Form #8 Form #8 Focus Group with Patients' Family Protocol

A

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

HRQ PFE Guide Focus Groups

Post-Implementation Protocol–Family members, Component 1

July 1, 2010

Research design

• AIR will conduct a total of 9 focus groups with patients and family members during the post-implementation period (3 groups at each of 3 hospitals). At each hospital we will conduct:

  • 1 group of 6-8 patients – Focus on Component 1

  • 1 group of 6-8 family members – Focus on Component 1 (this protocol)

  • 1 group of 6-8 patients and family members – Focus on Component 2

Recruitment criteria

• Family members of patients who stayed overnight in the hospital unit where the intervention was implemented from [MONTH, YEAR] to [MONTH, YEAR] and who spent at least some time in the hospital with their family member

• Family members defined as: immediate family member, close relative, or close friend

• As possible, mix of age, sex, race/ethnicity

Testing materials

• Copies of intervention materials

• Informed consent forms (1 copy for participant to sign, 1 copy for participant to keep)

• Incentive receipt forms

• Incentives Moderator time clock

• Name placards

Obtain informed consent

As participants arrive, have them read and sign the informed consent form. Give each person an unsigned copy of the form to keep.

Public reporting burden for this collection of information is estimated to average 90 minutes per response, the estimated time required to complete the group. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

PFE Focus Group with Family members– Component 1

Topic

Introduction (welcome; background, ground rules)

Warm-up --brief introductions

Background

Communication Packet

Bedside Change of Shift Report

Discharge Plan

General Experience

Closing

Introduction

INSTRUCTIONS:

AS PARTICIPANTS ARRIVE, GREET PARTICIPANTS AND GIVE THEM INFORMED CONSENT FORMS (1 TO SIGN, 1 TO KEEP).

1. Welcome

Thank people for coming.

2. Background—explain purpose of the group

• Hello. My name is {NAME} and I’m the moderator for today’s discussion.

I’m here with {NOTE-TAKER}, who will be taking notes. We both work for a company called the American Institutes for Research, which is an independent non-profit research organization.

• Our group discussion today is part of a project being funded by a governmental organization known as the Agency for Healthcare Research and Quality to develop a guide to patient and family engagement around the issues of hospital safety and quality.

• The purpose of this interview today is to talk about some of your experiences as a family member during your loved one’s most recent hospital stay at [HOSPITAL NAME]. In particular, we would like to discuss your reactions to materials that you and your loved one may have received and interactions you may have had with their health care providers at the hospital.

• Nothing that you say or share today will affect the patient’s treatment or care at the hospital. We will not share your name or connect your name with anything that you say.

• We are taping the discussion so that we can share what you say with other people who are working on this project.

• Questions?

3. Go over ground rules.

• During our discussion today, you may hear personal information about fellow participants. Please keep this information to yourself and within this room in order to be respectful of others’ privacy.

• We want to hear from everyone and want your honest opinions and reactions. There are no wrong answers—feel free to disagree.

• Don’t need to wait for me to call on you—though I may need to interrupt from time to time to keep the discussion moving. We have a lot to cover, so we can’t spend too long on just one topic.

• Since we’re recording, it’s very important for us to have only one person speaking at a time. So please take turns—let’s give everyone a chance to share their opinions.

• Also, because we’re recording, please try to speak in a voice at least as loud as the one I’m using now so that we can hear everyone on the tape.

• Location of bathroom.

• Turn off cell phones or set to vibrate.

• Questions?

Warm-up

Brief introductions

Let’s start with brief introductions. We’ll go around the table.

Starting with {name, seat #1},

1. Please give your first name only and then briefly tell us your relationship to the patient and about their most recent hospital stay at [HOSPITAL NAME].

   1. Why were they in the hospital?

   2. How long was their most recent stay for?

Background

I’d like to start our discussion today by asking some general questions about your experience as a family member during your loved one’s most recent hospital stay at [HOSPITAL NAME]. For purposes of our discussion today, I’m going to ask you to focus on the time that your loved one was a patient on the medical/surgical unit [INSERT UNIT NAME].

2. Tell me about your loved one’s most recent experience(s) at the hospital. Overall, would you say that it was a good experience or bad experience? For what reasons?

3. Under what circumstances were they admitted to the hospital?

   1. Was their admission to the hospital planned or unplanned?

   2. What did you think of the admissions process?

   3. What went well? What could have been improved?

4. In general, what was your experience like as a family member at the hospital?

1. Where did you stay?

2. How long did you stay?

3. Were you allowed to be with your loved one as much as you wanted?

4. Was there any time that you were asked to leave?

5. How involved did your loved one want you to be in their care? How were you involved? What kinds of things did you do to help them during their hospital stay?

Let’s talk a little bit about the health care providers that you interacted with during your loved one’s most recent hospital stay.

6. What doctor(s) did you interact with during your loved one’s hospital stay?

5. How often did you see the doctor(s)?

6. Did you talk to the doctor(s)? What kinds of things did you talk about?

7. How did the doctor(s) treat you? Did the doctor(s) treat you like an important member of the care team?

8. Did you feel wanted or included by the doctor(s)?

9. Were you able to voice any concerns you had regarding your loved one’s care? Did the doctor(s) listen to your concerns? Did you understand when the doctor(s) explained things to you?

10. Did the doctor(s) encourage you to ask questions, or not?

11. What kinds of questions did you ask the doctor(s)?

7. Tell me about your interactions with the nurse(s) who cared for your loved one during their hospital stay.

1. How often did you see the nurse(s)?

   1. Did you talk to the nurse(s)? What kind of things did you talk about?

   2. How did the nurses treat you? Did the nurses treat you like an important member of the care team?

   3. Did you feel wanted or included by the nurse(s)?

   4. Were you able to voice any concerns you had regarding your loved one’s care? Did the nurse(s) listen to your concerns? Did you understand when the nurse(s) explained things to you?

   5. Did the nurse(s) encourage you to ask questions, or not?

   6. What kinds of questions did you ask the nurse(s)?

8. Tell me about any other hospital staff that you remember interacting with from your loved one’s hospital stay. This could include staff such as nutritionists, respiratory therapists, physical or occupational therapists, and pharmacists.

12. What were these interactions like?

9. As a family member, were you able to get the information and answers about your loved one that you needed?

Communication Packet

[If the hospital ADMINISTERED the communication packet as a strategy, proceed to this section]

Now, let’s talk about when your loved one was first admitted to the hospital.

I am going to hand out some materials. [Describe the materials.] These are materials that the hospital should have given to the patient when they were admitted to the hospital.

10. How many people remember their loved one getting these materials? [COUNT SHOW OF HANDS]

11. How did they get these materials? (e.g., were they given to them when they checked in?)

    1. Did you see/read the materials?

    2. Who gave them to you to read? Your loved one or someone at the hospital?

12. Did any of the doctors or nurses mention these materials to you during your loved one’s hospital stay?

13. What were your reactions to these materials? [FOR THOSE WHO DON’T REMEMBER OR DIDN’T GET THEM: Take a minute to review these materials now. What do you think of them?]

1. Did you find the information helpful, or not?

2. Did you find the information easy to understand?

3. What did you like best? Was there anything you would have changed?

14. Why do you think the hospital gave you and your loved one these materials? What do you think they wanted you to do with them?

15. How, if at all, did you use the information in these materials during your loved one’s hospital stay?

16. How, if at all, did your loved one use the information in these materials during their hospital stay?

17. Did the information in the packet help you communicate with the doctor(s) and/or nurse(s)? Why or why not?

18. Did the information in the packet help you ask questions? Raise concerns? Feel more comfortable and confident talking to your loved one’s health care providers?

19. Did the information you received in the packet improve your experience at the hospital and the care your loved one received? Why or why not?

20. Did the information you received in the packet help you feel like a part of the medical team? Why or why not?

21. Would you like to see other hospitals using these materials?

Bedside Change of Shift Report

[if the hospital administered THE BEDSIDE CHANGE OF SHIFT REPORT as a strategy, proceed to this section]

As you may know, nurse shift changes occur when nurses who are going off duty share information about the patient with nurses coming on duty. At this hospital, this shift change may have happened at your loved one’s bedside.

22. Do you remember if this (i.e., bedside change of shift) happened during your loved one’s stay?

If YES,

1. Were you present during the bedside change of shift?

2. Tell me about what the shift change was like for you.

3. What did the nurses do?

4. How, if at all, did you participate in the process?

5. Did you find this helpful, or not?

   1. If YES, how so?

   2. If NO, why not?

6. How involved did you feel during the change of shift report? Were you involved as much as you wanted to be?

7. Were you satisfied with the way information about your loved one’s care was passed on from the nurse who was going off duty to the nurse who was coming on duty?

8. Were you able to ask any questions during this time? What types of questions did you ask? Were your questions answered?

9. Did you have the kind of information you needed in order to participate in the bedside change of shift?

10. Did you feel that your loved one’s information was shared in a respectful manner? Did you have any concerns about confidentiality?

11. How, if at all, did participating or being present for the bedside change of shift report contribute to how you felt as part of the medical team?

If NO,

1. Were you given the opportunity to be present and participate in shift changes?

2. Did anyone ever mention it to you?

Now, I am going to hand out some additional materials. These are materials that the hospital also should have given to you and your loved one during your hospital stay to help you understand how to participate in the bedside

23. How many people remember their loved one getting these materials? [COUNT SHOW OF HANDS]

24. How did you get these materials? (e.g., when were they given to you? when you checked in?)

    1. Did you see/read the materials?

    2. Who gave them to you to read? Your loved one or someone at the hospital?

25. Did your doctors or nurses mention these materials during your loved one’s stay?

26. What were your reactions to these materials? [FOR THOSE WHO DON’T REMEMBER OR DIDN’T GET THEM: Take a minute to review these materials now. What do you think of them?]

1. Did you find the information helpful, or not?

2. Did you find the information easy to understand?

3. What did you like best? Was there anything you would have changed?

27. Why do you think the hospital gave you and your loved one these materials? What do you think they wanted you to do with them?

28. How, if at all, did you use the information in these materials during your hospital stay?

29. Did the information in these materials prepare you to participate in the shift change process the way that you wanted to? Why or why not?

30. Did the information in these materials help you communicate with the doctor(s) and/or nurse(s)? Why or why not?

31. Did the information in these materials help you ask questions? Raise concerns? Feel more comfortable talking confidently to your loved one’s health care providers? Make you feel like a part of the medical care team?

32. Would you like to see other hospitals using these materials?

Discharge Plan

[If the this hospital Administered THE DISCHARGE PLAn as a strategy, proceed to this section]

I’d like to talk to you about what happened when your loved was getting ready to leave the hospital.

33. When did someone at the hospital start talking to you and your loved one about getting ready to leave the hospital or what would happen after you left the hospital? (Probe for: at what point during the hospital stay was discharge discussed.)

34. Were you included in this discussion?

35. What kinds of things did the hospital do to help your loved one get ready to leave the hospital? What worked well? What could have been improved?

1. Did you feel that your loved one was ready to leave the hospital? Why or why not?

2. Did you feel that you were ready to leave the hospital and had the information you needed to take care of your loved one after discharge?

3. Did your loved one have any problems with their health when they got home? Did you have any difficulties caring for them after they got home? Was there anything that could have been done before you and your loved one left to make this transition easier, or not?

I am going to hand out some materials you and your loved one may have gotten prior to their discharge.

36. How many people remember their loved one getting these materials? [COUNT SHOW OF HANDS]

37. How did you get these materials? (e.g., when were they given to you?)

    1. Did you see/read the materials?

    2. Who gave them to you to read? Your loved one or someone at the hospital?

38. Did the doctor(s) or nurse(s) mention these materials to you at any point during your loved one’s stay?

39. Why do you think the hospital gave you and your loved one these materials? What do you think they wanted you to do with them?

40. What were your reactions to these materials? [FOR THOSE WHO DON’T REMEMBER OR DIDN’T GET THEM: Take a minute to review these materials now. What do you think of them?]

1. Did you find the information helpful, or not?

2. Did you find the information easy to use?

3. What did you like best? Was there anything you would have changed?

4. How, if at all, did you use the information in these materials (either during or after your loved one’s hospital stay)?

5. Did these materials help you feel like a part of the medical care team?

6. Would you like to see other hospitals use these materials?

41. Did you feel that the hospital included you in the decisions that needed to be made while your loved one was preparing to leave the hospital? How so?

General Experience

42. Overall, on a scale from 1-10 with 1 being the worst care possible and 10 being the best care possible, how would you rate the quality of care your loved one received during their recent hospital stay? Please tell me more about that. How did you come up with that number? What contributed to the quality of care they received?

43. Overall, how would you rate the safety of care your loved one received during their recent hospital stay? Please tell me more about that. How did you come up with that number? What contributed to the safety of care you received?

1. Probe if necessary: What happened that made your loved one feel safe? How did the doctor(s) and/or nurse(s) make them feel safe?

2. Probe if necessary: What happened that made them not feel safe?

44. Were you able to participate in your loved one’s care as much as you wanted? Tell me about that. How did you want to participate?

1. Probe for specifics about what it means to them to participate in care.

45. How confident did you feel about your ability to participate in your loved one’s care?

46. Did you feel like your loved one’s health care providers wanted you to participate in their care?

47. How important is it to you to be involved in decision making with your love one’s doctor or other medical staff?

48. How important is it to you to be a partner in care with your loved one and their doctor or other medical staff?

49. How you would you compare the experience you had during this hospital stay to previous stays at this hospital? At other hospitals? If there are differences, why or how was the experience different this time?

Closing

Before we end, I’d like to give everyone a chance to share any additional thoughts or comments about the things we talked about today. Is there anything that you didn’t have a chance to say during our discussion today, or something that we didn’t talk about that you wish we had, or any other thoughts you’d like to share with us?

Thank you very much for participating in this discussion today. We appreciate your time.

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