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AN INDEPENDENT VOICE FOR NURSING
SAID ANOTHER WAY
Engaging Patients in Their Care Versus Obscurantism Huey-Ming Tzeng, PhD, RN, FAAN, Chang-Yi Yin, MA, and Kara Fitzgerald, BSN Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Student Affairs and Program Compliance, College of Nursing, Washington State University, Spokane, WA; Chang-Yi Yin, MA, is Professor, Department of History, Chinese Culture University, Taipei, Taiwan; and Kara Fitzgerald, BSN, is Staff Nurse, Kootenai Health, Coeur d’Alene, ID. Keywords Consumer involvement, hospital, nursing care, patient, patient engagement, safety Correspondence Huey-Ming Tzeng, PhD, RN, FAAN, College of Nursing, Washington State University, P.O. Box 1495, Room 167, Spokane, WA 99210-1495 E-mail: [email protected] [Correction added after first online publication on 24 August 2014: The title of the author has been changed to “Huey-Ming Tzeng, PhD, RN, FAAN, Professor of Nursing and Associate Dean for Student Affairs and Program Compliance.”] Source of support: None. Conflict of interest: The authors declare that they have no conflict of interest.
PROBLEM. Could engaging patients in their care be a means to oppose obscurantism? Obscurantism is defined by Merriam-Webster as “the practice of keeping knowledge or understanding about something from people”. METHODS. This paper discusses the importance of promoting patient engagement and emphasizes that patients and healthcare providers are equally important stakeholders in health care. FINDINGS. The discussion occurs in the context of hospital inpatient care as nurses play a critical role in patients’ hospitalization experience, including engaging patients in their own care during hospital stays. Paternalism of healthcare providers is recognized as one of the main barriers to integrating the concepts of patient engagement and patient centeredness into every aspect of the care system. Promoting patient engagement is a two-way responsibility, and it requires the cooperation of both patients and healthcare providers. CONCLUSIONS. As scientists and healthcare providers, we have the duty to counter obscurantism by promoting understanding of the health of individual citizens and society at large. A culture change in healthcare systems toward being patient-centric and placing value on patient engagement is warranted, and this change must come from healthcare providers. Patient-centered tools that support patient engagement, patient portals, or personal health records are still needed.
Introduction Nurses play a critical role in patients’ hospitalization experience, including engaging patients in their own care during hospital stays. While in the setting of inpatient care, patients spend more time with nurses than with any other healthcare providers. Strategies that will promote and sustain bedside staff nurses’ effort to 196 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 50, No. 3, July-September 2015
engage patients are central to improving patients’ experience during hospitalization and should be a focus (Dempsey, Reilly, & Buhlman, 2014). Could engaging patients in their care be a means to oppose obscurantism? Obscurantism is defined by Merriam-Webster (2014) as “the practice of keeping knowledge or understanding about something from people.”
H.-M. Tzeng et al. During an informal meeting related to seniors’ risks for falling and how to engage them in fall prevention care, held at a senior center in the northwest United States, an elderly woman offered her comments after testing a patient engagement tool (Tzeng & Yin, 2014) to help the authors gain a full understanding of the meaning of patient engagement in health care. She shared with us: “It’s all about me!” She expanded to say that when using the patient engagement tool, the process—by centering on herself, her fall risks, and the things she could do to prevent falls—made her put herself first. Moreover, it was presented in a way she could easily understand the information. Our takehome message from the conversation is that patient engagement is about promoting patient-centeredness and about countering obscurantism in healthcare information. In this short paper, we discuss the importance of promoting patient engagement, and emphasize that patients and healthcare providers are equally important stakeholders in health care. The duty of healthcare providers to counter obscurantism in the healthcare context is described, followed by a call to support the movement for patient engagement. The discussion occurs in the context of hospital inpatient care. Importance of Promoting Patient Engagement Patient engagement in hospital care could lead to measurable improvements in safety and quality because there are shared accountabilities between each patient and his or her healthcare provider that are required to make the partnership effective in delivering care (Agency for Healthcare Research and Quality, 2013; Carlson, Patterson, & Holm, 2014; National Alliance for Quality Care, 2012). Fully involving patients in their care is a not-so-secret tactic to transform care, which may lead to fewer preventable rehospitalizations and improve patients’ health literacy and their satisfaction levels with the hospital care they receive. Patients who are being active participants in their own care could help prevent harm during hospital stays (e.g., falls and medication errors). However, patients have often been passive recipients of care (Stempniak, 2014). As discussed in the article written by Stempniak (2014), paternalism of healthcare providers, an attitude of “we [healthcare providers] know what is best,” is recognized as one of the main barriers preventing the concepts of patient engagement and
Said Another Way patient-centeredness from being integrated into every aspect of the care system. The movement of promoting patient engagement is a two-way responsibility, which requires the cooperation of both patients and healthcare providers. One of the approaches to counter obscurantism is to engage patients in their care. It is rarely recognized that patients’ insights and experience could help healthcare providers and hospital administrators build an efficient, high-quality, and safe care delivery system. This paternalistic view can be changed by promoting and accepting patient engagement (Stempniak, 2014). In summary, the benefits of patient engagement transcend the relationship between care providers and patients, and patient engagement is a key component that can aid in transforming health care. Patient engagement is a concept that should be a main focus for care providers.
Patients and Healthcare Providers as Two of the Stakeholders in Health Care Stakeholders in health care (e.g., patients and healthcare providers) should include all who have a legitimate interest in the process or outcome of care. Stakeholder engagement is warranted due to limitations of clinical evidence and potential policy implications, and it is based on the principles of transparency and democracy (Cluzeau et al., 2012; Cornel, van El, & Dondorp, 2012). It is important to include interested stakeholders, who are the ultimate recipients of the desirable and undesirable impacts of such factors as decision making in the treatment or self-care, hospital policy, or program development and implementation. Components of developing guidelines for treating chronic obstructive pulmonary disease or building a governance infrastructure for genomic screening can be attributed to collaboration of stakeholders (Cluzeau et al., 2012; Cornel et al., 2012). The potential benefits of engaging stakeholders include creating policies or programs that address their concerns, improved implementation of policies, improved healthcare delivery, and better health outcomes. A parallel to this topic is public engagement, which is a process to encourage participation and public accountability, and to promote transparency (Oxman, Lewin, Lavis, & Fretheim, 2009). By the same logic, patient engagement can be viewed as a process to encourage patients’ participation in policy and program development and implementation 197
© 2014 Wiley Periodicals, Inc. Nursing Forum Volume 50, No. 3, July-September 2015
Said Another Way within healthcare systems, patients’ accountability for their own care, and transparency in decision making for care.
Engaging Patients as Opposing Obscurantism in Health Care As scientists and healthcare providers, we have the duty to counter obscurantism by, for example, promoting the understanding of the health of individuals and the society at large (Bossert & Galliot, 2012). A government may have a policy of obscurantism, which is undertaken with the intent to withhold knowledge from the general public (Merriam-Webster, 2014). In The Analects of Confucius, Taber chapter, the ninth verse, Confucius (551–479 B.C.) said that the public should be guided into abiding by regulations, and the public has no need to be aware of the reasons behind them (Chinese Text Project, 2013). In the last 50 years, a modern interpretation of the same verse has surfaced and has been widely adopted; the government should implement a new rule if the public agrees with it, and the government should clearly explain the new rule to the public if the public does not comprehend the reasons behind it (Chinese Text Project, 2013). The first interpretation of Confucius’ teaching promotes obscurantism in an ancient Chinese empire context. The second one emerged in a modern democratic Chinese society, which emphasizes the need to engage the public in implementing regulations by increasing the awareness of the public regarding the situations that the public is encountering. In the healthcare context, the movement for engaging patients in their own care is a movement away from obscurantism. Patient engagement must first be initiated by health authority parties (e.g., physicians and nurses in the care continuum) by involving patients in their health and their own care. Healthcare agencies and healthcare providers may encourage collaboration among patients through, for example, selfmanagement workshops for patients with chronic disease, or by giving patients the tools to help them understand and improve their conditions, sustain improvements, and respond to any changes in their conditions. Helping patients understand their health empowers them with the knowledge needed to stay healthy. Patients being engaged in their own care are more eloquent in communicating their own needs than those who are disengaged (Budryk, 2013; Robert Wood Johnson Foundation, 2014). 198 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 50, No. 3, July-September 2015
H.-M. Tzeng et al. Supporting the Movement of Patient Engagement In the article “A daughter’s frustration with the dearth of patient-and family-centered care” written by Brach (2014), she claims that health care with truly patient-centeredness is the exception rather than the norm. Brach, as a family partner, demands a healthcare facility that is committed to involve patients and their families to the healthcare venture, such as making time to engage patients and their families, and to honor their preferences. The healthcare system as a whole needs to strive to hard-wire the concept of patient-centered care across the spectrum of care. Brach suggested strategies such as engaging patients and families in identifying the opportunities for improvement, and involving patients and families in the quality improvement process within a healthcare facility. Engaging patients and their families as the partners in their respective healthcare-seeking journeys is a determination that requires top-to-bottom changes of the healthcare system as a whole and each individual healthcare facility. A change in the culture of healthcare systems (e.g., setting up policies) toward being patient-centric and valuing patient engagement is warranted, and the first step toward this change must come from health authority parties. These parties should seek to make their practice transparent by involving healthcare customers (e.g., patients and their families) in quality improvement efforts (Robert Wood Johnson Foundation, 2014). In a survey study of 40 physicians and 40 nurses in a teaching hospital located in London, United Kingdom, Davis and associates (Davis, Sevdalis, & Vincent, 2012) found that both physicians and nurses have positive opinions about patient involvement. Nurses are more willing to support patient involvement than physician colleagues. A consumer representative in the state of Maine in the United States reported that patients are willing and motivated to share their experiences with their providers, and they appreciate that their providers truly care but had not previously been aware of patients’ perspectives (Robert Wood Johnson Foundation, 2014). A survey study conducted by Davis and associates (Davis, Sevdalis, & Vincent, 2011) found that 80 hospitalized medical and surgical patients at an inner city London hospital were less willing to participate in interactional behaviors (e.g., asking physicians or nurses factual or challenging questions and notifying errors or problems) than in non-interactional behav-
Said Another Way
H.-M. Tzeng et al. iors (e.g., bringing the medicines used preadmission and sharing a list of allergies with healthcare providers at admission, choosing a hospital based on the safety record, and reporting an error experienced during a hospital stay to a national reporting system). Physicians’ and nurses’ encouragement appeared to increase patient-reported willingness to participate in interactional behaviors during hospitalization (Davis et al., 2011). Another study found that hospitalized patients could identify more than 83% of the undesirable events that occurred during their care in the hospital and were reported in their medical records (i.e., medical complications, healthcare process issues, and interpersonal problems) (Davis, Sevdalis, Neale, Massey, & Vincent, 2013). There are three components to safety-related behaviors that patients may be involved in: (a) the type of error the patient tries to prevent (e.g., not receiving a medication), (b) the action taken by the patient (e.g., asking questions), and (c) the traits of the action (e.g., interacting with a healthcare provider) (Davis, Sevdalis, Jacklin, & Vincent, 2012). A recent study (Davis, Sevdalis, Pinto, Darzi, & Vincent, 2013) found that both videos and leaflets could be effective in increasing patients’ perceived comfort levels in their involvement in some safety-related behaviors during hospital stays. Health information technology (HIT) tools are seen as being critical to the success of new models of care delivery. Clinically focused HIT tools have been widely adopted in outpatient clinics. Patient-centered HIT tools that support patient engagement, patient portals, and personal health records are not in widespread use, however (Adler-Milstein & Cohen, 2013). In other words, HIT tools have mainly been clinically centered. A literature review (Househ, Borycki, & Kushniruk, 2014) performed in 2012 examined the use of social media technology by patients, as well as patients’ perspectives of the benefits and challenges associated with this. The results showed that the use of social media technology is an emerging trend for patients who are seeking health information across the healthcare continuum. Evidence related to the efficacy and effectiveness of patient use of social media for improving patient engagement and community building is limited (Househ et al., 2014). In short, patient-centered tools that support patient engagement (e.g., via social media technology), patient portals, or personal health records have been perceived useful; however, more are still needed.
Conclusion Patient engagement is about promoting patientcenteredness. Engaging patients in their care could be a means to oppose obscurantism. Patients and healthcare providers are equally important stakeholders in healthcare delivery. As for the practical implications, educators in healthcare fields (e.g., medical, nursing, physical therapy) must prepare healthcare providers to effectively engage patients in their care in the continuum of care within their practice. It is equally important to pursue strategies initiated by nurses, physicians, pharmacists, and other allied healthcare providers that will promote and sustain effort in patient engagement across the care continuum. References Adler-Milstein, J., & Cohen, G. R. (2013). Implementing the IT infrastructure for health reform: Adoption of health IT among patient-centered medical home practices. AMIA Annual Symposium Proceedings, 2013, pp. 11–16, Washington, DC. Agency for Healthcare Research and Quality. (2013). Guide to patient and family engagement in hospital quality and safety. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved February 18, 2014, from http:// www.ahrq.gov/professionals/systems/hospital/ engagingfamilies/index.html?utm_medium=email&utm _source=govdelivery Bossert, P., & Galliot, B. (2012). How to use hydra as a model system to teach biology in the classroom. International Journal of Developmental Biology, 56(6/7/8), 637– 652. Brach, C. (2014). A daughter’s frustration with the dearth of patient-and family-centered care. Patient Experience Journal, 1(1), 43–47. Budryk, Z. (2013). 3 ways to boost patient engagement. FierceHealthcare, March 11, 2014. Retrieved March 13, 2014, from http://www.fiercehealthcare.com/story/3ways-boost-patient-engagement/2014-0311?eid=%%__AdditionalEmailAttribute1%% Carlson, D., Patterson, L., & Holm, M. (2014). The new rules of engagement. Washington Nursing Commission News, 8(1), 14. Chinese Text Project (no author). (2013). The analects of Confucius: Taber. Retrieved March 10, 2014, from http:// ctext.org/analects/tai-bo/zh Cluzeau, F., Wedzicha, J. A., Kelson, M., Corn, J., Kunz, R., Walsh, J. & Schünemann, H. J. (2012). ATS/ERS Ad Hoc Committee on Integrating and Coordinating Efforts in COPD Guideline Development. Stakeholder involvement: How to do it right: Article 9 in integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report. Proceedings of the American Thoracic Society, 9(5), 269–273. Cornel, M. C., van El, C. G., & Dondorp, W. J. (2012). The promises of genomic screening: Building a governance 199
© 2014 Wiley Periodicals, Inc. Nursing Forum Volume 50, No. 3, July-September 2015
Said Another Way infrastructure. Special issue: Genetics and democracy. Journal of Community Genetics, 3(2), 73–77. Davis, R. E., Sevdalis, N., Jacklin, R., & Vincent, C. A. (2012). An examination of opportunities for the active patient in improving patient safety. Journal of Patient Safety, 8(1), 36–43. Davis, R. E., Sevdalis, N., Neale, G., Massey, R., & Vincent, C. A. (2013). Hospital patients’ reports of medical errors and undesirable events in their health care. Journal of Evaluation in Clinical Practice, 19(5), 875–881. Davis, R. E., Sevdalis, N., Pinto, A., Darzi, A., & Vincent, C. A. (2013). Patients’ attitudes towards patient involvement in safety interventions: Results of two exploratory studies. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 16(4), e164–e176. Davis, R. E., Sevdalis, N., & Vincent, C. A. (2011). Patient involvement in patient safety: How willing are patients to participate? BMJ Quality & Safety, 20(1), 108–114. Davis, R. E., Sevdalis, N., & Vincent, C. A. (2012). Patient involvement in patient safety: The health-care professional’s perspective. Journal of Patient Safety, 8(4), 182–188. Dempsey, C., Reilly, B., & Buhlman, N. (2014). Improving the patient experience: Real-world strategies for engaging nurses. Journal of Nursing Administration, 44(3), 142–151. Househ, M., Borycki, E., & Kushniruk, A. (2014). Empowering patients through social media: The benefits and challenges. Health Informatics Journal, 20(1), 50–58.
200 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 50, No. 3, July-September 2015
H.-M. Tzeng et al. Obscurantism. (2014). In Merriam-Webster. Retrieved March 10, 2014, from http://www.merriam-webster.com/ dictionary/obscurantism National Alliance for Quality Care. (2012). Guiding principles for patient engagement. Retrieved February 2, 2014, from http://www.naqc.org/Main/Resources/2012-Nurses ContributionsFosteringSuccessfulPatientEngagement.pdf Oxman, A. D., Lewin, S., Lavis, J. N., & Fretheim, A. (2009). SUPPORT tools for evidence-informed health policymaking (STP) 15: Engaging the public in evidenceinformed policymaking. Health Research Policy and Systems, 7(Suppl. 1), S15. Retrieved April 4, 2014, from http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC3271826/ Robert Wood Johnson Foundation. (2014). Patient engagement—What we’re learning: Engaging patients improves health and health care. Quality Field Notes, 3, 1–3. Retrieved March 13, 2014, from http://www.rwjf .org/content/dam/farm/reports/issue_briefs/2014/ rwjf411217 Stempniak, M. (2014). Your not-so-secret weapon to transform care. Hospitals & Health Networks / AHA, 88(2), 57–60. Retrieved April 4, 2014, from http://www.hhnmag.com/ display/HHN-news-article.dhtml?dcrPath=/ templatedata/HF_Common/NewsArticle/data/HHN/ Magazine/2014/Feb/fea-patient-engagement Tzeng, H. M., & Yin, C. Y. (2014). i Engaging as an innovative approach to engage patients in their own fall prevention care. Patient Preference and Adherence, 8(May), 693–700.
AN INDEPENDENT VOICE FOR NURSING
SAID ANOTHER WAY
Engaging Patients in Their Care Versus Obscurantism Huey-Ming Tzeng, PhD, RN, FAAN, Chang-Yi Yin, MA, and Kara Fitzgerald, BSN Huey-Ming Tzeng, PhD, RN, FAAN, is Professor of Nursing and Associate Dean for Student Affairs and Program Compliance, College of Nursing, Washington State University, Spokane, WA; Chang-Yi Yin, MA, is Professor, Department of History, Chinese Culture University, Taipei, Taiwan; and Kara Fitzgerald, BSN, is Staff Nurse, Kootenai Health, Coeur d’Alene, ID. Keywords Consumer involvement, hospital, nursing care, patient, patient engagement, safety Correspondence Huey-Ming Tzeng, PhD, RN, FAAN, College of Nursing, Washington State University, P.O. Box 1495, Room 167, Spokane, WA 99210-1495 E-mail: [email protected] [Correction added after first online publication on 24 August 2014: The title of the author has been changed to “Huey-Ming Tzeng, PhD, RN, FAAN, Professor of Nursing and Associate Dean for Student Affairs and Program Compliance.”] Source of support: None. Conflict of interest: The authors declare that they have no conflict of interest.
PROBLEM. Could engaging patients in their care be a means to oppose obscurantism? Obscurantism is defined by Merriam-Webster as “the practice of keeping knowledge or understanding about something from people”. METHODS. This paper discusses the importance of promoting patient engagement and emphasizes that patients and healthcare providers are equally important stakeholders in health care. FINDINGS. The discussion occurs in the context of hospital inpatient care as nurses play a critical role in patients’ hospitalization experience, including engaging patients in their own care during hospital stays. Paternalism of healthcare providers is recognized as one of the main barriers to integrating the concepts of patient engagement and patient centeredness into every aspect of the care system. Promoting patient engagement is a two-way responsibility, and it requires the cooperation of both patients and healthcare providers. CONCLUSIONS. As scientists and healthcare providers, we have the duty to counter obscurantism by promoting understanding of the health of individual citizens and society at large. A culture change in healthcare systems toward being patient-centric and placing value on patient engagement is warranted, and this change must come from healthcare providers. Patient-centered tools that support patient engagement, patient portals, or personal health records are still needed.
Introduction Nurses play a critical role in patients’ hospitalization experience, including engaging patients in their own care during hospital stays. While in the setting of inpatient care, patients spend more time with nurses than with any other healthcare providers. Strategies that will promote and sustain bedside staff nurses’ effort to 196 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 50, No. 3, July-September 2015
engage patients are central to improving patients’ experience during hospitalization and should be a focus (Dempsey, Reilly, & Buhlman, 2014). Could engaging patients in their care be a means to oppose obscurantism? Obscurantism is defined by Merriam-Webster (2014) as “the practice of keeping knowledge or understanding about something from people.”
H.-M. Tzeng et al. During an informal meeting related to seniors’ risks for falling and how to engage them in fall prevention care, held at a senior center in the northwest United States, an elderly woman offered her comments after testing a patient engagement tool (Tzeng & Yin, 2014) to help the authors gain a full understanding of the meaning of patient engagement in health care. She shared with us: “It’s all about me!” She expanded to say that when using the patient engagement tool, the process—by centering on herself, her fall risks, and the things she could do to prevent falls—made her put herself first. Moreover, it was presented in a way she could easily understand the information. Our takehome message from the conversation is that patient engagement is about promoting patient-centeredness and about countering obscurantism in healthcare information. In this short paper, we discuss the importance of promoting patient engagement, and emphasize that patients and healthcare providers are equally important stakeholders in health care. The duty of healthcare providers to counter obscurantism in the healthcare context is described, followed by a call to support the movement for patient engagement. The discussion occurs in the context of hospital inpatient care. Importance of Promoting Patient Engagement Patient engagement in hospital care could lead to measurable improvements in safety and quality because there are shared accountabilities between each patient and his or her healthcare provider that are required to make the partnership effective in delivering care (Agency for Healthcare Research and Quality, 2013; Carlson, Patterson, & Holm, 2014; National Alliance for Quality Care, 2012). Fully involving patients in their care is a not-so-secret tactic to transform care, which may lead to fewer preventable rehospitalizations and improve patients’ health literacy and their satisfaction levels with the hospital care they receive. Patients who are being active participants in their own care could help prevent harm during hospital stays (e.g., falls and medication errors). However, patients have often been passive recipients of care (Stempniak, 2014). As discussed in the article written by Stempniak (2014), paternalism of healthcare providers, an attitude of “we [healthcare providers] know what is best,” is recognized as one of the main barriers preventing the concepts of patient engagement and
Said Another Way patient-centeredness from being integrated into every aspect of the care system. The movement of promoting patient engagement is a two-way responsibility, which requires the cooperation of both patients and healthcare providers. One of the approaches to counter obscurantism is to engage patients in their care. It is rarely recognized that patients’ insights and experience could help healthcare providers and hospital administrators build an efficient, high-quality, and safe care delivery system. This paternalistic view can be changed by promoting and accepting patient engagement (Stempniak, 2014). In summary, the benefits of patient engagement transcend the relationship between care providers and patients, and patient engagement is a key component that can aid in transforming health care. Patient engagement is a concept that should be a main focus for care providers.
Patients and Healthcare Providers as Two of the Stakeholders in Health Care Stakeholders in health care (e.g., patients and healthcare providers) should include all who have a legitimate interest in the process or outcome of care. Stakeholder engagement is warranted due to limitations of clinical evidence and potential policy implications, and it is based on the principles of transparency and democracy (Cluzeau et al., 2012; Cornel, van El, & Dondorp, 2012). It is important to include interested stakeholders, who are the ultimate recipients of the desirable and undesirable impacts of such factors as decision making in the treatment or self-care, hospital policy, or program development and implementation. Components of developing guidelines for treating chronic obstructive pulmonary disease or building a governance infrastructure for genomic screening can be attributed to collaboration of stakeholders (Cluzeau et al., 2012; Cornel et al., 2012). The potential benefits of engaging stakeholders include creating policies or programs that address their concerns, improved implementation of policies, improved healthcare delivery, and better health outcomes. A parallel to this topic is public engagement, which is a process to encourage participation and public accountability, and to promote transparency (Oxman, Lewin, Lavis, & Fretheim, 2009). By the same logic, patient engagement can be viewed as a process to encourage patients’ participation in policy and program development and implementation 197
© 2014 Wiley Periodicals, Inc. Nursing Forum Volume 50, No. 3, July-September 2015
Said Another Way within healthcare systems, patients’ accountability for their own care, and transparency in decision making for care.
Engaging Patients as Opposing Obscurantism in Health Care As scientists and healthcare providers, we have the duty to counter obscurantism by, for example, promoting the understanding of the health of individuals and the society at large (Bossert & Galliot, 2012). A government may have a policy of obscurantism, which is undertaken with the intent to withhold knowledge from the general public (Merriam-Webster, 2014). In The Analects of Confucius, Taber chapter, the ninth verse, Confucius (551–479 B.C.) said that the public should be guided into abiding by regulations, and the public has no need to be aware of the reasons behind them (Chinese Text Project, 2013). In the last 50 years, a modern interpretation of the same verse has surfaced and has been widely adopted; the government should implement a new rule if the public agrees with it, and the government should clearly explain the new rule to the public if the public does not comprehend the reasons behind it (Chinese Text Project, 2013). The first interpretation of Confucius’ teaching promotes obscurantism in an ancient Chinese empire context. The second one emerged in a modern democratic Chinese society, which emphasizes the need to engage the public in implementing regulations by increasing the awareness of the public regarding the situations that the public is encountering. In the healthcare context, the movement for engaging patients in their own care is a movement away from obscurantism. Patient engagement must first be initiated by health authority parties (e.g., physicians and nurses in the care continuum) by involving patients in their health and their own care. Healthcare agencies and healthcare providers may encourage collaboration among patients through, for example, selfmanagement workshops for patients with chronic disease, or by giving patients the tools to help them understand and improve their conditions, sustain improvements, and respond to any changes in their conditions. Helping patients understand their health empowers them with the knowledge needed to stay healthy. Patients being engaged in their own care are more eloquent in communicating their own needs than those who are disengaged (Budryk, 2013; Robert Wood Johnson Foundation, 2014). 198 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 50, No. 3, July-September 2015
H.-M. Tzeng et al. Supporting the Movement of Patient Engagement In the article “A daughter’s frustration with the dearth of patient-and family-centered care” written by Brach (2014), she claims that health care with truly patient-centeredness is the exception rather than the norm. Brach, as a family partner, demands a healthcare facility that is committed to involve patients and their families to the healthcare venture, such as making time to engage patients and their families, and to honor their preferences. The healthcare system as a whole needs to strive to hard-wire the concept of patient-centered care across the spectrum of care. Brach suggested strategies such as engaging patients and families in identifying the opportunities for improvement, and involving patients and families in the quality improvement process within a healthcare facility. Engaging patients and their families as the partners in their respective healthcare-seeking journeys is a determination that requires top-to-bottom changes of the healthcare system as a whole and each individual healthcare facility. A change in the culture of healthcare systems (e.g., setting up policies) toward being patient-centric and valuing patient engagement is warranted, and the first step toward this change must come from health authority parties. These parties should seek to make their practice transparent by involving healthcare customers (e.g., patients and their families) in quality improvement efforts (Robert Wood Johnson Foundation, 2014). In a survey study of 40 physicians and 40 nurses in a teaching hospital located in London, United Kingdom, Davis and associates (Davis, Sevdalis, & Vincent, 2012) found that both physicians and nurses have positive opinions about patient involvement. Nurses are more willing to support patient involvement than physician colleagues. A consumer representative in the state of Maine in the United States reported that patients are willing and motivated to share their experiences with their providers, and they appreciate that their providers truly care but had not previously been aware of patients’ perspectives (Robert Wood Johnson Foundation, 2014). A survey study conducted by Davis and associates (Davis, Sevdalis, & Vincent, 2011) found that 80 hospitalized medical and surgical patients at an inner city London hospital were less willing to participate in interactional behaviors (e.g., asking physicians or nurses factual or challenging questions and notifying errors or problems) than in non-interactional behav-
Said Another Way
H.-M. Tzeng et al. iors (e.g., bringing the medicines used preadmission and sharing a list of allergies with healthcare providers at admission, choosing a hospital based on the safety record, and reporting an error experienced during a hospital stay to a national reporting system). Physicians’ and nurses’ encouragement appeared to increase patient-reported willingness to participate in interactional behaviors during hospitalization (Davis et al., 2011). Another study found that hospitalized patients could identify more than 83% of the undesirable events that occurred during their care in the hospital and were reported in their medical records (i.e., medical complications, healthcare process issues, and interpersonal problems) (Davis, Sevdalis, Neale, Massey, & Vincent, 2013). There are three components to safety-related behaviors that patients may be involved in: (a) the type of error the patient tries to prevent (e.g., not receiving a medication), (b) the action taken by the patient (e.g., asking questions), and (c) the traits of the action (e.g., interacting with a healthcare provider) (Davis, Sevdalis, Jacklin, & Vincent, 2012). A recent study (Davis, Sevdalis, Pinto, Darzi, & Vincent, 2013) found that both videos and leaflets could be effective in increasing patients’ perceived comfort levels in their involvement in some safety-related behaviors during hospital stays. Health information technology (HIT) tools are seen as being critical to the success of new models of care delivery. Clinically focused HIT tools have been widely adopted in outpatient clinics. Patient-centered HIT tools that support patient engagement, patient portals, and personal health records are not in widespread use, however (Adler-Milstein & Cohen, 2013). In other words, HIT tools have mainly been clinically centered. A literature review (Househ, Borycki, & Kushniruk, 2014) performed in 2012 examined the use of social media technology by patients, as well as patients’ perspectives of the benefits and challenges associated with this. The results showed that the use of social media technology is an emerging trend for patients who are seeking health information across the healthcare continuum. Evidence related to the efficacy and effectiveness of patient use of social media for improving patient engagement and community building is limited (Househ et al., 2014). In short, patient-centered tools that support patient engagement (e.g., via social media technology), patient portals, or personal health records have been perceived useful; however, more are still needed.
Conclusion Patient engagement is about promoting patientcenteredness. Engaging patients in their care could be a means to oppose obscurantism. Patients and healthcare providers are equally important stakeholders in healthcare delivery. As for the practical implications, educators in healthcare fields (e.g., medical, nursing, physical therapy) must prepare healthcare providers to effectively engage patients in their care in the continuum of care within their practice. It is equally important to pursue strategies initiated by nurses, physicians, pharmacists, and other allied healthcare providers that will promote and sustain effort in patient engagement across the care continuum. References Adler-Milstein, J., & Cohen, G. R. (2013). Implementing the IT infrastructure for health reform: Adoption of health IT among patient-centered medical home practices. AMIA Annual Symposium Proceedings, 2013, pp. 11–16, Washington, DC. Agency for Healthcare Research and Quality. (2013). Guide to patient and family engagement in hospital quality and safety. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved February 18, 2014, from http:// www.ahrq.gov/professionals/systems/hospital/ engagingfamilies/index.html?utm_medium=email&utm _source=govdelivery Bossert, P., & Galliot, B. (2012). How to use hydra as a model system to teach biology in the classroom. International Journal of Developmental Biology, 56(6/7/8), 637– 652. Brach, C. (2014). A daughter’s frustration with the dearth of patient-and family-centered care. Patient Experience Journal, 1(1), 43–47. Budryk, Z. (2013). 3 ways to boost patient engagement. FierceHealthcare, March 11, 2014. Retrieved March 13, 2014, from http://www.fiercehealthcare.com/story/3ways-boost-patient-engagement/2014-0311?eid=%%__AdditionalEmailAttribute1%% Carlson, D., Patterson, L., & Holm, M. (2014). The new rules of engagement. Washington Nursing Commission News, 8(1), 14. Chinese Text Project (no author). (2013). The analects of Confucius: Taber. Retrieved March 10, 2014, from http:// ctext.org/analects/tai-bo/zh Cluzeau, F., Wedzicha, J. A., Kelson, M., Corn, J., Kunz, R., Walsh, J. & Schünemann, H. J. (2012). ATS/ERS Ad Hoc Committee on Integrating and Coordinating Efforts in COPD Guideline Development. Stakeholder involvement: How to do it right: Article 9 in integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report. Proceedings of the American Thoracic Society, 9(5), 269–273. Cornel, M. C., van El, C. G., & Dondorp, W. J. (2012). The promises of genomic screening: Building a governance 199
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Said Another Way infrastructure. Special issue: Genetics and democracy. Journal of Community Genetics, 3(2), 73–77. Davis, R. E., Sevdalis, N., Jacklin, R., & Vincent, C. A. (2012). An examination of opportunities for the active patient in improving patient safety. Journal of Patient Safety, 8(1), 36–43. Davis, R. E., Sevdalis, N., Neale, G., Massey, R., & Vincent, C. A. (2013). Hospital patients’ reports of medical errors and undesirable events in their health care. Journal of Evaluation in Clinical Practice, 19(5), 875–881. Davis, R. E., Sevdalis, N., Pinto, A., Darzi, A., & Vincent, C. A. (2013). Patients’ attitudes towards patient involvement in safety interventions: Results of two exploratory studies. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 16(4), e164–e176. Davis, R. E., Sevdalis, N., & Vincent, C. A. (2011). Patient involvement in patient safety: How willing are patients to participate? BMJ Quality & Safety, 20(1), 108–114. Davis, R. E., Sevdalis, N., & Vincent, C. A. (2012). Patient involvement in patient safety: The health-care professional’s perspective. Journal of Patient Safety, 8(4), 182–188. Dempsey, C., Reilly, B., & Buhlman, N. (2014). Improving the patient experience: Real-world strategies for engaging nurses. Journal of Nursing Administration, 44(3), 142–151. Househ, M., Borycki, E., & Kushniruk, A. (2014). Empowering patients through social media: The benefits and challenges. Health Informatics Journal, 20(1), 50–58.
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H.-M. Tzeng et al. Obscurantism. (2014). In Merriam-Webster. Retrieved March 10, 2014, from http://www.merriam-webster.com/ dictionary/obscurantism National Alliance for Quality Care. (2012). Guiding principles for patient engagement. Retrieved February 2, 2014, from http://www.naqc.org/Main/Resources/2012-Nurses ContributionsFosteringSuccessfulPatientEngagement.pdf Oxman, A. D., Lewin, S., Lavis, J. N., & Fretheim, A. (2009). SUPPORT tools for evidence-informed health policymaking (STP) 15: Engaging the public in evidenceinformed policymaking. Health Research Policy and Systems, 7(Suppl. 1), S15. Retrieved April 4, 2014, from http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC3271826/ Robert Wood Johnson Foundation. (2014). Patient engagement—What we’re learning: Engaging patients improves health and health care. Quality Field Notes, 3, 1–3. Retrieved March 13, 2014, from http://www.rwjf .org/content/dam/farm/reports/issue_briefs/2014/ rwjf411217 Stempniak, M. (2014). Your not-so-secret weapon to transform care. Hospitals & Health Networks / AHA, 88(2), 57–60. Retrieved April 4, 2014, from http://www.hhnmag.com/ display/HHN-news-article.dhtml?dcrPath=/ templatedata/HF_Common/NewsArticle/data/HHN/ Magazine/2014/Feb/fea-patient-engagement Tzeng, H. M., & Yin, C. Y. (2014). i Engaging as an innovative approach to engage patients in their own fall prevention care. Patient Preference and Adherence, 8(May), 693–700.
