (PCMH) demonstration in Singapore, launched in November 2016, aimed to deliver integrated and patient-centred care for patients with biopsychosocial needs. Implementation was based on principles of comprehensiveness, coordinated care and shared decision-making. METHOD: We conducted a prospective single-arm pre-post study design, which aimed to perform cost analysis of PCMH from the perspectives of patients, healthcare providers and society. We assessed short-to-intermediate-term health-related costs by analysing data on resource use and unit costs of resources. RESULTS: We analysed 165 participants enrolled in PCMH from November 2017 to April 2020, with mean age of 77 years. Compared to the 3-month period before enrolment, mean total direct and indirect participant costs and total health system costs increased, but these were not statistically significant. There was a significant decrease in mean cost for primary care (government primary care and private general practice) in the first 3-month and second 3-month periods after enrolment, accompanied by a significant decrease in service utilisation and mean costs for PCMH services in the second 3-month period post-enrolment. This suggested a shift in resource costs from primary care to community-based care provided by PCMH, which had added benefits of both clinic-based primary care and home-based care management. Findings were consistent with a lower longer-term cost trajectory for PCMH after the initial onboarding period. Indirect caregiving costs remained stable. CONCLUSION The PCMH care model was associated with reduced costs to the health system and patients for usual primary care, and did not significantly change societal costs.
Aged ; Health Care Costs ; Humans ; Independent Living ; Patient-Centered Care ; Prospective Studies ; Singapore

Background and Objectives: Person-centered care aims to involve people in making decisions for their health care. The Canadian Occupational Performance Measure (COPM) is an easy-to-use functional assessment scale that can facilitate person-centered care. However, cultural nuances and individual differences in English proficiency may affect the administration of the original tool. This study translated and adapted the COPM to Filipino. Methodology: Two translators independently translated the COPM to Filipino. A multidisciplinary expert panel reviewed the translations and composed an initial Filipino version. The initial Filipino version was translated back to the source language. A second expert panel meeting produced a pre-final Filipino version of the tool. Pre-test and cognitive interviews followed, and revisions were made to generate a final version of the tool. Results: The expert panel discussed issues such as preservation of the original thought, understandability to the local population, consistency with the terms used, and avoidance of redundancy during the evaluation of the proposed translations. Meanwhile, analysis of cognitive interviews revealed that despite the issues encountered in some of the translated words, the participants found the adapted version to be generally understandable and easy to follow. The semi-structured interview format also allowed elaborated assessment and goal setting for self-care, productivity, and leisure. Conclusion Findings of this study suggest the potential usefulness of the Filipino version of the COPM in further facilitating person-centered goal-setting in the Filipino context. Future studies are warranted to examine the psychometric properties of the instrument for use in specific client groups, conditions, or settings.
Patient-Centered Care

Background: Colorectal cancer is highly preventable through early screening, but disparities in screening create a negative impact on the lives of those at risk. One approach to address this is patient navigation. This systematic review and meta-analysis therefore aimed to provide evidence of the effectiveness of patient navigation in increasing colorectal cancer screening uptake. Objectives: This study aimed to determine the effectiveness of patient navigation on colorectal cancer screening uptake. Specifically, it aimed to study the effects of different methods of navigation on the uptake of initial screening tests among persons with average risk. Methods: The studies included were randomized clinical trials conducted within 2011-2021 and involving only humans as participants. Data were analyzed by calculating the risk ratio and 95% confidence intervals of each successful outcome, and the investigators independently appraised each study’s risk of bias. Subgroup analysis was conducted to assess consistency of study effects. Certainty of evidence was assessed using the GRADE standard. Results: Eleven (11) studies were included in this systematic review and meta-analysis. All studies encompassed health systems of different countries, and they utilized different means of navigation to achieve outcome measure of colorectal cancer screening uptake. Results show a statistically significant increase in screening uptake with patient navigation in a forest plot. However, there is a high level of heterogeneity among the studies, hence a subgroup analysis was conducted among these studies according to navigation method. Conclusion This systematic review and meta-analysis show an increase in screening rates in those who were navigated. Results in favor of patient navigation was consistent when all studies were analyzed together and when they were analyzed according to navigation method. Increase in screening uptake is more statistically significant among patients navigated via face-to-face and via phone call, but data is more consistent for patient navigation via phone call alone.
Colorectal Neoplasms ; Patient Navigation

BACKGROUND: Patient navigators are trained to provide support and guidance to patients throughout the cancer care continuum. They help "navigate" through the maze of doctors' clinics, outpatient centers, insurance and payment systems, patient-support organizations, and other components of the health care system. Yet there is no existing patient satisfaction tool to assess the patient navigation program in the Philippines for pediatric cancer. OBJECTIVES: This study aims to evaluate satisfaction with the patient navigation program using a validated Satisfaction with Interpersonal Relationship with Navigator (SN-I-Ph) Measure among Filipino caregivers in a tertiary referral center for childhood cancer. METHODOLOGY: The tool was first translated for cultural appropriateness, translated, and back translated into Filipino; the content validity and internal consistency were tested. Caregivers of Filipino children with cancer were recruited to answer the survey and the results analyzed. OUTCOME: Content validity for all 9 items was acceptable with scores of 4.5-5 and internal consistency showed satisfactory results with cronbach alpha of 0.9067. A total of 202 participants were recruited to join the survey. Results showed mean±SD of 42.6±7.8. All the 9 items showed excellent satisfaction. CONCLUSION: This study showed good satisfaction with the interpersonal relationship of the navigators among caregivers. Participants enrolled in the patient navigation program reported a positive overall experience with the medical care. RECOMMENDATIONS The tool is recommended for use among hospitals with the patient navigation program to assess satisfaction of the caregivers. Further studies can assess caregiver’s satisfaction as to logistic aspects as well as how to measure benefits and outcomes with the program.
Patient Navigation

The biopsychosocial approach to healthcare is fundamental to Family and Community Medicine specialists. Using the patient-centered, family-focused, community-oriented (PFC) matrix, the interplay of a myriad of biomedical and psychosocial factors is assessed in order to provide a thorough medical management that is custom-made to meet the needs and inherent values of a patient and his/her family. Family assessment tools are also utilized to better understand the family dynamics of a patient that may impact on the prescribed management plan. In addition, social determinants of health are evaluated to ascertain which ones may facilitate or hamper proper utilization of community resources. This family case analysis documented the medical ordeal of a young professional who had been diagnosed with two rare medical conditions: necrotizing fasciitis and Chiari malformation Type II. Employing the PFC matrix, the Family and Community Medicine specialist was able to provide inter-disciplinary care for the patient and his family in a holistic manner by recognizing patient needs, creating an enabling family support environment, and helping the family unit navigate various community resources.
Humans ; Social Determinants of Health ; Family Health ; Social Factors ; Patient-Centered Care