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Patient orientation is a crucial point of information exchange, designed to support and enhance patient safety, comfort, and understanding during their hospital stay. Currently, most hospital patients receive face-to-face orientation with a nurse. The quality and content of orientation information can be affected by the nurse’s emotional state, job satisfaction, knowledge, and authenticity for the information conveyed, which can have a positive or negative impact on the patient.
Aim
Focusing on key hospital policies and protocols, in a regional New South Wales hospital and compared to routine ward orientation, the objective was to assess the efficacy of digital video orientation.
Methods
A two-group design was conducted utilising quantitative and qualitative approaches and drew on self-report, focusing on overall Understanding and Emotional Comfort. Participants (n = 35) were selected and randomly allocated into a digital orientation or face-to-face orientation group.
Findings
Emotional Comfort scores for both groups were found to be similar (p < 0.05 level, t(33) = 0.27, p = 0.09), while the digital orientation group was found to have significantly higher understanding of key hospital policy (t(33) = −3.98, p < 0.001). Additionally, there was a negative correlation (r = −0.45, p = 0.006) between age and self-reported understanding, revealing that the lower age groups had scored higher.
Discussion
This research has demonstrated that key concepts can be effectively communicated using a digital format.
Conclusion
It is recommended that this method of orientation be implemented and its efficacy continues to be evaluated.
The quality and content of orientation information can be affected by the nurse’s emotional state, job satisfaction, knowledge, and authenticity for the information conveyed, which can have a positive or negative impact on the patient.
What is already known
Digital video technology is beginning to emerge as an effective way of communicating health information and may provide a solution to the delivery of a consistent ward orientation experience for the patient.
What this paper adds
This research demonstrated that patients felt comfortable with digital video orientation and that key concepts can be effectively communicated using a digital format.
1. Introduction
Patient orientation is a crucial point of information exchange, designed to support and enhance patient safety, comfort, and understanding during their stay in the hospital (
Improvement of patient orientation and patient safety in health care: fom competency-based and interprofessional medical education to cross-sector care.
Improvement of patient orientation and patient safety in health care: fom competency-based and interprofessional medical education to cross-sector care.
). However, with the increasing prevalence of technology in the healthcare setting, digital video orientation may be an effective tool to improve the patient experience, save time, and support the consistent exchange of information (
The use of portable video media vs standard verbal communication in the urological consent process: a multicentre, randomised controlled, crossover trial.
In recent years, due to the nature of healthcare delivery, there has been a conceptual shift toward viewing the patient as a “customer”, meaning that ward orientation has become a “service” by which patients can measure quality of care (
). Perhaps, it is because patients are unable to access the technical side of their treatment, such as their plans of care or medical records, ward orientation plays a primary role in establishing the expectations of the patient, and has a direct impact on their behaviour, satisfaction, and commitment to care (
Improvement of patient orientation and patient safety in health care: fom competency-based and interprofessional medical education to cross-sector care.
). In most instances, orientation occurs as part of the greater admission process where nurses are required to complete a computerised checklist, while simultaneously explaining policies and processes. The quality and content of orientation information can be affected by the nurse’s emotional state, job satisfaction, knowledge, and authenticity for the information conveyed, which can have a positive or negative impact on the patient (
). The benefits associated with a positive exchange of information, have been linked to a reduction in patient anxiety, improvements in understanding, and a decrease in the need for ongoing follow-ups, which means there is value in improving this service (
Digital video technology is beginning to emerge as an effective way of communicating health information and may provide a solution to the delivery of a consistent ward orientation experience for the patient (
). Tested in a range of hospital settings throughout the world, digital video technology has shown promise in delivering patient education about medical interventions (
Impact of video on the understanding and satisfaction of patients receiving informed consent before elective inpatient coronary angiography: a randomized trial.
), significantly reduce anxiety levels, and impact patient satisfaction that has been shown to be associated with a shorter length of stay and improved patient outcomes (
The barriers associated with digital technology use in healthcare continue to be explored in this new and expanding area of research. A lack of digital literacy, knowledge, and confidence has been identified, particularly in the older population (
). Research suggests that knowledge and confidence may improve in this population, if digital technology is introduced in a way that is useful and manageable (
). Thus, when introducing digital video technology during orientation, it has potential to not only improve the process of information exchange and patient experience, but to also improve self-efficacy about the use of technology (
). This research, focused in a rural New South Wales (NSW) hospital and compared to routine ward orientation, aimed to assess the impact that a digital video orientation had on patient comfort, as well as understanding of key hospital policies and protocols.
3. Procedure
3.1 Design
A two-group comparative experimental design was conducted. Both pragmatism and critical realism contributed to the construction of a mixed methods approach that utilised patient self-report to focus on a hospital orientation experience. The design allowed for quantitative and qualitative responses to be considered together, thus providing verification and further dimensional meaning. According to
this type of purposeful data integration, enables a deeper perspective of findings and gives participants the opportunity to actually express their experiences and thoughts. Ethical approval was obtained from both Southern Cross University and NSW Health (Approval HREA257 — 2019/ETH12971).
3.2 Participants
Participants were selected from a group of patients within the medical ward of a regional hospital in NSW, Australia. Between the months of June and September 2019, newly admitted patients that met the eligibility criteria were invited to participate in the research. Patients were deemed eligible if they were above the age of 18 years old, had a Glasgow Coma Scale rating of 15/15, had all clinical observations within acceptable parameters, were not currently delirious, and had no other conditions that would impair their ability to watch a video on an iPad (
). For example, being sight- or hearing-impaired. Ethically, this criterion was necessary so as to not distract from the care of very sick patients.
3.3 Methods
Consenting patients were, dependent on their order of admission, allocated alternatively into either Group A or Group B. Both groups received orientation within 24 hours of their admission. Group A received digital orientation via an iPad, while Group B received orientation face-to-face with a nurse. A four-minute digital video was designed by the researchers in collaboration with hospital staff, for use by Group A to describe the same hospital policies and processes that would be given to Group B during face-to-face orientation. The orientation topics included information on hospital initiatives such as the “recognise, engage, act, call, help is on its way” REACH rule, medication administration, handover, hand hygiene, use of anti-slip socks, buzzer information, mealtimes and processes, and visiting hours. The language was kept simple and pictures were used as references (see Fig. 1). For both groups A and B, nursing staff, regardless of the orientation type, provided opportunity for any further questions.
Fig. 1Examples of digital video orientation content.
Following the completion of an orientation session, each participants was invited to complete a paper-based survey. This focused on a measure of emotional comfort and four further questions about specific aspects of the orientation.
3.4 Instrumentation
The validated Patient Evaluation of Emotional Comfort Experienced scale (PEECE) (
), was used to measure patient comfort. The PEECE is a 12-item questionnaire that is designed for the evaluation of the state of emotional comfort as a measure of wellbeing and intended for use with patients within the acute care hospital setting (
). The scale uses a four-point Likert scale, 0 = “not at all”, 1 = “very little”, 2 = “somewhat”, 3 = “very”, and 4 = “extremely”, to measure the extent to which a patient felt relaxed, valued, safe, calm, cared for, at ease, smiling, energised, content, in control, informed, and thankful.
The researchers designed four further questions to measure patient understanding of key components of hospital orientation, “I clearly understand the REACH rule”, “I clearly understand how to escalate my concerns after receiving this information”, “I clearly understand why I should be wearing my antislip socks”, and “I clearly understand how to operate my buzzer”. These responses were also measured using the four-point Likert scale that was adopted by the PEECE scale. An open-ended qualitative question was also included to gather participants’ opinions on their orientation experience: “Do you have any further comments about your orientation process and the way in which you received it?”.
3.5 Analyses
Basic demographics were collated such as age and gender. Complete data sets were imported into SPSS v.27 (IBM Corp: Armonk, NY) (
) for analysis. A measure of Comfort for each participant was calculated by adding all items of the PEECE. Mean values for both Comfort and Understanding were calculated and compared using t-tests with significance accepted at p < 0.05. T-tests were conducted to show the relationship between the two groups, with the digital orientation being the intervention and as such the independent variable. Additionally, an analysis of covariance (ANCOVA) was conducted to assess age and understanding across both groups. Qualitative data were collated into responses for either group and considered for key themes.
4. Results
During the period of data collection, approximately 94 patients were admitted to the ward. A total of 35 participants were recruited from June to September 2019. The average age of all participants was 72.40 years (±11.30). The average age of Group-A participants was 66.6 years (±10.9), while Group B was 77.9 years (±8.78). Group-A iPad orientation had slightly less participants (n = 17) than Group-B Face to Face orientation (n = 18). Group A had a slightly higher distribution of females (n = 9) to males (n = 8), whereas Group B had more males (n = 11) than females (n = 7).
4.1 Outcomes for emotional comfort for all participants
Utilising the PEECE scale, participants in both groups (N = 35) self-reported that they felt emotionally comfortable with the type of orientation that they had received (mean = 3.66, SD = 0.46). The overall response range was between 2.50 and 4, with the highest score possible being 4 (extremely emotionally comfortable).
4.2 Emotional comfort for the digital and face-to-face patient orientations
The independent-samples t-test showed that the one-degree-of-freedom contrast of primary interest was not significant at a specified p < 0.05 level, t(33) = 0.27, p = 0.09. The digital orientation score for emotional comfort (mean = 3.69, SD = 0.37) was very similar to the face-to-face orientation (mean = 3.64, SD = 0.52). Essentially, this has shown that the participants following both types of orientation self-reported that they were similarly emotionally comfortable.
4.3 Outcomes for understanding
Overall, the participants showed a good understanding of the four key orientation components. The role and importance of the buzzer showed the highest understanding (mean = 3.91, SD = 0.28), followed by how to escalate their concerns (mean = 3.60, SD = 0.73) and the use of the slip socks (mean = 3.57, SD = 0.82). Understanding of the REACH rule (mean = 3.17, SD = 1.29) was the lowest scoring of the four items but still well understood.
When compared, Group-A digital orientation was found to have a significantly higher understanding of the four key orientation components than group B t(33) = −3.98, p < 0.001. Group A also scored significantly higher in understanding of the individual orientation items; anti-slip socks, t(33) = 3.49, p < 0.001; REACH rule, t(33) = 3.29, p < 0.001; how to escalate concerns t(33) = 2.34, p < 0.001. There was no statistically significant difference between the groups for understanding of how to operate their buzzer t(33) = 0.54, p < 0.28. A summary of these results is shown in Table 1.
Table 1Scores for participant understanding of the use of the buzzer, wearing of antislip socks, recognise, engage, act, call, help is on its way (REACH) rule, and escalating of concerns.
4.4 Age differences and the impact upon the understanding scores
An independent t-test revealed that the groups were significantly different when considered for age. The digital group was significantly younger, t(33) = −3.39, p = 0.002. The mean value for the digital group (n = 17) was 66.59 years (SD = 10.99), whereas the face-to-face group (n = 18) had a mean age of 77.94 (SD = 8.78).
Using Age as the independent variable, an ANCOVA was conducted to explore its effect on the digital orientation group. Significance was again accepted at p < 0.05. The outcome was that the differences between groups were established, with the digital orientation group scoring higher for self-reported understanding.
However, the ANCOVA revealed that there was a negative correlation (r = −0.45) between group age and the self-reported understanding scores for both groups following the orientations and this was significant at p = 0.006. Hence, for the participants in both groups, the lower age groups scored higher on understanding and those who were older scored lower. Further to this, a Pearson correlation also indicated a negative association between the ages of the participants and the scores for self-reported understanding (r(35) = −0.45, p = 0.006). This correlation is demonstrated in Fig. 2.
Fig. 2Graph showing negative correlation between Age in Years and the Scores for Understanding for all participants (n = 35). Younger participants reported higher Likert scores for Understanding, while those who were older reported lower scores, r = −0.45, p = 0.006.
One of the most varied and interesting data responses found was within the qualitative comments section. Participants were asked whether they had any comments about their orientation and the way in which they received it. There was a 40% (n = 14) response rate to this question, with 85% (n = 12) of all responses coming from Group A.
Group B, face-to-face orientation, expressed that they were “fully satisfied” (participant 16) but their comments suggested that information exchange may have been inconsistent: “went smoothly and logically. Great treatment. No idea about the sock?” (participant 4). Group A digital orientation provided comments that could be grouped into themes that included enthusiasm for the iPad orientation and satisfaction with content and method of information exchange.
The digital orientation was mostly enthusiastically received, with participants indicating they were comfortable with the approach: “Great presentation and idea” (participant 11, group A), “great” (participant 7, group A), and “orientation on the computer is the way to go” (participant 2, group A). These comments are supported by the high comfort scores.
Participants from the digital orientation group also commented about the video: “Loved the video, very informative” (participant 5, group A), “the presentation is very informative” (participant 13, group A), “great video, very informative” (participant 17, group A). These comments indicate that participants found the information shared in the digital orientation was valuable and easy to understand.
The digital orientation group further communicated that they found that the format and content of the digital orientation were easy to engage with: “Excellent presentation- easy to understand- has relevant information in easy-to-use format” (participant 1, group A), “easy to follow” (participant 5, group A). “helpful and well explained (participant 16, group A), “The process was very clearly explained from the beginning. At every step, explanations were forthcoming, and questions answered to my satisfaction. Job well done!” (participant 15, group A). These comments further support the quantitative findings of increased understanding.
5. Discussion
With a focus on hospital orientation and the provision of meaningful information to patients, this research sought to evaluate the use of a digital video. The orientation was designed to improve patient experience. Importantly, when patients were directly asked about their experiences, they confirmed that this was a worthwhile way to introduce them to aspects of care while in hospital. This was further supported by the measures of emotional comfort and specific understanding. Overall, this research project demonstrated that key concepts of care could be effectively communicated via a digital video platform.
In order to appropriately convey health information that caters to all literacy levels, experts recommend that information should be shared in a succinct manner (
How to practice person-centred care: a conceptual framework.
Health Expectations: an International Journal of Public Participation in Health Care and Health Policy.2018; 21: 429-440https://doi.org/10.1111/hex.12640
). For particularly acutely ill patients, emotional comfort has been previously correlated with reported decreases in physical discomfort and also shortened lengths of hospitalisation (
). Research has also shown that patients who feel emotionally comfortable experience a greater sense of empowerment and engagement and are thus more likely to participate in activities to improve their health (
A framework of comfort for practice: an integrative review identifying the multiple influences on patients’ experience of comfort in healthcare settings.
). The framework of patient-centred care, and the healthcare system as a whole, relies upon patients’ understanding of often-complex written and spoken medical information (
Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review.
Digital technology is clearly emerging as an effective way of communicating simple health information. Traditionally, a gap has existed between the health literacy levels of health professionals and patients (
). As a result, if healthcare professionals do not adjust their information sharing to a level that is easily understood, a breakdown in communication can occur (
Patient attitudes toward digital technology are a key factor when considering its use and place within a patient-centred care framework. Previously, overall attitudes toward technology in general have been positive (
Attitudes towards the use and acceptance of eHealth technologies: a case study of older adults living with chronic pain and implications for rural healthcare.
). Existing research has mainly focused on measures of anxiety and satisfaction, which either affect or fall under the umbrella of comfort themselves, but are slightly different constructs (
Incidentally, with our participants, the digital orientation group were, on average, 10 years younger than those receiving face-to-face orientation. We did find that while understanding for both groups was at a good level, the younger group self-reported higher understanding. Previous research has suggested that younger patients are generally more adaptive when it comes to technology, while older patients tend to have negative attitudes and anxiety around new technology (
). In fact, a study analysing the use of an iPad to provide information about warfarin, was able to show that, when compared with older patients, those younger actually enjoyed using the iPad (
). These are interesting considerations if we are to move forward with the use of technology for orientation processes.
Owing to this evaluation being conducted in a small 16-bed ward with many long-term patients, the main limitation was the small sample. Moreover, due to ethical responsibility and eligibility criteria, the research understandably excluded some patients who were very sick, delirious, sensory impaired, or otherwise unable to view information on an iPad. Therefore, those that were included were those who were deemed coherent. Consequently, we recommend the conducting of a larger evaluation across different wards and if possible hospitals. Furthermore, Covid-19 has changed the way society communicates and thus technology is, at this time, more favourable than ever before (
It is recommended that digital orientation be implemented and its ongoing efficacy evaluated. To start, this type of orientation could be offered as an adjunct to traditional face-to-face orientation. We also recommend providing the information for a cross-section of cultural differences with provision in different languages. If successful, digital orientation may lessen the need for interpreters and improve the process of information sharing across a wider cohort of patient demographic.
Also recommended for validation and efficacy is that future research be conducted for a longer period of time and across multiple ward settings. An evaluation of the opinions of nurses and caregivers could also deepen current understanding of digital orientation and its value in healthcare delivery. Additionally and in many cases, families are translating and assisting patients, so their opinion would also contribute valuable knowledge.
The results of this research, conducted in one ward in a regional hospital, have been able to show that digital orientation can enable the delivery of information that supports the principles of the promotion of health literacy and patient engagement.
This paper does not regard a commercial product and the authors have not received support or funding to conduct the research or writing of this paper. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical statement
This study protocol was conducted according to the national statement on Ethical Conduct in Human Research (2007) and approved in December 2020 by both Southern Cross University and NSW Health (Approval HREA257 — 2019/ETH12971).
Previous submissions
The authors declare that no previous submissions have been made to other journals or organisations for this work.
Conflict of interest
None.
Acknowledgements
The authors would like to acknowledge Ryan Armstrong and the staff on the medical ward for their expertise and assistance throughout this project. Thank you to the Northern New South Wales Local Health District (NNSW LHD) for their support of this project. Portions of these findings were presented at NNSW LHD symposium.
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Attitudes towards the use and acceptance of eHealth technologies: a case study of older adults living with chronic pain and implications for rural healthcare.
Improvement of patient orientation and patient safety in health care: fom competency-based and interprofessional medical education to cross-sector care.
Impact of video on the understanding and satisfaction of patients receiving informed consent before elective inpatient coronary angiography: a randomized trial.
How to practice person-centred care: a conceptual framework.
Health Expectations: an International Journal of Public Participation in Health Care and Health Policy.2018; 21: 429-440https://doi.org/10.1111/hex.12640
Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review.
A framework of comfort for practice: an integrative review identifying the multiple influences on patients’ experience of comfort in healthcare settings.
The use of portable video media vs standard verbal communication in the urological consent process: a multicentre, randomised controlled, crossover trial.
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