Date of Award

2021-8

Degree Name

PhD Nursing

Dissertation Committee

Eileen K. Fry-Bowers, PhD, JD, RN, CPNP, FAAN, Chairperson;Ann M. Mayo, DNSc, RN, FAAN;Committee Member;Laurie Ecoff, PhD, RN, NEA-BC, CNL, Committee Member

Keywords

patient experience, Hispanic, safety-net, HCAHPS, Chronic illness, Grounded theory

Abstract

Purpose: The purpose of this study was to understand how English- and Spanish-speaking Hispanic patients seeking kidney and liver transplant care at a safety-net facility perceive and interpret the care experience with the goal of generating a grounded theory model to guide care delivery and improve perception of care for this population.

Background/Rationale: The patient experience is the current federally mandated hospital quality indicator that measures the range of interactions patients have with their hospital admission, which has fiscal and clinical implications for the delivery of care. Many safety-net health care delivery systems, which primarily serve traditionally underserved populations, and those facilities providing highly coordinated care such as patients suffering from chronic liver or kidney failure needing transplantation, can be especially challenged in meeting federal goals. This quality indicator is measured via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Historically, minority representation in health care instrument development has been poor and the HCAHPS survey is no different. As a result, this population’s perception of their care may be influenced by factors not readily assessed in the HCAHPS survey. To date, knowledge of the Hispanic patient’s hospital experience has been primarily derived from results of HCAHPS surveys and the evidence reveals mixed findings on their perspective of their experience. Furthermore, qualitative inquiry into the patient experience remains understudied, especially regarding minority groups such as the Hispanic patient population. Therefore, further research is needed to improve understanding of their experience of care.

Theoretical/Conceptual Framework: The Conceptual Framework of Interpersonal Processes of Care, which focused on care for diverse populations, informed this study. The model provided a foundation for understanding elements to investigate in this study.

Methods: This study employed a qualitative approach to conduct individual, in-depth semi-structured interviews with purposively selected Hispanic patients of a transplant institute (N =20). Data was analyzed using grounded theory methods to code, interpret symbols, and analytically frame the concepts to generate a model explicating the Hispanic transplant patient’s experience of care.

Results: The findings of this study provide an in-depth description of the patient experience through the perspective of Hispanic patients and provided insight into the elements crucial for a positive hospital admission. “Comfort,” “communication,” “connection,” and “care” emerged as interdependent concepts related to the patient experience process for this subset of patients. Further, “cultural context” was found to influence perception of each of these concepts.

Implications: The results of this study confirm that the HCAHPS survey measures experiential factors of importance to this sub-group of Hispanic patients, but it does not measure other factors that support positive hospital experience for this population. Hispanic patients are a heterogenous group and additional research is needed to better understand the influence of culture on the patient experience for Hispanic sub-groups. Further, mixed method approaches should be employed to garner more robust patient experience data.

Document Type

Dissertation: Open Access

Department

Nursing

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