ORCID Profile
0000-0001-8238-3081
Current Organisations
VA Portland Health Care System
,
University of Michigan
,
San Diego State University
,
Universidad de Alcalá
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Publications
Using Qualitative Methods to Explore Communication Practices in the Context of Patient Care Rounds on General Care Units
Publisher: Springer Science and Business Media LLC
Date: 12-12-2019
It’s like sending a message in a bottle: A qualitative study of the consequences of one-way communication technologies in hospitals
Publisher: Oxford University Press (OUP)
Date: 27-09-2021
Abstract: We examine how physicians and nurses use available communication technologies and identify the implications for communication and patient care based on the theory of workarounds. We conducted a qualitative study at 4 U.S. hospitals during 2017. Researchers spent 2 weeks at each hospital conducting unit-based observation, shadowing, interviews, and focus groups with nurses and physicians. Using an iterative process, we inductively coded and thematically analyzed data to derive preliminary themes. The theory of workarounds provides an organizational lens on workarounds, consisting of 5 components: antecedents, types, effects, managerial stance, and organizational challenges of workarounds. The first 3 components of the theory helped us to organize and explain our findings. Communication technologies consisted of pagers and telephones. Antecedents to workarounds included one-way information flow, differential access related to differences in technology types, and technology mismatch. Types of workarounds included bypassing a variety of obstacles and substituting for unavailable resources. Direct effects of workarounds included pager fatigue, interruptions in patient care, and potential errors. One-way communication technologies created an environment where workarounds could flourish. By placing results within the context of the theory of workarounds, we extend what we know about why and how workarounds develop, and offer strategies to minimize workarounds’ adverse effects. Through the theory of workarounds, we see that there is a trajectory to workarounds with potential consequences for clinicians and patients. Two-way communication technologies could minimize workarounds and gaps in information exchange, and reduce unnecessary interruptions and the potential for adverse events.
Influences of Physical Layout and Space on Patient Safety and Communication in Ambulatory Oncology Practices: A Multisite, Mixed Method Investigation
Publisher: SAGE Publications
Date: 25-06-2021
DOI: 10.1177/19375867211027498
Abstract: To examine how physical layouts and space in ambulatory oncology practices influence patient safety and clinician communication. Ambulatory oncology practices face unique challenges in delivering safe care. With increasing patient volumes, these settings require additional attention to support patient safety and efficient clinical work processes. This study used a mixed methods design with sequential data collection. Eight ambulatory oncology practices (of 29 participating practices) participated in both the quantitative and qualitative phases. In surveys, clinicians ( n = 56) reported on safety organizing and communication satisfaction measures. Qualitative data included observations and semistructured interviews ( n = 46) with insight into how physical layout influenced care delivery. Quantitative analysis of survey data included descriptive and correlational statistics. Qualitative analysis used inductive and thematic content analysis. Quantitative and qualitative data were integrated using side-by-side comparison tables for thematic analysis. Safety organizing performance was positively correlated with clinician communication satisfaction, r(54 df) = .414, p = .002. Qualitative analyses affirmed that the physical layout affected communication around chemotherapy infusion and ultimately patient safety. After data integration, safety organizing and clinician communication were represented by two themes: visibility of patients during infusion and the proximity of clinicians in the infusion center to clinicians in the clinic where providers see patients. Physical layouts of ambulatory oncology practices are an important factor to promote patient safety. Our findings inform efforts to construct new and modify existing infusion centers to enhance patient safety and clinician communication.
The Expat Life with a Thai Wife: Thailand as an Imagined Space of Masculine Transformation
Publisher: Springer Netherlands
Date: 26-11-2013
Causes and Consequences of Chemotherapy Delays in Ambulatory Oncology Practices: A Multisite Qualitative Study
Publisher: Oncology Nursing Society (ONS)
Date: 07-2020
Transnational intimacy and economic precarity of western men in northeast Thailand
Publisher: Informa UK Limited
Date: 28-01-2020
Which Factors Promote Shared Understanding Between Physicians and Nurses in Inpatient Oncology Care Settings?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-05-2021
Patient Sense of Belonging in the Veterans Health Administration
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-07-2022
DOI: 10.1097/MLR.0000000000001749
Abstract: Health care systems have increasingly focused on patient engagement in efforts to improve patient-centered care. Appointment attendance is an integral component of patient engagement, and missed appointments are an ongoing problem for health care systems. Virtually no studies have examined how the sense of belonging is related to patient engagement within a health care system. To examine patient experiences in the Veterans Health Administration (VA) with outpatient appointment attendance to identify factors that affect sense of belonging and patient engagement. This study draws from qualitative data collected as part of a study to reduce missed appointments through use of enhanced appointment reminder letters. We conducted semistructured interviews with 27 VA patients with primary care or mental health clinic visits, using deductive and inductive analysis to develop themes. More than half of the participants were Vietnam veterans, 24 were over 40 years old, 21 were White, and 18 were men. We identified 3 factors that influence sense of belonging within the VA: (1) feelings of camaraderie and commitment toward other veterans were relevant to patient experience in the VA (2) interactions with all staff influenced the engagement a patient felt with a particular clinic, care team, and the VA (3) personalized communication and messaging could humanize the VA and demonstrate its interest in engaging with veterans. Lastly, we found (4) sense of belonging appeared to promote appointment attendance and patient engagement. There are multiple opportunities to strengthen patients’ sense of belonging within the health care system that serves them. For veterans, strategies that build their sense of belonging may be a novel approach to increase appointment attendance and patient engagement in their health care.
VA-Delivered or VA-Purchased Care: Important Factors for Veterans Navigating Care Decisions
Publisher: Springer Science and Business Media LLC
Date: 15-03-2023
Women of the Gulf War: Understanding Their Military and Health Experiences Over 30 Years
Publisher: Oxford University Press (OUP)
Date: 30-09-2022
Abstract: Women Veterans of the Persian Gulf War (GW) expanded the military roles they had filled in previous military eras, with some women engaging in direct combat for the first time. Many GW service members, including women, had unique combat exposures to hazardous agents during deployment, which might have contributed to the development of chronic health problems. This study aims to understand the experiences of women GW Veterans (GWVs) as it is related to their military service and subsequent health in order to better inform and improve their clinical care. We conducted in-depth interviews with 10 women GWVs to understand their experiences and perspectives about how their military service in the Gulf has impacted their lives and health. We used an integrated approach of content analysis and inductive thematic analysis to interpret interview data. Besides having many of the same war-related exposures as men, women faced additional challenges in a military that was inadequately prepared to accommodate them, and they felt disadvantaged as women within the military and local culture. After service, participants had emergent physical and mental health concerns, which they described as developing into chronic and complex conditions, affecting their relationships and careers. While seeking care and service connection at Veterans Health Administration (VA), women voiced frustration over claim denials and feeling dismissed. They provided suggestions of how VA services could be improved for women and GWVs. Participants found some nonpharmacological approaches for symptom management and coping strategies to be helpful. Women in the GW encountered challenges in military and healthcare systems that were inadequately prepared to address their needs. Women faced chronic health conditions common to GWV and voiced the desire to be understood as a cohort with unique needs. There is an ongoing need to expand services within the VA for women GWVs, particularly involving psychosocial support and management of chronic illness. While the small s le size can limit generalizability, the nature of these in-depth, minimally guided interviews provides a rich narrative of the women GWVs in this geographically erse s le.
Clinicians Report Barriers and Facilitators to High-Quality Ambulatory Oncology Care
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2020
Balancing the benefits of patient-clinician relationships with professional boundaries in Home-based Primary Care
Publisher: Informa UK Limited
Date: 30-03-2017
DOI: 10.1080/01621424.2022.2056106
Abstract: In the home care setting, boundaries may be difficult to identify when behavioral changes are made to accommodate the nature of care being delivered. In this secondary qualitative study, we examined how Home-based Primary Care (HBPC) clinicians understand role and relationship boundaries with patients and how these dynamics support patient care. The data set consisted of 14 semi-structured interviews with HBPC clinicians representing multiple disciplines and field observations of 6 HBPC team meetings. Using a directed approach to content analysis, we identified and described how HBPC clinicians worked to build relationships with patients, experienced challenges with emotional attachment, and negotiated boundaries in the patient-clinician relationship. Our findings illustrate how the home care setting is a site for which strong, therapeutic patient-clinician relationships can be developed while also highlighting the work that clinicians must do to balance addressing patient needs stemming from social isolation and adherence to their own professional boundaries.
A Leucine-Rich Repeat Motif of Leishmania Parasite Surface Antigen 2 Binds to Macrophages through the Complement Receptor 3
Publisher: The American Association of Immunologists
Date: 15-04-2004
DOI: 10.4049/JIMMUNOL.172.8.4902
Abstract: Membrane glycoconjugates on the Leishmania parasites, notably leishmanolysin and lipophosphoglycan, have been implicated in attachment and invasion of host macrophages. However, the function of parasite surface Ag 2 (PSA-2) and membrane proteophosphoglycan (PPG) has not been elucidated. In this study we demonstrate that native and recombinant Leishmania infantum PSA-2, which consists predominantly of 15 leucine-rich repeats (LRR) and a recombinant LRR domain derived from L. major PPG, bind to macrophages. The interaction is restricted to macrophages and appears to be calcium independent. We have investigated the PSA-2-macrophage interaction to identify the host receptor involved in binding and we show that binding of PSA-2 to macrophages can be blocked by Abs to the complement receptor 3 (CR3, Mac-1). Data derived from mouse macrophage studies were further confirmed using cell lines expressing human CR3, and showed that PSA-2 also binds to the human receptor. This is the first demonstration of a functional role for PSA-2. Our data indicate that in addition to leishmanolysin and lipophosphoglycan, parasite attachment and invasion of macrophages involve a third ligand comprising the LRRs shared by PSA-2 and PPG and that these interactions occur via the CR3.
White migrant masculinities in Thailand and the paradoxes of Western privilege
Publisher: Informa UK Limited
Date: 28-03-2014
Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study
Publisher: BMJ
Date: 09-11-2020
DOI: 10.1136/BMJQS-2020-011441
Abstract: How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe patient care. The purpose of this study was to describe the factors contributing to physician responsiveness to text or numeric pages, telephone calls and face-to-face messages delivered by nurses on adult general care units. Using a qualitative design, we collected data through observation, shadowing, interviews and focus groups of bedside registered nurses and physicians who worked in four hospitals in the Midwest USA. We analysed the data using inductive content analysis. A total of 155 physicians and nurses participated. Eighty-six nurses and 32 physicians participated in focus groups or in idual interviews we shadowed 37 physicians and nurses across all sites. Two major inter-related themes emerged, message and non-message related factors. Message-related factors included the medium nurses used to convey messages, physician preference for notification via one communication medium over another and the clarity of the message, all of which could cause confusion and thus a delayed response. Non-message related factors included trust and interpersonal relationships, and different perspectives between nurses and physicians on the same clinical issue that affected perceptions of urgency, and contributed to delays in responsiveness. Physician responsiveness to communications from bedside nurses depends on a complex combination of factors related to the message itself and non-message related factors. How quickly physicians respond is a multifactorial phenomenon, and strategies to promote a timely response within the context of a given situation must be directed to both groups.
Related Organisations
Related Funding Activities
No related grants have been discovered for Antonio Jimenez-Ruiz.