Care Environment Research Articles

Counter-professionalisation in collective childcare: The case of communities of care in Barcelona

Post-industrial transformations have significantly reshaped how young children are cared for outside the family home. Among other factors, the labour market participation of young mothers and a concomitant wish for intensive mothering have led to more diversified childcare solutions for the under-threes. Collective childcare projects (CCPs) promote approaches that are based on a home-like care environment and are run by educators and parents who have usually not trained in formal institutions but who become professionals in informal communities. Applying a discursive approach, this article asks: what characterises professionalism in CCPs? What type of professionalisation is being pursued? We analyse the case of Barcelona, using 45 interviews with association representatives, policymakers, campaigners, educators and parents. Our findings show the important role played by communities of care in defining professionalism and in consolidating a counter-professionalisation ethos, while evidencing their reluctance to pursue formal professionalisation.

A 5-Year Review of a Tracheostomy Quality Improvement Initiative: Reducing Adverse Event Frequency and Severity.

The number of tracheostomies performed annually in resource-rich countries is estimated at 250,000. While an essential procedure, approximately 20% to 30% of patients will experience at least 1 tracheostomy-related adverse event. Within tracheostomy careand across wider health care environments, quality improvement (QI) programs have been shown to reduce patient harm and improve outcomes. Herein we report on a 5-year long, tracheostomy QI initiative aimed at improving patient experience and reducing the frequency and severity of adverse events. A 5-year (ongoing) QI initiative led by the Cardiff and Vale University Health Board tracheostomy team, within a tertiary, 1000-bedded hospital in South Wales, United Kingdom. The QI initiative has focused on 3 main themes: (1) Education and training; (2) Clinical oversight and decision making; and (3) improved data collection. Data were collected from existing tracheostomy databases. Over the past 5 years, we have observed a sustained reduction in both the frequency and severity of adverse events, with less than 1 patient per 100 experiencing a moderate or severe adverse event. This has resulted in improvements in patient experience and a cost reduction of £GBP364,726 per annum. Our 5-year ongoing tracheostomy QI initiative has resulted in improved outcomes with increased achievement of tracheostomy weaning markers and sustained reductions in both the frequency and severity of adverse events. A continuous focus on QI is associated with improved patient and service outcomes. These improvements can be spread and scaled to benefit more patients and organizations.

Digital transformation in public health: a software tool for efficient health record management and improved healthcare delivery

Background In today’s world, the abundance of data in many areas of society has increased the need to use efficient technological tools to analyse, accurately and clearly present information. The objective was to develop a virtual platform to increase efficiency in the control of medical records (MR) and reduce errors in the recording of clinical data. To improve the quality of medical care in public health centres. Method The research used a methodology that follows a four-stage process for the development of the medical records management software. It started with planning where the user stories and their priority were defined. In the design phase, the system architecture and code structure were developed. Subsequently, in the coding phase, pair programming with incremental implementation was emphasised. Finally, in the testing phase, automatic and manual integration tests were carried out, documented by means of acceptance tests to ensure the quality of the developed software. Results The web-based platform has led to a significant increase in the number of patients seen, resulting in significant improvements in resource management at the health centres. In addition, the reduction in the incidence of errors highlights the superior accuracy in recording and tracking medical information, promoting a safer and more efficient care environment for patients. Conclusions The main focus of this study is the management of medical records, with the aim of reducing the time spent on registration, ensuring secure access to information, reducing documentation errors and facilitating instant data retrieval through a web-based platform. The results show the effectiveness of this methodology and its positive impact on the management of medical records.

Paw some Connection: Pet Adoption and Donation

"Paw some Connection" is a comprehensive project aimed at promoting pet adoption and facilitating donations for animal welfare organizations. The initiative seeks to address the growing issue of abandoned and stray animals by creating a user-friendly platform that connects potential pet parents with rescue animals in need of loving homes. This project integrates an intuitive adoption portal, where users can browse profiles of pets available for adoption, learn about their stories, and connect with shelters or foster families. Additionally, a streamlined donation system is incorporated to support the financial needs of these organizations, ensuring proper care, medical attention, and rehabilitation for rescued animals. The platform leverages modern technology and social media integration to amplify its reach, encouraging a wider audience to engage in the noble cause of providing safe and caring environments for animals. By fostering a sense of community and compassion, "Paw some Connection" aims to make a positive impact on the lives of both pets and humans, creating lasting connections that benefit all involved parties. Keywords: Comprehensive project, Promoting pet adoption, Facilitating donations, User-friendly platform.

The impact of preceptorship on the newly qualified nurse and preceptors working in a critical care environment: An integrative literature review.

Preceptorship has been found to be effective in supporting Newly Qualified Nurses (NQNs) during their transition into challenging environments, particularly in addressing issues related to confidence and anxiety. Effective preceptorship is an element of best practice and essential to support NQNs' transition into the critical care setting. However, the impact of preceptorship on NQNs and their preceptors in critical care units is yet to be completely understood. To review the impact of preceptorship on NQNs and preceptors working in a critical care environment. An integrative literature review of the literature. The review employed Whittemore and Knafl's (2005) five-stage integrative review approach. Three databases (MEDLINE, CINAHL and PsycINFO) were searched for papers published between January 2010 and May 2022. The PRISMA framework was used to guide the search and screening. Thematic analysis was used to extract, organize and analyse the data. Nine studies were included in this review. Reflective thematic analysis revealed three themes, with four related subthemes. Preceptorship has an impact on the development of the NQNs and preceptors' 'nurturing' relationship. NQNs develop their knowledge, competence and confidence when experiencing supportive preceptorship. Meanwhile, preceptors experience a combination of increased workload and opportunities for learning and professional development as a result of preceptorship. There is evidence of the impact of preceptorship on learning and professional development for both NQNs and preceptors, but this is a complex phenomenon and further research is required to understand this area more fully. In nursing practice, it is well-established that Newly Qualified Nurses (NQNs) often face heightened levels of anxiety and a lack of confidence when embarking on their careers, particularly in the demanding and stressful environment of critical care units. This review holds particular significance in the realm of clinical practice as it delves into the pivotal role of preceptorship in nurturing the professional growth and development of NQNs within the challenging domain of critical care. Effective preceptorship, as an essential component of best practice, plays a pivotal role in aiding NQNs' transition into critical care settings.

Community Awareness Model Based on Integrity, Attitude, Knowledge and Perception Towards Solid Waste Management and Environmental Care

Globally, the solid waste management (SWM) and environmental care (EC) are critical issues that require significant attention. Increasing community Awareness is one solution to address these challenges. Community awareness on SWM and EC refers to a community's knowledge and understanding of the importance of proper waste management and environmental care. The objectives in this study are: i) to identify the strength of relationships between variables and ii) to develop a multiple linear regression model for community Awareness, Integrity, Attitude, Knowledge, and Perception. A total of 254 respondents from UiTM Perak Branch, Tapah Campus participated by completing an online questionnaire, with 70.87% female and 29.13% male respondents. The study used a simple random sampling technique and applied correlation analysis and multiple linear regression. The results showed moderate associations (0.4 < r < 0.7) between community Awareness and Integrity, Attitude, Knowledge, and Perception regarding SWM and EC. The multiple linear regression model was found to be significant with a p-value of less than 0.05 where all variables were significantly contributed on community Awareness.

Current arrangements for training dentists in the UK in primary care dentistry

Primary Care Dentistry is the destination for the majority of UK dental graduates for some if not all of their future careers. Traditionally Undergraduate Dental Education has been set and delivered within the Secondary Care (specialist referral and Dental Hospital) environment, which may create challenges for new graduates when preparing them for their careers. This article discusses undergraduate dental training for and within Primary Care Dentistry.

Pharmacist management of atrial fibrillation in UK primary care: a cross-sectional study.

Atrial Fibrillation (AF) increases the risk of stroke by a factor of five, leading a significant cost burdens on healthcare system. Pharmacists, especially those based in a primary care environment are well placed to support patients in this therapeutic area. To assess primary care pharmacists' actual knowledge on the management of AF symptoms and anticoagulation. Furthermore, to investigate the resources used by pharmacists. A cross-sectional study using survey was conducted, targeting UK-based registered pharmacists employed within primary care settings. Quantitative data were analysed utilising descriptive univariate and bivariate statistics. 349 pharmacists completed the adapted 19-questions of the pharmacists' knowledge. Out of a maximum of 19 points, the mean score was 14.34 ± 2.2 (75 ± 11.6%). The questionnaire revealed several significant gaps in pharmacists' knowledge. Most of the surveyed pharmacists (62.8%) reported that they used sources of information to support their consultations. Half reported that they used the National Institute for Health and Care Excellence (NICE) guidance (52.4%) and the British National Formulary (BNF) (50.7%). Primary care pharmacists are knowledgeable about AF and its management; however, some gaps exist which may require addressing. Although pharmacists use a variety of information resources, it is the traditional resources that remain the most frequently used.

Cardiology career satisfaction: a little academic activity goes a long way.

The professional landscape for clinical cardiologists and most physicians has changed dramatically in the last decade in the United States. By the end of 2020, 87% of cardiologists were integrated with a health system (employed or part of a professional services agreement). Physicians transitioning to a large employer are often dissatisfied with the lack of autonomy and the pressure from "one-size-fits-all" productivity targets. The results from physician surveys indicate that physicians practicing clinically in an academic environment have greater job satisfaction. Potentially even a modest amount of time comprising 10-20% of total effort spent on academic pursuits that are most meaningful to the individual physician can result in nearly a two-thirds lower risk of burnout compared with physicians who don't receive this time. The opportunity to participate in this special topic compendium by cardiovascular specialists at one regional integrated health system in the United States is an example of an opportunity to successfully incorporate meaningful professional academic opportunities into a clinical care environment.

CORRIGENDUM to Impact of the Physical Environment of Residential Health, Care, and Support Facilities (RHCSF) on Staff and Residents: A Systematic Review of the Literature

CORRIGENDUM to Impact of the Physical Environment of Residential Health, Care, and Support Facilities (RHCSF) on Staff and Residents: A Systematic Review of the Literature

Looking beneath the surface: associations between varied outdoor surfaces and children’s diverse play behaviours in early childhood education and care institutions

This study assumes that surfaces in outdoor environments in early childhood education and care (ECEC) institutions exert an important influence on children’s play diversity. Gibson (1979) claims that surfaces are important because they are where most action occurs; some surfaces may lead to a diversity of play behaviours, while others afford a narrower range of actions. This study was conducted as part of a three-year mixed-methods project. The sample consisted of 464 video observations (mean duration: 122 seconds) of 79 children’s free play in the outdoor environments of eight ECEC institutions. Multilevel regression analysis, controlled for children’s age and gender, indicated that functional play was positively associated with surfaces resistant to deformation (e.g. rubber) and that constructive play was positively associated with surfaces with low resistance to disintegration (e.g. sand or forest floor). These results can help develop and design outdoor environments that facilitate children’s play diversity in ECEC.

Abstract P322: Mapping Geographic Variation in Hypertension Prevalence in United States Congressional Districts Using Spatial Modeling

Introduction: Using spatial methods to explore drivers of hypertension (HTN) risks, commonalities, and differences across geographical areas can be assessed to inform future public health research and advocacy efforts. Objectives: To examine ecological associations between social determinants of health (SDoH), space, and HTN across congressional districts (CDs) in effect for the 118th US Congress. Methods: We obtained aggregate district-level data from Congressional District Health Dashboard on health behaviors, exposures, and outcomes for US CDs in 2019. Primary outcome was HTN prevalence, defined as proportion of adults who self-reported diagnosed HTN. Exposure variables were SDoH: health outcomes (diabetes, obesity, frequent physical and mental distress), health behaviors (physical activity, binge drinking, smoking), clinical care (routine checkups), and physical environment (air pollution). We fitted a hierarchical Bayesian Besag-York-Mollié model using the integrated nested Laplace approximation (INLA) method, which allowed the estimation of spatial autocorrelation of HTN prevalence at CDs level, accounting for SDoH. Results: Across 421 CDs, we found a variation in the modeled linear proportion of 83% across the CDs in the United States after adjusting for known HTN risk factors at the CDs level. A notable degree of variation in HTN prevalence exists within specific CDs, independent of recognized risk factors ( Figure ). These unmeasured variables act as confounding elements, and districts with darker shading indicate increased HTN attributed to the district, while lighter, red-shaded districts exhibit a reduced district-specific proportion of HTN. Conclusions: Our findings show significant geographic variation of HTN beyond known risk factors which underscores the significance of adopting a spatial perspective to understand HTN prevalence. It emphasizes the necessity for tailored public health interventions that consider the unique geographic context of each CDs.

Work With ChatGPT, Not Against: 3 Teaching Strategies That Harness the Power of Artificial Intelligence.

Technological advances have expanded nursing education to include generative artificial intelligence (AI) tools such as ChatGPT. Generative AI tools challenge academic integrity, pose a challenge to validating information accuracy, and require strategies to ensure the credibility of AI-generated information. This article presents a dual-purpose approach integrating AI tools into prelicensure nursing education to enhance learning while promoting critical evaluation skills. Constructivist theories and Vygotsky's Zone of Proximal Development framework support this integration, with AI as a scaffold for developing critical thinking. The approach involves practical activities for students to engage with AI-generated content critically, thereby reinforcing clinical judgment and preparing them for AI-prevalent health care environments. Incorporating AI tools such as ChatGPT into nursing curricula represents a strategic educational advancement, equipping students with essential skills to navigate modern health care.

Caring for our graduate academy

This article examines the neglected hardships faced by graduate students and advocates for a paradigm shift towards care and empathy. Drawing upon a feminist ethic of care theoretical framework, four scholars from tourism and hospitality programs in the United States, Canada, and United Kingdom engaged in a dialogical and introspective inquiry. The authors present four vignettes reflecting on their own doctoral experiences, revealing experiences of exploitation, pain, unworthiness, and loneliness endured during their graduate studies. The authors conclude by calling for a reevaluation of academic norms, advocating for a more humane, caring, and supportive environment for future scholars.

Clinical Impact of Covid-19 Omicron Variant on Patients in Home Health Care

Coronavirus disease 2019 (COVID-19) risk factors for hospitalization and mortality have been reported to be older age, comorbidities, and vaccination status. However, its clinical course and the risk of hospitalization and mortality in patients who received home health care for their predisposing status and diseases remain unclear. This study aimed to determine the characteristics and outcomes of these patients after being infected with the Omicron variant of COVID-19. This retrospective study included 33 patients diagnosed with COVID-19 after we initiated home health care. We classified the patients into 2 groups, that is, hospitalization (n = 7) and non-hospitalization (n = 26), and non-survival (n = 6) and survival (n = 27) and compared their backgrounds. COVID-19 severity was an affecting factor in hospitalization and survival. The nursing care environments and low daily life activities also affected hospitalization but not survival. The proportion of patients with terminal malignancies (50.0% vs 3.7%, p = .017) and the Charlson Comorbidity Index (5.0 vs 2.0, p = .096) were higher in the non-survival than in the survival group. Some patients had urinary tract infections and persistent weight and appetite loss (post COVID-19 syndrome), regardless of this improvement. Serum IL-6 levels were higher in patients with post COVID-19 syndrome than those without symptoms. Optimizing the nursing care environment is essential to continue home health care and lower the hospitalization rate even with SARS-CoV-2 infection. Post COVID-19 syndrome, such as appetite and weight loss, are associated with IL-6-induced inflammation.

Eating at Risk within Long-Term Care: A Case for the Relational Ethics Lens.

Within long-term care homes (LTCHs), conflicts occur between residents' desires, LTCH constraints, and healthcare providers' concerns about risks of harm. Due to the high prevalence of dysphagia and malnutrition in these settings, decisions regarding food choices are a common source of such tensions. Existing biomedical ethical models fail to capture the complexity of the interprofessional chronic care environment. This article proposes an alternative ethical lens, the relational ethics model. We describe a case illustrating the application of a decision-making framework with a relational ethics lens for a resident with severe dysphagia and malnutrition. We highlight how the bioethics model excludes important actors from ethical decision making. We encourage registered dietitians working in LTCH to incorporate a relational ethics model into their practice to help identify resident's values and bring attention to the interconnectedness of caring relationships and contextual factors. This approach can inform difficult decisions regarding the food and nutrition choices of residents and may facilitate meaningful outcomes for both individuals and the long-term care community.

Experiences of family members when accompanying patients in intensive care units: A qualitative study.

Family members of Intensive Care Unit (ICU) patients encounter numerous challenges while providing companionship to their hospitalized loved ones. This study aims to explore the experiences of family members with loved ones hospitalized in ICUs. Qualitative research was conducted using a content analysis approach. Ten family members of ICU patients were recruited using purposive sampling. Data were collected through semi-structured, in-depth interviews and analysed following Graneheim and Lundman's suggested steps. Analysis of interviews with ten family members of ICU patients revealed a theme of "challenging companionship on an obscure path," encompassing four categories (1-4) and nine subcategories (a, b and c). These included (1) the interplay between the patient and the family: a. family affected by the patient's condition; b. patient affected by the family's condition; (2) mixed emotions of apprehension and anticipation regarding ICU admission: a. fear of ICU hospitalization; b. hope for ICU hospitalization; (3) unaddressed needs and concerns: a. pressure from the ICU's visiting limitations; b. lack of a resting room to settle; c. vague information about the patient's condition; (4) two-way care suffering for families a. direct suffering associated with companionship; b. indirect suffering while observing the patients' suffering. Families of ICU patients encounter various challenges, revealing the complex interplay of emotions, needs and challenges within the ICU. This highlights the intricate dynamics in this critical health care environment. A holistic and empathetic approach in clinical practice is crucial in ICU care, particularly during the challenging journey patients and their families undergo in this critical setting. Health care systems and providers should adapt ICU rules to address evolving needs, alleviate concerns and enhance the overall family experience during their loved one's hospitalization in the ICU.

Utilizing the physical green care environment to support activities of daily living for nursing home residents: a focused ethnographic case study

BackgroundThe nursing home residents’ ability to carry out Activities of Daily Living (ADLs) is influenced by the physical care environment. One emerging area of interest in scientific research is the green care environment within nursing home care, where agricultural activities such as gardening and animal care are integrated alongside daily care. Previous research has neglected to explore how these environments can be employed to enhance ADL performance. This study, therefore, explores how a green care environment, specifically one with an animal shelter, can be used to support nursing home residents in their ADLs.MethodsA focused ethnographic case study was conducted in one nursing home. Data was collected employing participatory observations, informal conversations, and semi-structured interviews, which we analyzed by employing a thematic analysis.ResultsOverall, 25 residents were observed for a total time of 89h, and interviews were conducted with 10 staff members. The nursing home integrates activities in the green care environment into daily care for a broad scope of residents. The analysis revealed four themes: (1) The (in)visibility of ADL, (2) Reciprocal care dynamics: Fostering ADL performance through connection and teamwork, (3) Seized and missed opportunities for meaningful integration of ADL in the physical green care environment, and Theme (4) Professional fulfillment and ADL task obligation: Views from staff and management.ConclusionsThis physical green care environment carries the potential to enhance the residents’ daily activities and foster better staff-resident relationships. Yet, there are varying views among staff and management regarding its integration into the residents’ lives and care.

Why Patient-Centered Built Environment Standards Matter More Than Numbers of Beds in Inpatient Psychiatry.

This article canvasses extant literature about values, evidence, and standards for inpatient psychiatry units' design. It then analyzes apparent trade-offs between quality of care and access to care using empirical and ethical lenses. From this analysis, the authors conclude that standards for the built environment of inpatient psychiatric care should align with patient-centeredness, even if a downstream consequence of implementing new patient-centered designs is a reduction in beds, although this secondary outcome is unlikely.

An integrative review of home care recommendations for women after caesarean section.

To describe home-based care and practices recommended for mothers after caesarean section (CS), existing in the literature. Systematic review. This integrative literature review was conducted by using Google Scholar, PubMed and Hinari databases from its inception to June 2021. The search included research articles, protocols and guidelines that describe home care practice after CS and assessed for their quality. Synthesis of recommendations from the included literature was classified based on the type of study design, and the review was guided by methodology registered in Prospero (ID CRD42021276905). A total of 681 literatures were found, and 12 met the criteria. Recommended home care components were divided into four major categories; wound care practice (wound cleaning, drying and bandage change); nutrition (high-protein diet, vitamin C, fibre and balanced diet); exercise (pelvic floor muscle, walking and breathing exercise) and hygiene (bathing and wearing clean clothes). There was limited literature addressing the components of perineal care and home environment. Varying recommendations were found regarding wound cleaning and dressing in the studies done in low- and high-income countries.