Complex Health Care Environment Research Articles

Sequenced co-design with stakeholder communities to support the development of spaces for mental health recovery and healing

This research reports on a sequenced co-design process to engage lived experience consumers, carers, healthcare professionals, sector advocates and government representatives in co-designing spatial and experiential inputs to a residential eating disorders facility. The stakeholder community was enabled to co-design a model of care and, building on this, shape the functional brief for the design of health spaces. The stakeholder community input provided architects and designers with a more expansive understanding of user needs regarding specific architectural qualities including psychological safety, flexibility, social connection, and sensory experiences. Our approach yields insights across three interlinked areas: capacity building in the stakeholder community to develop the design language to contribute to design discussions; co-design processes to question pre-existing design assumptions; and subsequently, the development of a more nuanced brief for health spaces. The research supports designers, architects, health organizations and health planners to meaningfully engage with future users of complex healthcare environments.

Workplace stressors and their impact on the nurse managers role

Background: Nursing is one of the professions that is known to expose its members to stress. Additionally, nurse managers work in complex health care environments that expose them to a substantial amount of stress. Workplace stressors have a negative impact on the nurse managers’ performance. Objective: To explore workplace stressors and their impact on the nurse managers’ role. Methodology: The study followed a qualitative exploratory inquiry. Participants were nurse managers working in 11 public hospitals in Botswana. A total of 49 nurse managers participated in this study. A semi-structured interview guide was used to collect data through written narratives. Emerging themes were identified through the use of thematic analysis. Results: The study identified 6 themes that outlined workplace stressors as experienced by nurse managers as follows: shortage of resources; lack of managerial and leadership skills; lack of progression; lack of support from supervisors; staff indiscipline, and nature of work. Participants perceived that exposure to workplace stressors resulted in low morale, customer complaints, and compromised quality of care. Conclusions: The study revealed that nurse managers were exposed to various workplace stressors in the healthcare environment. It was identified that the stress impacted negatively on the quality of care delivered to patients.

Navigating patient journeys across healthcare borders: hot potatoes, medical professionalism and a negotiated order

PurposeThis study explores the dynamics of patient transfers within the Polish healthcare system during the COVID-19 pandemic, focusing on the roles of negotiation, boundary work and systemic flexibility. Despite extensive literature on patient transfers, gaps remain in understanding the general mechanisms that complicate these processes, especially under crisis conditions.Design/methodology/approachBy interviewing 18 specialists across various medical fields, our research provides empirical evidence from Poland, highlighting the experiences of medical practitioners who navigated the complex landscape of patient transfers during the pandemic.FindingsBy integrating negotiation and boundary work theories, we reveal how healthcare professionals manage patient flows and the challenges they face. Our findings show that during the unique situation caused by the uncertainties and lack of preparedness for the pandemic, while standardization and rationalization tools have limited effectiveness, proactive involvement and strategic negotiation are crucial for successful patient management.Research limitations/implicationsThe study's primary limitation is its focus solely on the Polish healthcare system during the COVID-19 pandemic, which may not fully represent other contexts or healthcare systems.Originality/valueThe study underscores the importance of communication and interpersonal skills in facilitating patient transfers. We also argue that the previous experiences with negotiating orders, dealing with limited resources and making constant compromises had, in a way, built resilience in Polish medical experts and prepared them for the uncertainties encountered while treating COVID-19 patients. These insights contribute to academic theories and offer practical recommendations for enhancing healthcare system resilience and adaptability in future crises. Ultimately, the study emphasizes that flexibility and strategic negotiation are key to managing patient transfers in a fragmented and complex healthcare environment.

Registered Nurses' Attitudes Towards ChatGPT and Self-Directed Learning: A Cross-Sectional Study.

Self-directed, lifelong learning is essential for nurses' competence in complex healthcare environments, which are characterised by rapid advancements in medicine and technology and nursing shortages. Previous studies have demonstrated that ChatGPT technology fosters self-directed learning by motivating users to engage with it. To explore the relationships amongst socio-demographic data, attitudes towards ChatGPT use, and self-directed learning amongst registered nurses in Taiwan. A cross-sectional study design with an online survey was adopted. Registered nurses from various healthcare settings were recruited through Facebook and LINE, a widely used messaging application in East Asia, reaching over 1000 nurses across five distinct online groups. An online survey was used to collect data, including socio-demographic characteristics, attitudes towards ChatGPT use, and a self-directed learning scale. Data were analysed using descriptive statistical methods, t-tests, Pearson's correlation, one-way analysis of variance, and multiple linear regression analysis. Amongst the 330 participants, 50.6% worked in hospitals, 51.8% had more than 15 years of work experience, and 78.2% did not hold supervisory positions. Of the participants, 46.7% had used ChatGPT. For all nurses, work experience and awareness of ChatGPT statistically significantly predicted self-directed learning, explaining 32.0% of the variance. For those familiar with ChatGPT, work experience in nursing and the technological/social influence of ChatGPT statistically significantly predicted self-directed learning, explaining 35.3% of the variance. Work experience in nursing provides critical opportunities for professional development and training. Therefore, ChatGPT-supported self-directed learning should be customised for degrees of experience to optimise continuous education. This study explores nurses' diverse use of and attitudes towards ChatGPT for self-directed learning. It suggests that administrators customise support and training when incorporating ChatGPT into professional development, accounting for nurses' varied experiences to enhance learning outcomes. No patient or public contribution. This study adhered to the relevant cross-sectional STROBE guidelines.

Keeping medical information safe and confidential: a qualitative study on perceptions of Israeli physicians

BackgroundPatients expect their information to remain confidential, and physicians have a legal and ethical obligation to keep it this way. Confidentiality is not just a legal requirement but a crucial element in establishing trust between patients and healthcare providers. Patients must feel confident that their personal and medical information is kept confidential and shared only with those who need to know. Previous studies have primarily concentrated on patients’ perceptions of medical confidentiality, data privacy, and data protection issues. However, research on the practical practices and perceptions of medical confidentiality among hospital physicians is scant, underscoring the need for a deeper understanding of this critical issue.MethodsThrough qualitative methods and as part of a large-scale study on aspects of patient dignity and responsiveness in Israel, physicians shared their views and practices on managing medical information.ResultsThe study revealed the practical challenges physicians face in upholding various aspects of data protection within hospital settings. These challenges, strategies, and deviations from data protection principles that physicians discussed are of significant practical relevance. The importance of patient consent and the practical measures for safeguarding patient information were also highlighted. While physicians acknowledged the importance of protecting patient information, they also grappled with the realities of doing so in a complex healthcare environment. In future healthcare policies, it is critical to ensure robust measures are in place to safeguard and uphold medical confidentiality. These can include specific measures to increase compliance, such as regularly monitoring compliance with confidentiality policies, producing safe and anonymous channels to voice concerns, and enforcing consequences for any breaches to ensure accountability.ConclusionsWhile protecting medical information has emerged as an important goal, it is equally crucial to strike a balance between the need to share information to advance and provide quality medical care. Physicians and policymakers must navigate this delicate balance. Additionally, organizations should strengthen compliance to enhance their monitoring and enforcement of confidentiality policies. Ineffective implementation of medical confidentiality leads to theoretical guidelines that do not translate effectively into practice.

Flipping the script: Assessing clinical judgement in student-led clinical evaluation

Introduction and background: Strong clinical judgement and reflective thinking and practice are imperative to make safe, ethical clinical decisions, particularly in today’s complex healthcare environment. Yet clinical judgement and underlying thinking are challenging to assess in post-licensure specialty nursing clinical education due to their complexity and invisibility.Methods: Problem: Clinical evaluation can be subjective, based on observed behaviours rather than on assessment of thinking processes and clinical judgement underlying students’ clinical decisions and actions. Approach: The BCIT Clinical Evaluation Tool (CET) and Evaluation Process (CET-EP) were developed using a shared accountability approach that shifts responsibility for demonstration of learning from instructor/preceptor to student, and facilitates the reflective thinking and practice necessary to develop clinical judgment.Conclusions: Use of this CET-EP in post-licensure specialty certificate programs has assisted instructors, preceptors, and students to reach insights into learners’ thinking, tailor learning interventions, and promote reflective practice, as well as provided greater objectivity in clinical evaluation.

Beyond error: A qualitative study of human factors in serious adverse events.

The field of healthcare quality and safety has been informed by the study of Human Factors contributing to adverse events. Hitherto, much of the study of Human Factors has been focused on a narrow lens of human error, identifying cognitive-based or knowledge-based errors and cognitive processes such as loss of situational awareness contributing to error. While these factors are important, this narrow approach fails to consider the complexity of relational and systemic factors that also contribute to adverse events. We aimed to explore the relational and systemic human factors, including shared clinician attitudes and behavior, that contribute to serious adverse patient events in a public health setting. The study, set in a metropolitan local health district in New South Wales, Australia, was conducted using a retrospective qualitative multi-incident content analysis design. Serious adverse event reviews (SAER) over 6 months (2022-2023) were subject to qualitative content analysis until data saturation was reached. Data saturation reached at 20 reports. Emergent themes related to human factors in serious adverse events included: (i) delays and inertia-with a subtheme of inertia of ageism; (ii) "All-or-nothing" approach to end-of-life care and planning; (iii) communication lapses; and (iv) implementation gap between standards and practice. Error-based incidents accounted for only 35% of the serious adverse events examined. The sample studied involved mostly (65%) male patients, with a mean age of 69 (70% aged >65), managed across the gamut of specialties, with the most common incident being the management of acutely deteriorating patients. In conclusion, there is more to Human Factors in adverse events than cognitive or knowledge-based error. While identifying and correcting errors is absolutely essential, we need adjunctive "soft measures" to address clinical attitudes, behaviors, and relationships in health care, particularly in increasingly complex, fraught, and stressful health care environments.

The relationship between attitudes towards professional autonomy and nurse-nurse collaboration: A cross-sectional study.

This study aimed to determine the relationship between attitudes towards professional autonomy and nurse-nurse collaboration among nurses. Professional autonomy is crucial for nurses in today's complex and ever-changing healthcare environment. Therefore, attitudes towards professional autonomy may result in effective collaboration among nurses, one of the nursing roles and responsibilities. This descriptive, cross-sectional study was conducted with 685 nurses in four private hospitals affiliated with a university. Descriptive tests, correlation analysis and hierarchical regression analysis were used. An ethics committee approved this study, and the STROBE Statement guidelines for cross-sectional studies were followed. Significant predictors for nurse-nurse collaboration were identified as job-related independence, autonomous clinical judgement and working unit from control variables. This study's results provided valuable insights for nurse managers to enhance nurses' attitudes towards professional autonomy and foster collaborative work environments. Nurse managers can increase nurses' participation in decision-making processes and allow them to recognize their autonomy and that of their colleagues.

Guide for the efficient and safe delivery of Telepharmacy

ObjectivesThis study aims to develop a guide establishing the requirements for developing and implementing telepharmacy in Hospital Pharmacy Services (HPS). A secondary objective is providing a reference frame to promote and allocate the necessary resources. MethodsThe project was developed in 5 phases from May-October 2021: (1) constitution of a working team; (2) literature review; (3) semi-structured interviews using the nominal group technique (with direct communications between experts and face-to-face discussion); (4) development of online workshops to raise awareness and debate each of the aspects considered essential in the document; (5) preparation of the final document and validation by the working group. ResultsAs a result of this methodology, the Guide for the Efficient and Safe Provision of Telepharmacy was obtained. This Guide proposes that pharmacists follow a Strategic Plan to develop a new telepharmacy program in an HPS under quality standards. This Strategic Plan has been structured in 4 organizational phases in which the requirements or resources necessary for its implementation are established: Strategy Phase, Planning Phase, Action Phase, and Phase of monitoring results and continuous improvement. ConclusionsThis study provides a practical guide for hospital pharmacists and managers to develop and implement telepharmacy in an HPS with quality guarantees. The Guide provides the pharmacists collective with a reference framework to promote and allocate the necessary resources in an increasingly complex healthcare environment where telepharmacy is an essential strategy for sustainability.

Biblical Foundations for Interprofessional Collaboration in Nursing.

Interprofessional collaboration is an essential competency for nurses in today's complex healthcare environment. The Interprofessional Education Collaborative (IPEC) four competencies of values, teamwork, roles, and communication provide the organizing framework for effective interprofessional collaboration. In this article, the four competencies are used to explore biblical underpinnings and principles of collaboration for Christian nurses, showing how interprofessional collaboration helps achieve one's faith-based and professional commitments.

A design thinking approach to developing an online curriculum in interprofessional education in health in South Africa

Background. The design of contemporary curricula in health professions education in South Africa (SA) is constantly evolving, as there is a need to ensure that students are adequately prepared to work in complex healthcare environments. The World Health Organization proposes that a way to accomplish this is through interprofessional education (IPE), where students from two or more professions learn from one another to improve health outcomes. Objectives. To reflect on the design of an introductory module of a postgraduate diploma in IPE in health at a historically disadvantaged institution in SA, where a student-centred approach to learning and teaching was adopted. Methods. Through an auto-ethnographic methodology, a design thinking approach was used to carefully construct and align an introductory module in IPE in the postgraduate programme. Considering the remote learning environment, this article also examines the importance of educational technologies in the design process of this online curriculum. Results. The results of this study demonstrated the process used in the design of an IPE module supported by the five stages of design thinking to critically appraise the student-centred approach to learning and teaching. The instructional design tools used for this module included the university’s learning management system, Google Suite, Flip, Google Jamboard, webinars, presentations, elevator speeches, quizzes and guest speakers. The end product was an interactive online module that was intentionally designed to be interactive and provide students with a core understanding of IPE. Conclusion. This article demonstrates how an IPE module with a focus on theories, models and concepts can provide the foundation for students to understand the importance of IPE to transform the future of healthcare in SA.

Advancing equity, diversity, inclusivity, and accessibility in primary care: The development of an integrated educational experience model.

This article presents the development of the Equity, Diversity, Inclusivity, and Accessibility (EDIA) Cross-Cutting Theme Project within the Team Primary Care (TPC) initiative, aimed at addressing systemic inequities through innovative educational strategies. Grounded in the social accountability of health professions framework, this project aims to equip primary care teams with the knowledge, skills, and attitudes necessary to promote health equity. The EDIA Integrated Educational Experience (IEE) model includes a self-assessment tool, digital learning space, and national mentorship network, providing a comprehensive approach for primary care teams to promote health equity. The IEE model utilizes a layered micro, meso, and macro approach to support cultural transformation within highly complex healthcare environments. Key lessons learned involve trust- and relationship-building processes to help dismantle historical silos and encourage open dialogue. Future efforts focus on implementation, ensuring adaptability, scalability, and sustainability, positioning the model as a catalyst for equitable primary care delivery.

The Effect of Workload and Stress on Work Productivity in Nurses at Sabah Al Ahmad Urology Center Kuwait

Background: Nursing is a profession that receives a lot of pressure and has an extreme workload that can cause stress and reduce work productivity due to the heavy tasks that nurses have to perform, which in turn can result in considerable work-related tension. This is especially relevant during the current period of uncertainty that has emerged as a result of the COVID-19 pandemic Objective : Toevaluate the effect of workload and stress on the work productivity of nurses. In a complex healthcare environment, nurses often face high workload demands and significant stress levels, which can affect their productivity. Methods: This research method uses a quantitative approach with a Cross Sectional research design. Data was collected through a questionnaire given to a sample of nurses working in hospitals. This questionnaire includes a measurement scale to measure the nurse's workload level, stress level, and work productivity level. Data analysis was carried out using SEM PLS. Results: The results of the analysis showed that there was no significant relationship between workload and nurse work productivity (p value 0.194 >0.05) and there was a significant relationship between work stress and nurse work productivity (p value 0.0000 <0.05). The higher the level of workload experienced by nurses, the higher the level of stress they experience, and the lower their work productivity. The implication of this study is the importance of effective workload management and stress management in an effort to increase the work productivity of nurses. Conclusion: There is a significant relationship between work stress and nurse work productivity in SAUC. This means that the work stress felt by nurses at SAUC affects the work productivity of nurses at SAUC, when the level of stress experienced by nurses at SAUC is getting higher, it will cause a decrease in the work productivity of nurses at SAUC.

The establishment and value of peer group clinical supervision: A qualitative study of stakeholders' perspectives.

Explore perspectives of steering group members and external clinical supervision facilitators of developing and establishing peer group clinical supervision. The climate of healthcare is complex which can lead to staff burnout and challenges to practice. Clinical supervision is suggested as an approach to managing and leadership of such complexities. Qualitative descriptive. Focus group interviews with 19 members of the peer group clinical supervision steering groups and individual interviews with five external clinical supervision facilitators from the Western region of Ireland were conducted. Data analysis followed Elo and Kyngäs' content analysis method, involving preparation, organising and reporting, to extract meaning and identify patterns from the qualitative data collected. Developing peer group clinical supervision practice requires, clarity of purpose and function that address the pros and cons of clinical supervision. Organisational leadership is required to support and release staff for peer group clinical supervision and peer group clinical supervisors need to be credible and have a level of expertise in practice. When prepared and supported, the aspects of confidence, leadership, personal development and resilience develop. Peer group clinical supervisors need training and ongoing continual professional development for their role, scope of practice and responsibilities. Sustainability rests on staff awareness and familiarity with the purpose and format of peer group clinical supervision and the regularity of sessions. Peer group clinical supervision is a means of supporting improvement of patient care delivery while in parallel supporting personal and professional development of staff, building resilience in the workplace. This study explored the implementation of peer group clinical supervision for staff across nursing and midwifery disciplines. It found that implementing peer group clinical supervision had a positive impact on staff well-being and morality and on patient care delivery. These findings influence healthcare service providers in implementing peer group clinical supervision in a sustainable way enabling nurses to continue working in complex healthcare environments delivering safe person-centred care. The qualitative reporting guidelines Standards for Reporting Qualitative Research (SRQR) were followed. Patient/public involvement was addressed in this study by staff, managers, planners, directors, leaders and educationalists being involved at all stages of the study (concept, design, analysis and reporting).

Adaptive Leadership in Virtual Nursing Environments: Enhancing Teamwork, Engagement, and Retention

Adaptive leadership is a skill that nurse leaders can further develop to help meet the emerging needs of our complex healthcare environment. Now more than ever, hybrid virtual teams are part of healthcare organizations. Due to this change, the leadership approach to engagement and retention must evolve. Leveraging adaptive leadership skills enables the creation of innovative solutions to emerging challenges, fosters team culture and community, encourages collaboration, and enhances staff engagement and retention.

From corners to community: exploring medical students’ sense of belonging through co-creation in clinical learning

BackgroundBelonging is critical for the development and wellbeing of medical students. Belonging, particularly within a ‘relational being’ paradigm, presents a significant challenge for students, especially within clinical learning environments. Co-creation is a learning relationship in which students are actively involved in the education process. It is inherently relational and promotes belonging within higher education environments. Little is known about utilising co-creation in the curriculum, within medical education. The aim of this study was to explore medical students’ experience of co-creation of learning resources within the clinical learning environment.MethodsFollowing ethical approval, medical students were invited to become co-creators of a learning bulletin resource, within the paediatric acute receiving unit, at a paediatric teaching hospital. Interpretative phenomenological analysis (IPA) was used to enable an in-depth exploration of how medical students experienced co-creation within the clinical learning environment. Medical students participated in semi-structured interviews about their experience, which were transcribed verbatim and analysed using IPA. The analysis integrated individual lived experiences into an analytic summary.ResultsNine medical students participated. Three group experiential themes were identified: identity maturation; learning community and workplace integration. The support found within this co-created learning community, along with maturation of their identity, allowed the participants to experience a challenge to their existing worldview. This shift in perspective resulted in them responding and behaving in the workplace in new ways, which enabled them to belong as themselves in the clinical learning environment. These findings were situated within the developmental concept of self-authorship, as well as contributing to a new understanding of how co-creation promoted social integration.ConclusionsCo-creation enabled students to learn in a meaningful way. The relational power of co-creation, can be harnessed to deliver participatory learning experiences, within our increasingly complex healthcare environment, to support the learning, development and integration of doctors of the future.

Relation-intersectional Ethics Trestle: A Harmonious Merging of Relational Ethics and Intersectionality

This article endeavors to merge relational ethics with the theory of intersectionality to create a harmonious platform that could support understanding and applications of their essential concepts in today's diverse and complex health care environments. The key tenets of both frameworks are provided followed by an explanation of a coalesced conceptualization and illustration of a relation-intersectional ethics trestle for consideration of its adaptability in the health care workplace and post-secondary education curriculum. The main objective is to explain and promote the benefits of integrating the chief precepts of relational ethics and the theory of intersectionality to further strengthen the way health care providers support patients in ethical decision-making. The relation-intersectional ethics trestle aims to support the construction of authentic and mutually respectful therapeutic relationships in clinical settings where ethics and intersectionality unite.

Integrating Human-Centered Approaches to Align Doctor of Nursing Practice Curriculum With Real-World Practice

DNP programs, preparing nurse leaders for today’s complex healthcare environment, must support needed competencies and provide fresh, innovative strategies that align with real world practices. A traditional post-graduate DNP program created an integrated curriculum and expanded the leadership thread to incorporate a contemporary and evidence-based theoretical framework, Human-Centered Leadership in Healthcare™ (HCL-HC)™. This leadership theory with its highly relational approach between leaders, peer leaders, and teams quickly resonated with students. Two DNP final projects and their positive outcomes are shared. The HCL-HC™ framework offers promise in restoring joy, meaning, and excellence to leaders in education and practice.

Comparison of the Effects of E-learning Blended with Collaborative Learning and Lecture-Based Teaching Approaches on Academic Self-Efficacy among Undergraduate Nursing Students: A Quasi-Experimental Study.

Applying new technologies in teaching has led to the phenomenon of blended learning (BL), which is currently flourishing as a specific requirement for higher self-efficacy and success in increasingly complex healthcare environments. Although various forms of novel education are on the rise worldwide, the effects of electronic learning (EL), combined with collaborative learning (CL) and lecture-based teaching (LBT) approaches, have not yet been validated on academic self-efficacy among undergraduate nursing students. Utilizing a pre-/post-test comparison-group design, this quasi-experimental study was conducted on 70 undergraduate nursing students of Urmia University of Medical Sciences, Urmia, Iran, selected by the census sampling technique in 2020. The eligible participants were allocated to intervention groups, viz., the EL+LBT group (n=34) and the EL+CL group (n=36). A learning management system (LMS) was used for both intervention groups along with the LBT approach, and then 10 steps were integrated into the CL approach during 14 sessions, lasting 150 minutes. Afterward, a demographic information form and the College Academic Self-Efficacy Scale (CASES) were administered to collect the data. The data were analyzed using descriptive statistics, Chi-square test, independent-samples t-test, and analysis of covariance (ANCOVA). No significant difference was observed in the CASE scores between the students were taught using the EL+LBT (113.76±16.98) and the EL+CL approaches (107.66±16.70) before the interventions (P=0.136). However, the CL+EL approaches resulted in the highest changes in the CASE scores at the pre- (107.66±16.70) and post-test (119.08±25.49) stages (P=0.019). Moreover, the female students attending the CL+EL classrooms experienced significantly positive differences in their CASE scores (127.12±30.34), compared to the males (112.65±19.30) (P=0.011). Blending the EL and CL approaches significantly promoted CASE among the undergraduate nursing students in this study by providing sufficient collaboration, essential educational equipment, and better technical support.

The effects of a novel, continuous disinfectant technology on methicillin-resistant Staphylococcus aureus (MRSA), fungi, and aerobic bacteria in 2 separate intensive care units in 2 different states: An experimental design with observed impact on health care associated infections (HAIs)

Hospitals are exposed to abundant contamination sources with limited remediation strategies. Without new countermeasures or treatments, the risk of health care-associated infections will remain high. This study explored the impact of advanced photohydrolysis continuous disinfection technology on hospital environmental bioburden. Two acute care intensive care units in different locations (ie, Kentucky, Louisiana) during different time periodswere sampled every 4 weeks for 4 months for colony-forming units (CFUs) of methicillin-resistant Staphylococcus aureus (MRSA) and fungi on surfaces and floors and fungi and aerobic bacteria in theair. At both sites, surface testing showed greater than 98% reduction in mean fungi and MRSA CFUs. Floor results had reductions by more than 96% for fungi and MRSA at both sites. Aerobic bacterial air and fungal CFUs had reductions up to 72% and 89%, respectively. HAIs declined 70% when postactivation data were compared to preactivation data. The continuous nature of advanced photohydrolysis decontamination, its ability to be used in occupied rooms, and its independence of human resourcesprovidean innovative intervention for complex healthcare environments. This study is on the pioneering edge of demonstrating that continuous decontamination can reduce surface, floor, and air contamination and thereby reduce the acquisition of HAIs.