Hospital Processes and the Nurse-Patient Interaction in Breast Cancer Care. Findings from a Cross-Sectional Study

Abstract

(1) Background: Evidence suggests that organizational processes of hospitals have an impact on patient-professional interactions. Within the nurse-patient interaction, nurses play a key role providing social support. Factors influencing the nurse-patient interaction have seldomly been researched. We aimed to examine whether the process organization in hospitals is associated with breast cancer patients’ perceived social support from nurses.; (2) Methods: Data analysis based on a cross-sectional patient survey (2979 breast cancer patients, 83 German hospitals) and information on hospital structures. Associations between process organization and perceived social support were analyzed with logistic hierarchical regression models adjusted for patient characteristics and hospital structures.; (3) Results: Most patients were 40–69 years old and classified with UICC stage II or III. Native language, age and hospital ownership status showed significant associations to the perception of social support. Patients treated in hospitals with better process organization at admission (OR 3.61; 95%-CI 1.67, 7.78) and during the hospital stay (OR 2.11; 95%-CI 1.04; 4.29) perceived significantly more social support from nurses.; (4) Conclusions: Designing a supportive nursing work environment and improving process organization in hospitals may create conditions conducive for a supportive patient-nurse interaction. More research is needed to better understand mechanisms behind the associations found.

Organizational Health Literacy in a Hospital—Insights on the Patients’ Perspective

“…While these characteristics have been found to be associated with individual health literacy [17,[21][22][23][24][25][26]29], our results are partly in line with previous findings on associations between patient characteristics and patients' reports of communication with healthcare providers. Previous results concerning the association between age, educational level, ethnicity, native language, and comorbidities and patientprovider communication or interaction are inconsistent, and partially do not show any significant associations [52,53,[68][69][70]. However, neither our data nor previous data deliver any explanation for the findings.…”

“…Concerning the association between organizational processes and health literacysensitive communication, we can confirm the assumptions of previous literature that problems with process organization negatively affects the patient-professional interaction [52,53]. Hence, our results are in line with the communication framework developed by Feldman-Stewart et al [51], which suggests patient-professional interactions to be influenced by the context in which they take place.…”

“…Hence, our results are in line with the communication framework developed by Feldman-Stewart et al [ 51 ], which suggests patient–professional interactions to be influenced by the context in which they take place. A possible explanation for this might be that physicians and nurses working in hospitals with worse process organization might have fewer ressources to interact with their patients because they are preoccupied with managing these processes [ 53 , 68 ]. Hence, deficits in process organization might reflect as stress and high workload among physicians and nurses [ 53 ].…”

“…Moreover, we assumed that individual health literacy itself might have an impact on health literacy-sensitive communication. As an environmental factor, process organization (e.g., coordination between wards as well as professions or waiting times) was assessed since it has already been found to be associated with patient–professional interaction in hospitals [ 52 , 53 ]. Previous studies assumed that professionals working in hospitals with worse process organization have fewer resources available for adequate interaction with their patients [ 53 ].…”

“…As an environmental factor, process organization (e.g., coordination between wards as well as professions or waiting times) was assessed since it has already been found to be associated with patient–professional interaction in hospitals [ 52 , 53 ]. Previous studies assumed that professionals working in hospitals with worse process organization have fewer resources available for adequate interaction with their patients [ 53 ]. Our research questions were the following: Are individual patient characteristics, in terms of education, migration background, age, number of chronic diseases, and individual health literacy associated with the patients’ perception of health literacy-sensitive communication?…”