A experiência do paciente em internação hospitalar: construção e validação de instrumento

Abstract

Patient experience is considered an integral element of quality care and encompasses all interactions that users experience, perceive, and value when seeking care at a healthcare institution. Healthcare professionals and the institution itself shape the impressions formed by patients and their families; thus, the experience is a process that must be prioritized to ensure a positive perception among care recipients. In Brazil—particularly within public institutions—patient experience remains an unfamiliar concept to many professionals, as this perspective shifts the view of the patient to that of a potential source of valuable information regarding care—a concept previously associated primarily with private healthcare or the service sector. In this context, the study seeks to answer the following research question: How can the experience of hospitalized patients be evaluated? The objective of this thesis is to develop and validate an instrument to assess the experience of patients undergoing hospital admission. This is a descriptive, methodological study employing a quantitative approach to develop and validate an instrument for assessing the hospitalized patient experience. The development and validation process comprised seven stages: establishing the conceptual framework; defining the instrument's objectives and the target population; developing items and response scales; selecting and organizing items; structuring the instrument; establishing content validity; and conducting a pre-test. The instrument was structured around three domains: the patient journey, patient safety, and person-centered care. Questions were formulated for each domain to assess the patient's perception of the respective topic. A total of five expert judges evaluated the instrument. General recommendations focused on language, specifically the need to make the instrument more accessible and understandable for the target audience. Consequently, the wording of many items was revised to replace technical terms with more colloquial language. The instrument's title was also modified from "Patient Experience Assessment Instrument" to "Patient Experience Assessment Survey." Consequently, the wording of 19 of the instrument's initial 34 items was modified to ensure better understanding by respondents. Nine items remained unchanged from the first version, and six were excluded. Thus, the final version comprises 28 items: 15 addressing the Person-Centered Care dimension, 7 regarding Patient Safety, and 6 evaluating the Patient Journey. The pre-test phase took place in a pediatric ward at a university hospital in the interior of São Paulo state. The 32 participants (patients' companions) reported having no questions during the survey administration and found it easy to select an answer for each item. Furthermore, all participants considered the survey relevant and comprehensive, noting that it accurately reflected their experience during the hospital stay. All participants agreed that the questions were appropriate for assessing the quality of care as perceived by them. Although there were no questions regarding meaning, it was suggested that the response options—"Strongly Agree," "Agree," "Neither Agree nor Disagree," "Disagree," and "Strongly Disagree"—be changed to alternatives that were easier to understand. 96.8% of participants indicated that the survey adequately represented the experience lived during the hospital stay. Additionally, all participants recommended using the instrument to evaluate the experience.