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Patient Engagement

Among the factors that improve nurses’ performance and motivate them to provide high-quality service, patient engagement is worth emphasizing. The nurse, who fulfills all the instructions and guidelines of her work but fails to cope with the patient’s problems of non-attendance or indifference, is unlikely to be successful. It is common knowledge that combination of the most efficient medication and proficient nursing team will not promote healing in case the patient does not accelerate recovery. The aim of current paper is to provide holistic and multi-dimensional concept analysis of patient engagement, as well as to demonstrate its relation to pediatric obesity prevention.

The concept analysis of patient engagement will be based on the article titled “The Many Faces of Patient Engagement” written by Gallivan et al. (2012). The authors indicate the significance of the concept among healthcare professionals and aim at proving that there are many terms used to describe similar activities. The concept analysis conducted by them shows that ‘patient engagement’ is frequently confused with similar terms despite its relevance for nursing practice. Thus, due to a variety of synonyms to patient engagement, the authors aim at providing a more clear vision of the concept’s perspective. The authors found little consistency among terms and definitions regarding the use of concept among the key stakeholders (Gallivan et al., 2012, p. 4). To achieve meaningful patient engagement, all the stakeholders should have the same understanding and expectations concerning the phenomenon. Though the concept is very complex, its significance is recognized by various representatives of modern healthcare system. The article begins with the claim which proves that patient engagement is recognized as a major factor in safety of health and quality services improving. In addition, the authors provide both literature reviews and focus groups experiments to find appropriate research methodology that could guide the study. It is worth mentioning that among the key research questions of the study the authors attempted to find different ways to define and describe patient engagement and to explore the components of the concept. Thus, the authors formulated the concept’s definition: “Engagement considers and incorporates the values and needs of patients, clinicians, and communities into health service decision making to enhance transparency and accountability” (Gallivan et al., 2012, p. 5).

To understand the implications of concept analysis conducted by Gallivan et al., one should take into account that the authors identified the following terms that are connected to patient engagement: citizen engagement, community engagement, consumer, career and community engagement, consumer engagement, involvement, meaningful patient involvement, patient involvement and some others. Moreover, the participants of the focus groups provided feedback on their vision of the given concept. The above-mentioned terms similar to patient engagement were used by the patients, leaders and providers at the program, organizational, and point-of-care levels (Gallivan et al., 2012, n.p.). The authors agree that the term ‘patient engagement’ was frequently used in discussion regarding the meaningful patient involvement in healthcare services, but rarely found in the literature. For example, one of the patient defined patient engagement as “the patient, the family and the caregiver are being involved in the development of programs, the administration and the evaluation of programs, so that they are getting the best quality care and also, the patient is safe” (Gallivan et al., 2012, n.p.). The service provider defined patient engagement as “involving patients and families in all different levels and all different ways in our health system, so that we can learn from their experiences and so that we can work with them and they can work with us” (Gallivan et al., 2012, n.p.). However, the crucial problem of the article is that the authors do not offer complex and multi-dimensional definition of the term based on the research results. The discussion of different aspects of the given phenomenon explores its various components, meanings, and significance. It may be summarized that patient engagement can be characterized as cooperation between the patients and the healthcare service providers to develop public health programs. Nevertheless, current article is not sufficient to provide a holistic understanding of the concept, which creates a need for the analysis of patient engagement by other authors.

Most of contemporary authors claim that the concept lacks clear and holistic definition and state that it is necessary to conceptualize it. For instance, Barello et al. (2014) in the article “The Challenges of Conceptualizing Patient Engagement in Health Care: A Lexicographic Literature Review” claim that authors emphasize only some aspects of the phenomenon without in-depth analysis and articulate the urgent need for a deeper understanding of what patient engagement really is. However, Barello et al. do not offer their definition of patient engagement throughout the article as well. They provide brief definition of the concept in the conclusion: “propose to define patient engagement as a processual multi-level experience that results from conjoint cognitive (think), emotional (feel) and conative (act) orientation of individuals towards their health management” (Barello et al., 2014, n.p.). Taking into account the analysis of the other literature sources dedicated to the issue of patient engagement conceptualization, the above-stated definition of the concept should be considered the most holistic and appropriate. Graffina et al., for example, define patient engagement as four-stage process, made of blackout, arousal, and eudemonic project phases (2013). During the first stage people are under emotional, cognitive and behavioral blackout resulted from the unexpected critical event. The second phase is followed by patients’ hyperactive responses to the symptoms produced by their bodies. And the final stage is people’s acceptance of themselves and recognition of it as one of their possible selves. Such modeling, according to Barello et al., pays attention to the roles and features of pivotal elements in the process of patient engagement (2014).

The scientist who were asked to identify the most widespread mortality reasons claim that ignorance regarding traditional medicine is the topical cause of deaths worldwide. Thus, due to inappropriate use of traditional or alternative medicine, people damage their health and die. Such destructive behavior may be motivated by absence of access to medicine, incurable disease or suicidal tendencies. However, such factors may be strengthen by absence of engagement into own health and public healthcare system. As it was mentioned at the beginning of the paper, recovery is the result of two parties’ interaction: patient and his family on the one hand, and nurse, healthcare provider and healthcare system on the other hand. Moreover, the concept of healing that implies recovery and touches interpersonal communication between the patient and the nurse cannot be gained without both sides’ willingness to adjust relationship. Based on two key assumptions, it is worth concluding that patient engagement is extremely significant aspect of recovery and healing. I have chosen it for analysis because I realize its significance in the context of patient-healthcare system relationship and relevance regarding daily practice. In addition, my practice in Emergency Department proves that people, who are not involved in their health maintenance, have more health problems and need more time for recovery.

After the significance of patient engagement is discussed, it is necessary to demonstrate its relation to the problem of child obesity prevention. It is common knowledge that obesity prevention is one of the most topical issues of contemporary medicine, as obesity creates risks of different deceases. However, pediatric obesity should not be interpreted only in terms of medicine, as it is the result of main cultural and worldview shifts in the society. In other words, pediatric obesity is a deep social issue that remains challenging both for medicine and philosophy. Patients’ indifference towards their own health is also worth separate medical, cultural, social, and philosophical and psychological types of analyses. Thus, on a theoretical level of problem statement such perspectives create inter-disciplinary challenge. On the empirical level, it is necessary to recognize that it is impossible to solve child obesity problems in case those who are interested in the problem solution ignore potential ways of reaching it. For example, the statistic of pediatric obesity aspects provided by the WHO states that around 170 million children worldwide are overweight and obese (The WHO, 2012, p. 13). Thus, along with the stereotype of sexualized trained body, overweight is frequently accepted as usual state of things. Therefore, some people may think that overweight is not a severe problem, which makes its treatment unnecessary. Hence, some people, including children, refuse to be treated, whereas others do not want to make efforts to achieve long-term results of treatment. As a result, sources spent on the pediatric obesity prevention strategies are wasted, while the positive results are not reached. Another important aspect of combination of the two issues is educational or pedagogic. When it comes to pediatric obesity, it is worth noting that the patients may be too young to comprehend negative results of their health problems. As some obese children are not yet repressed by dominative culture standards as adults are, they may believe that obesity prevention is wasting of their time and, consequently, ignore it. However, the adults, including obese children’s parents and healthcare professionals, should recognize the need for obesity prevention and the role of patients’ engagement in it. Children diagnosed with obesity and overweight should be taught how to treat such health challenges and how to be involved in their own health treatment. As obesity and overweight embrace not only physiological, but also psychological and cognitive aspects of human health, it is necessary for children to be involved in the solution of obesity problems to reach healing.

In the article “Patient Engagement and Attrition in Pediatric Obesity Clinics and Programs: Results and Recommendations” by Hampl et al. (2011), the authors tended to “shed additional light on patient engagement and retention practices in children's hospital pediatric weight-management clinics and programs” (Hampl et al., 2011). It is common knowledge that pediatric care institutions are positioned to provide intensive interventions for pediatric obesity, including three stages of treatment. Those children who fail to lose sufficient amount of weight at the first and the second stages are directed to the third stage of treatment (Spear et al., 2007). At this stage, the participants pass through multidisciplinary weight-management programs, including frequent visits. The third stage of treatment is associated with numerous barriers that challenge practical implementation of the program. For instance, multilevel character of such treatment demands interaction between the patient, healthcare provider, institutional-managed care, as well as the community barriers affecting program’s outcome (Hampl et al., 2011). Nevertheless, many authors agree that the crucial aspect that may ruin the positive effect of the most sophisticated program is patient attrition at stage 3 (Hampl et al., 2011; Cote et al., 2004; Zeller et al., 2004; Jelalian et al., 2008). Furthermore, a high rate of patient attrition is creating difficulties that do not allow implementing treatment at full scope. There exist pediatric weight-management clinics and group-based programs to minimize patient attrition, though very little is known about them. The survey regarding patient non-attendance at initial and follow-up clinics was initiated. The results demonstrated that 50% of program follow-up visits were not completed by the majority of patients.

Taking into account the negative effects of attrition, its minimization is a challenge for contemporary healthcare professionals. Though literature lacks the discussion of attrition in terms of obesity and overweight, it is known that patient attrition is caused by patient’s Medicaid status, older age, ethnicity, lower self-concept, depression and some other factors. It is difficult to apply such approach to pediatric obesity, as children may suffer from obesity due to distinct reasons. Nevertheless, the essential factor affecting patient attrition is children’s desire to leave the program (Barlow et al., 2006). Thus, the discussion of pediatric obesity from the perspective of patient engagement promotion clarifies the features of pediatric prevention strategies implementation. The programs aimed at improving patient engagement and reducing attrition offer the strategies that could promote healthcare services functioning. For instance, Hampl et al. emphasize the factors that promote patient attrition, among which the following are worth underlining: fear of weight stigmatization, length of visits and incompetence of weight-management providers (2011). The discussion of pediatric obesity and patient engagement helps comprehend the holistic character of healthcare system. Patients’ fears and stigmas regarding their weight lead to their desire to leave weight-management programs. Though some aspects of factors leading to patient attrition cannot be used for children obesity issues interpretation, it is worth noting that both adult patients and children face similar conflicts and challenges. The analysis of the two perspectives promotes concepts clarification, as well as clearer vision of relationship between various phenomena of healthcare system.

In conclusion, it is necessary to discuss the significance of conceptualization in the context of nursing practice. The example of such need is the absence of one holistic approach to the definition of patient engagement. Though many authors offer different interpretation to this phenomenon’s aspects, it is worth considering its multi-dimensional character and significance for multi-disciplinary spheres of healthcare system. As pediatric obesity is a challenge for current healthcare system, the understanding of patient attrition may reduce non-attendance of weight-management programs among the children and the adults. The exploration of interaction between two perspectives allows outlining the healthcare system main features, its problems and challenges to improve its functioning in the future.