Papers by Michelle Beattie
BMJ Open, Jun 1, 2016
To develop a structurally valid and reliable, yet brief measure of patient experience of hospital... more To develop a structurally valid and reliable, yet brief measure of patient experience of hospital quality of care, the Care Experience Feedback Improvement Tool (CEFIT). Also, to examine aspects of utility of CEFIT. Background: Measuring quality improvement at the clinical interface has become a necessary component of healthcare measurement and improvement plans, but the effectiveness of measuring such complexity is dependent on the purpose and utility of the instrument used. Methods: CEFIT was designed from a theoretical model, derived from the literature and a content validity index (CVI) procedure. A telephone population surveyed 802 eligible participants (healthcare experience within the previous 12 months) to complete CEFIT. Internal consistency reliability was tested using Cronbach's α. Principal component analysis was conducted to examine the factor structure and determine structural validity. Quality criteria were applied to judge aspects of utility. Results: CVI found a statistically significant proportion of agreement between patient and practitioner experts for CEFIT construction. 802 eligible participants answered the CEFIT questions. Cronbach's α coefficient for internal consistency indicated high reliability (0.78). Interitem (question) total correlations (0.28-0.73) were used to establish the final instrument. Principal component analysis identified one factor accounting for 57.3% variance. Quality critique rated CEFIT as fair for content validity, excellent for structural validity, good for cost, poor for acceptability and good for educational impact. Conclusions: CEFIT offers a brief yet structurally sound measure of patient experience of quality of care. The briefness of the 5-item instrument arguably offers high utility in practice. Further studies are needed to explore the utility of CEFIT to provide a robust basis for feedback to local clinical teams and drive quality improvement in the provision of care experience for patients. Further development of aspects of utility is also required.
Objective 1: To determine what domains capture the contemporary meaning of healthcare quality to ... more Objective 1: To determine what domains capture the contemporary meaning of healthcare quality to inform the development of a theoretical model of quality of healthcare.
Nurse Education Today, 2018
Systematic Reviews, Aug 1, 2020
Background: Psychological stress is a prevalent factor in inflammatory bowel disease (IBD) with d... more Background: Psychological stress is a prevalent factor in inflammatory bowel disease (IBD) with detrimental effects on patients' quality of life and possibly disease course. Although the aetiology of symptom exacerbation in IBD has been explored, determining any causation between psychological stress and symptom worsening remains challenging and requires a methodologically rigorous approach. Aim: The aim of this systematic review with meta-analysis was to determine a causal relationship between psychological stress and symptom exacerbation in IBD, subsequently utilising Bradford Hill's criteria (approach never used in this topic area before) to evaluate the likelihood of causal associations. Methods: Medline, EMBASE, CINAHL and PsycInfo were searched for relevant studies up to July 20, 2019. Data extraction and quality appraisal were performed by two independent reviewers. Results of all retained papers were presented as a narrative synthesis. A random-effect meta-analysis was conducted on studies meeting the criteria for meta-analysis. Bradford Hill criteria were applied to assess the causality of the relationship between all psychological factors and symptom exacerbation. Results: The searches yielded 2472 potential articles. Nineteen clinical prospective cohort studies were eligible for the narrative review with five suitable for the meta-analysis. Meta-analysis showed depression, anxiety and perceived stress did not have a statistically significant association with an increased risk of symptom exacerbation. Four of the Bradford Hill criteria were met which indicates that there is weak to moderate evidence of a causal association between all the psychological factors and disease activity. Inconsistent results and a dearth of studies using the same tools for measuring psychological factors suggest the need for more research to be done to facilitate more conclusive findings.
Rural and Remote Health, 2021
Introduction: Due to global nursing shortages, recruitment and retention of nurses is a major int... more Introduction: Due to global nursing shortages, recruitment and retention of nurses is a major international concern, exacerbated in Rural and Remote Health rrh.org.au
Journal of Research in Nursing, 2020
Background Global nurse shortages present a threat to the sustainability of remote and rural heal... more Background Global nurse shortages present a threat to the sustainability of remote and rural healthcare. Interventions have been developed to support recruitment and retention of nurses that focus on providing pre-nursing experience for school pupils who intend to pursue nursing careers. However, there is a lack of evidence around how pre-nursing experience supports transition into nurse education. Aims This study aims to explore the impact of a pre-nursing scholarship for school pupils in remote and rural areas of Scotland on experiences of transition into nurse education. Methods This was a qualitative study involving semi-structured telephone and face-to-face interviews with pre-nursing scholarship participants. Results An authentic pre-nursing experience supported school pupils’ transition to nurse education. First, it increased students’ self-efficacy, both in their decision to choose nursing as a career and their ability to nurse. Second, it helped students to realise that the...
the International Journal of Person-Centered Medicine, 2012
Rationale, aims and objectives: Devising indicators to measure quality of care is challenging in ... more Rationale, aims and objectives: Devising indicators to measure quality of care is challenging in Emergency Departments (ED). It is difficult to measure aspects of quality which are less amenable to measurement; hence waiting time has often been relied on. This study aimed to determine whether patients’ perceptions of empathy are a measurable indicator of quality of care in comparison to waiting time within the ED. Method: A cross sectional survey of patients who attended an ED during a 10 day period was conducted to assess correlation between a measure of empathy (the CARE measure), waiting times and perception of care quality. Data other than waiting times were obtained using a questionnaire completed by patients immediately on completion of treatment. Waiting times were obtained from an existing database. Both waiting times and CARE scores were correlated with responses to a patient satisfaction question using Spearman’s rho. Results: Of the 81 patients who participated the majori...
BMJ Open Quality, 2020
Reforming the delivery of outpatient appointments (OPA) was high on the healthcare policy agenda ... more Reforming the delivery of outpatient appointments (OPA) was high on the healthcare policy agenda prior to COVID-19. The current pandemic exacerbates the financial and associated resource limitations of OPA. Videoconsulting provides a safe method of real-time contact for some remotely residing patients with hospital-based clinicians. One factor in failing to move from introduction of service change to its general adoption may be lack of patient and public involvement. This project, based in the largest Island in the Inner Hebrides of Scotland, aimed to codesign the use of the NHS Near Me video consulting platform for OPA to take place in the patient’s home. A codesign model was used as a framework. This included: step 1—presenting a process flow map of the current system of using Near Me to public participants and establishing their ideas on various steps in the process, step 2—conducting numerous Plan, Do, Study, Act (PDSA) tests and creating a current process flow diagram based on ...
BMJ Open Quality, 2021
Increasing demand for outpatient appointments (OPA) is a global challenge for healthcare provider... more Increasing demand for outpatient appointments (OPA) is a global challenge for healthcare providers. Non-attendance rates are high, not least because of the challenges of attending hospital OPAs due to transport difficulties, cost, poor health, caring and work responsibilities. Digital solutions may help ameliorate these challenges. This project aimed to implement codesigned outpatient video consultations across National Health Service (NHS) Highland using system-wide quality improvement approaches to implementation, involving patients, carers, clinical and non-clinical staff, national and local strategic leads. System mapping; an intensive codesign process involving extensive stakeholder engagement and real-time testing; Plan, Do, Study, Act cycles; and collection of clinician and patient feedback were used to optimise the service. Standardised processes were developed and implemented, which made video consulting easy to use for patients, embedded video into routine health service s...
BMJ Open Quality, 2018
Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to sel... more Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments. The intensive care unit (ICU) at Raigmore Hospital, NHS Highland, initiated a quality improvement (QI) project using the Model for Improvement (MFI) to implement an analgesia-first approach utilising a validated and reliable behavioural pain assessment tool, namely the Critical-Care Pain Observation Tool (CPOT). Over a six-month period, the project deployed QI tools and techniques to test a...
Systematic Reviews, 2020
Background The use of survey instruments to measure women’s experiences of their maternity care i... more Background The use of survey instruments to measure women’s experiences of their maternity care is regarded internationally as an indicator of the quality of care received. To ensure the credibility of the data arising from these instruments, the methodological quality of development must be high. This paper reports the protocol for a systematic review of self-report instruments used to measure women’s experiences of their maternity care. Methods Citation databases CINAHL, Ovid MEDLINE and EMBASE will be searched from 2002 to 2018 using keywords including women, experience, maternity care, questionnaires, surveys, and self-report. Citations will be screened by two reviewers, in two rounds, for inclusion as per predetermined inclusion and exclusion criteria. Data extraction forms will be populated with data, extracted from each study, to evaluate the methodological quality of each survey instrument and the criteria for good measurement properties using quality criteria. Data will als...
International Journal of Health Care Quality Assurance, 2019
Purpose The purpose of this paper is to determine the relative influence of the different domains... more Purpose The purpose of this paper is to determine the relative influence of the different domains of healthcare quality from the Care Experience Feedback Improvement Tool (CEFIT) and identify key predictors of healthcare quality from the patients’ perspective. Measurement is necessary to determine whether the quality of healthcare is improving. The CEFIT was developed as a brief measure of patient experience. It is important to determine the relative influence of the different domains of healthcare quality to further clarify how the CEFIT can be used and identify key predictors of healthcare quality from the patients’ perspective. Design/methodology/approach In sum, 802 people with a healthcare experience during the previous 12 months were telephoned to complete the CEFIT questions and an additional 11-point global rating of patient experience. To estimate the influence of different domains of healthcare quality on patient overall ratings of quality of healthcare experience, the aut...
BMJ Open Quality, 2018
While the reported incidence of heroin use in the UK has reduced, related hospital admissions and... more While the reported incidence of heroin use in the UK has reduced, related hospital admissions and associated mortality have continued to increase. Prompt access to treatment (opiate replacement therapy (ORT) and counselling support) have been shown to reduce risk and offer clients the optimal route to recovery. The Specialist Drug and Alcohol Recovery Service (Osprey House) within National Health Service Highland had lengthy delays from referral to commencing ORT (median wait 56 days), which this project aimed to reduce.A rapid process improvement workshop (RPIW) was undertaken to redesign the patient pathway from referral to recovery. The RPIW consisted of three phases: phase I, planning and preparation (12 weeks before the workshop week); phase II, the workshop week; and phase III, the follow-up. Metrics included the lead time from referral to initiating ORT and other process measures at baseline, and then repeated at 30, 60, 90 and 180 days, respectively. Additionally, data were ...
BMJ open quality, 2018
Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with more emergency hospital admiss... more Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with more emergency hospital admissions due to adverse drug reactions than any other class of medicine. One way to tackle this is to ensure that patients understand how to take their NSAIDs in the safest way possible. The aim of this project was to ensure that key safety information is given to every patient, every time an NSAID is sold or dispensed. The project started as part of the Scottish Patient Safety Programme's Pharmacy in Primary Care Collaborative. An NSAIDs bundle was developed, tested and implemented using the Model for Improvement as a framework, including multiple Plan, Do, Study, Act cycles. The bundle, and associated improvement package, was developed during phase I of the project and tested by seven teams (five pharmacies and two dispensing practices). Phase II tested the spread of the defined improvement package across an additional five community pharmacies and eight dispensing general practitioner...
Higher Education Research & Development, 2016
Nursing Open, 2015
To develop a model of pre-nursing experience from evaluation of a pre-nursing scholarship for sch... more To develop a model of pre-nursing experience from evaluation of a pre-nursing scholarship for school pupils in Scotland. Design Action research study. Methods School pupils (n = 42) completed questionnaire surveys and participated in anecdote circles. Student nurses acting as pupil 'buddies' (n = 33) participated in focus groups. Descriptive quantitative data and thematic analyses of qualitative data were integrated across cohorts and campuses. Results Ten recommended components of a model of pre-nursing experience were identified: educational experience of: (1) face-to-face on-campus teaching; (2) hands-on clinical skills sessions; and (3) andragogy, practice exposure to (4) nursing language; (5) nurses' emotional labour; (6) patients' stories; (7) pupils socializing with buddies; (8) buddies planning placement activities; and (9) supporting pupils during placements. Academic attainment was not a central component of the model due to pupils' need to (10) prioritize examined work for further/higher education entry.
Journal of Research in Nursing
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Papers by Michelle Beattie