Ways of Knowing

            The community health care facilities aim to improve the provision of proper primary care to individuals earning low incomes.  However, the high no-show rates have currently been affecting the health facilities. There has been research on how to reduce the no-show rate cases that are evident in private heath facilities, health facilities that serve low-income people who cannot afford the intervention methods due to financial and physical constraints that the community health care faces. Some patients do schedule health appointments and fail to turn up and end up having a negative impact on health care. The impact on the financial cannot be lifted by same-day appointments rather by long-term appointments. Quite often, patients with higher no-show rates tend to be younger and with a lower social-economic status. Such patients fail to understand the purpose of appointments in most cases, with most of them coming up with excuses for not showing up. Some of the issues that patients encounter include trouble getting off from work, transportation costs, and issues and feeling too unwell to show up for appointments. Several interventions have been put in place to counter the no-show rates yet non of which has proved effective. However, sending reminder calls, messages and emails have proved to have some impact.

Professional Experience

            Mental clinics have higher missed appointments levels than other specialty clinics in the US. Studies by Hung et al. (2019) and Van et al. (2013) observed that mental health care clinics experience a typical no-show rate of 18 percent in 2013, only to increase to 25 percent by 2016.  Rashid et al. (2021) attributed this clinical experience to many factors among them poor scheduling by mental health care clinics, poor communication between nurses and patients, as well as financial and work-related issues emanating from the patient’s side. Though, Rashid et al. (2021) observed that the high no-show rate was largely caused by systematic failure by mental health care clinics to improve communication between the care providers and the patients. For instance, Rashid et al. (2021) and Van et al. (2013) found many youths (18-35 years) to have dodged their medical appointments because of perceived fear and disrespect by health care providers such as nurses. In particular, Rashid (2021) claimed that youth patients at mental health care clinics disowned medical appointments after waiting in the queue for quite longer than expected. Personally, as a nurse, I have experienced many circumstances where patients fail to show up because they forget about their medical appointments. In 2019, an old-aged lady suffering from Alzheimer’s disease consecutively failed to present herself for a medical appointment because she forget and the health care clinic did not remind the lady about the doctor’s appointment. (So what happened after that…like did she miss a medication refill, break in continuity of care….need more details).

            As discussed earlier, common assumptions, beliefs, and values associated with a high no-show rate are perceived fear and disrespect where patients assume that they will wait longer on queues yet they have many pending errands to meets. It is also believed that the no-show rate in mental health care clinics is caused by emotional barriers and forgetfulness (Samuels et al., 2015). For example, many patients at mental health care clinics undergoes various emotional issues due to their weak intellectual capability, which makes them unable to recall medical appointment  Lacy et al. (2004) mentioned that it is a common belief that patient fear to be told the bad news about their health condition. For instance, some patients are unable to deal with stigmatization if they are told that they have contracted diseases such as HIV. Also, patients would skip medical appointments since they cannot handle the bad news of being told that they have cancer.

            For mental health, a no-show appointment may lead to functional impairment, poor quality of life, and poor adherence to treatment. (Rashid et al., 2021). Therefore, understanding ways of knowing to address the problem using information technologies interventions such as text message notification for a medical appointment could help nursing professionals to increase patient outcome and service quality (Marbouh et al., 2020).

Ways of knowing

            The two ways of knowing the high no-show rate are personal and empirical knowledge acquisition. Nurses should learn to personally know underlying factors that lead patients to have perceived fear, assumptions of disrespect that could also lead to the possibility of failing to show up for a medical appointment. The personal way of acquiring knowledge can help nurses to empathize with patients as they encounter difficult illnesses. Personal knowing is the understanding and actualization of an association between a nurse and patient, Personal knowing in the context of no-show rate would allow the nurse to notice reduced turnout of patient medical appointments and be able to deduce factors for such botched appointments. Chinn and Kramer (2015) observed that personal knowledge is obtained by a nurse through the procedure of observing, experience, and reflecting. It is through personal observation and practice that nurses can determine and come up with practical solutions to improve, therapeutic relationships with patients to eliminate negative beliefs, assumptions, and values such as perceived fear and disrespect that tend to trigger high no-show rates. Once a nurse is capable of reflecting their experience with a patient, improved communication will be harnessed. For instance, after acknowledging that poor communication channels could be the leading factor of high no-show rare, the nurse can personally decide to use technology to enhance communication. 

            Empirical knowing is the ideas and knowledge that the nurse gains from objective facts and evidence-based study. Empirical knowing encourages nurses to utilize fact-based techniques to address a clinical problem. Empirical knowledge is methodically organized into universal theories and scientific principles (Corwin et al., 2019). This forms a critical approach through which nurses use empirical knowledge after conducting a clinical-based study to ascertain the causes of a clinical problem and solutions required to eliminate the problem. Evidence obtained from the clinical study is thereafter implemented by the nurse practitioner. Empirical knowledge is associated with the experience of high patient no-show rate can be obtained by documenting the no-show rate by dividing the total number of patients that canceled their visit to the health facility by the total number of appointments for a particular period. Once adequate data has been gathered, the nurse can analyze the obtained data along with different socio-economic parameters. The empirical analyses would generate insightful information that nurses can compare and make recommendations. For instance, using the obtained empirical information, the nurse can be able to understand major reasons that cause patients to skip the medical appointment.

            The nurse can use the empirical finds to design evidence-based clinical interventions to address the no-show rate. For example, if the results find that many patients are not showing up for medical appointments due to the inability to recall in advance, the nurse can advocate the health care clinic to create an automatic communication technology to remind patients of upcoming appointments. According to Dossey and Keegan (2015), personal knowledge together with clinical expertise is a significant component with evidence-based. Personal knowing allows nurses to proactively participate in care and become mindful of present nursing challenges. Therefore, the nurse can use the observed challenges as a trigger to conduct an evidence-based study to empirically confirm their validity of personal knowledge (Dossey & Keegan, 2015).

Future action

            The education on nurses about the no-show rate to be much broader than the simple health framework. Thus, in addition to necessarily multi-professional and interdisciplinary teamwork, it requires creativity and openness, and continuous knowledge acquisition to confront different the high no-show rates. Secondly, the nurse should understand effective communication channels with the patient to reduce the risk of ineffective scheduling policy and perhaps patient’s forgetfulness. Lastly, nurses must gather empirical knowledge through a clinical evidence-based study that identifies patient’s beliefs, assumptions, and other risks factors to no-show behavior and address the obtained risk factors.

            Personal and empirical knowledge impacted the choice of possible recommendations by allowing me to access, learn, and understand through actual experiences. Subsequently, the two ways of knowledge helped me to take congruent action towards the development of necessary nursing practice. Dossey and Keegan (2015) claimed that empirical knowledge is critical in obtaining evidence as well as shaping nursing practice.  On the other hand, personal knowledge incorporates personal observation and practice based on the emotional intelligence and self-actualization of the nurse. Besides, uses the natural insight of meanings based on personal experiences to improve care provision. Many nurses acquire personal knowledge because of the need to improve communication and relationship with patients to improve care.

Conclusion

            Patient no-show rate is a critical clinical problem that undermines the quality of care provision and patient outcome.  A high no-show rate is associated with poor patient care, the financial burden to the health care facility, and might lead to further worsening of the patient’s health condition. As such, nurses need to use both personal and empirical knowledge acquisition techniques to address the clinical problem.

References

Chinn, P. L., & Kramer, M. K. (2015). Knowledge development in nursing: Theory and    process, 9th edn., Mosby.

Corwin, E., Redeker, N. S., Richmond, T. S., Docherty, S. L., & Pickler, R. H. (2019). Ways        of knowing in precision health. Nursing outlook, 67(4), 293-301.

Dossey, B. M., & Keegan, L. (2013). Holistic nursing: A handbook for practice Burlington.          MA: Jones & Bartlett.

Ross, C., Rogers, C., & King, C. (2019). Safety culture and an invisible nursing workload.            Collegian, 26(1), 1-7.

Hung, D., Gray, C., Truong, Q., Harrison, M., Meich, E., Green, B., & Leibowitz, A. (2019).        Abstracts from the 25th Annual Health Care Systems Research Network Conference, April 8–10, 2019, Portland, Oregon. Journal of Patient-centered Research and           Reviews, 6(1), 52-126.

Kheirkhah, P., Feng, Q., Travis, L. M., Tavakoli-Tabasi, S., & Sharafkhaneh, A. (2016). Prevalence, predictors and economic consequences of no-shows. BMC health services research, 16(1), 1-6.

Lacy, N. L., Paulman, A., Reuter, M. D., & Lovejoy, B. (2004). Why we don’t come: patient perceptions on no-shows. The Annals of Family Medicine, 2(6), 541-545.

Marbouh, D., Khaleel, I., Al Shanqiti, K., Al Tamimi, M., Simsekler, M. C. E., Ellahham, S., & Alibazoglu, H. (2020). Evaluating the impact of patient no-shows on service quality. Risk Management and Healthcare Policy, 13, 509.

Rashid, A., Rickman, K., & Saraykar, S. (2021). How to Reduce the No-Show Rate in the Psychiatric Oncology Clinic: Clinical Safety and Effectiveness Project. Psychiatric Services, 72(5), 610-613.

Samuels, R. C., Ward, V. L., Melvin, P., Macht-Greenberg, M., Wenren, L. M., Yi, J., & Cox, J. E. (2015). Missed appointments: factors contributing to high no-show rates in an urban pediatrics primary care clinic. Clinical pediatrics, 54(10), 976-982.

Van Dieren, Q., Rijckmans, M. J. N., Mathijssen, J. J. P., Lobbestael, J., & Arntz, A. R. (2013). Reducing no‐show behavior at a community mental health center. Journal of Community Psychology, 41(7), 844-850.