Describe Health Care Professionals Research Articles

Fluctuation between Powerlessness and Sense of Meaning--A Qualitative Study of Health Care Professionals' Experiences of Providing Health Care to Older Adults with Long-Term Musculoskeletal Pain.

BackgroundThere is an increasing number of older adults living with long-term musculoskeletal pain and related disabilities. These problems are frequently unrecognized, underreported, and inadequately treated. Since many older adults desire to remain at home for as long as possible, it is important that individualized and holistically tailored care is provided in these settings. However, there is a complexity in providing care in this context. The aim of this study was to describe health care professionals’ experiences of providing health care to older adults living with long-term musculoskeletal pain at home.MethodsThe phenomenon, “To provide health care to older adults living with long-term musculoskeletal pain at home”, was studied using reflective lifeworld research (RLR) which is based on phenomenological epistemology. Ten health care providers (nurse, physiotherapists, and occupational therapists) were interviewed and data was analysed.ResultsThe health care professional’s emotions fluctuated between powerlessness and meaningfulness. Needs, opportunities, understanding and respect had to be balanced in the striving to do good in the provision of health care in differing situations. Caring for older adults with long-term pain required courage to remain in the encounter despite feelings of insecurity and uncertainty about the direction of the dialogue. The essence of caring for older adults with long-term pain consisted of the following constituents: Sense of powerlessness; striving to provide good health care; and understanding and respect.ConclusionsThe findings indicated that the health care professionals strived to do good and to provide health care that was holistic and sensitive to the older adults’ needs. A significant sense of powerlessness in the situation was experienced by the health care professionals. These findings address and support the need to develop methods that can be used to guide health care providers who support older adults in the context of their homes.

Health care professionals’ experience-based understanding of individuals’ capacity to work while depressed and anxious

Aim: The meaning of capacity to work while depressed and anxious is not well comprehended. The aim of this study was to explore and describe health care professionals’ experience-based understanding of capacity to work in individuals with depression and/or anxiety disorders. Method: An exploratory qualitative design was used. Four focus groups were conducted with 21 professionals from psychiatric, occupational, and primary health care. Data were analysed using inductive content analysis. Results: Capacity to work while depressed and anxious was understood as a change from the familiar to a no longer recognizable performance at work. Managing time, daily work demands, and emotions was described as difficult for the patients, and capacity to work could be fragmented by anxiety attacks. Patients were perceived as continuing to work while life outside work crumbled. Capacity to work was described as part of a greater whole, the work community, and the patient’s participation in the work community was considered problematic. Conclusions. The findings provide a deeper understanding of the reduced capacity to work compared with theoretical or medico-administrative descriptions. Applied to patient encounters it could promote fitness-for-work dialogues, rehabilitation, and tailor-made work interventions.

Breastfeeding Counselling can be a Matter of Interprofessional Communication

The need of breastfeeding mothers often remains unmet. Breastfeeding has both biological and emotional impacts on the mother’s and the child’s health. Breastfeeding is a “negotiation process” triggered by interactive initiatives of the infant and the caregiver’s interpretations and responses thereto. A parallel negotiation process is evident between a mother and her midwife. The Swedish Act on Patient Safety decrees that planned care should include maternal consultation. The aim of this study was to describe health care professionals’ own reflections on given formula of infants after birth and differences in how midwives perceived their responsibilities, and how they valued patient participation, in caring situations regarding breastfeeding. A total of 39 midwives wrote reflections on the degree of care they used when promoting breastfeeding; the data were analysed hermeneutically. The hospital hierarchy influenced midwives’ work and how midwives co-operated with other professionals. It also influenced what participation and responsibility can mean for a midwife, and three themes emerged as evident: asymmetrical responsibility, symmetrical responsibility, and abdication of responsibility. Midwives focused principally on how their actions were viewed by medical professionals; this was paralleled by the treatment of mothers and newborns. It is important to realise that breastfeeding poses a challenge to interprofessional co-operation and a good communication between doctors and midwives; otherwise they will be losing the holistic view.

Caring for older people living alone with dementia: Healthcare professionals’ experiences

Older adults living alone with dementia are at greater risk of placement in long-term care homes compared with those living with others. Healthcare professionals have vital roles in supporting them to continue living in the community. Yet, little is known about how healthcare professionals fulfill these roles and what their experiences are like. The study purpose was to describe health care professionals' experiences of caring for older people with dementia living alone. Using a qualitative descriptive approach and qualitative content analysis method, 15 healthcare professionals were interviewed in Ontario, Canada. The overall theme of the findings, doing the best we can for them, involved discussing sensitive care issues with what professionals viewed as gentle realism. Walking the tightrope expressed tensions in meeting professional responsibilities. Constraints (my hands are tied) and boundaries (it's not my job, it's not my decision) described perceived limitations on professional roles. Effects of the emotional struggle involved in working with these older people were lessened by believing I did the right thing. The findings have implications for what we could do better for older people with dementia living alone, through integration of person-centered/relationship-centered principles in education programs, community agency policies, a national dementia care strategy, and culture change in community care.

Speaking up for patient safety by hospital-based health care professionals: a literature review

BackgroundSpeaking up is important for patient safety, but often, health care professionals hesitate to voice concerns. Understanding the influencing factors can help to improve speaking-up behaviour and team communication. This review focused on health care professionals’ speaking-up behaviour for patient safety and aimed at (1) assessing the effectiveness of speaking up, (2) evaluating the effectiveness of speaking-up training, (3) identifying the factors influencing speaking-up behaviour, and (4) developing a model for speaking-up behaviour.MethodsFive databases (PubMed, MEDLINE, CINAHL, Web of Science, and the Cochrane Library) were searched for English articles describing health care professionals’ speaking-up behaviour as well as those evaluating the relationship between speaking up and patient safety. Influencing factors were identified and then integrated into a model of voicing behaviour.ResultsIn total, 26 studies were identified in 27 articles. Some indicated that hesitancy to speak up can be an important contributing factor in communication errors and that training can improve speaking-up behaviour. Many influencing factors were found: (1) the motivation to speak up, such as the perceived risk for patients, and the ambiguity or clarity of the clinical situation; (2) contextual factors, such as hospital administrative support, interdisciplinary policy-making, team work and relationship between other team members, and attitude of leaders/superiors; (3) individual factors, such as job satisfaction, responsibility toward patients, responsibility as professionals, confidence based on experience, communication skills, and educational background; (4) the perceived efficacy of speaking up, such as lack of impact and personal control; (5) the perceived safety of speaking up, such as fear for the responses of others and conflict and concerns over appearing incompetent; and (6) tactics and targets, such as collecting facts, showing positive intent, and selecting the person who has spoken up.ConclusionsHesitancy to speak up can be an important contributing factor to communication errors. Our model helps us to understand how health care professionals think about voicing their concerns. Further research is required to investigate the relative importance of different factors.

Health care professionals' pain narratives in hospitalized children's medical records. Part 1: pain descriptors.

Although documentation of children's pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children. To describe health care professionals' use of written language related to the quality and quantity of pain experienced by hospitalized children. Free-text pain narratives documented during a 24 h period were collected from the medical records of 3822 children (0 to 18 years of age) hospitalized on 32 inpatient units in eight Canadian pediatric hospitals. A qualitative descriptive exploration using a content analysis approach was used. Pain narratives were documented a total of 5390 times in 1518 of the 3822 children's medical records (40%). Overall, word choices represented objective and subjective descriptors. Two major categories were identified, with their respective subcategories of word indicators and associated cues: indicators of pain, including behavioural (e.g., vocal, motor, facial and activities cues), affective and physiological cues, and children's descriptors; and word qualifiers, including intensity, comparator and temporal qualifiers. The richness and complexity of vocabulary used by clinicians to document children's pain lend support to the concept that the word 'pain' is a label that represents a myriad of different experiences. There is potential to refine pediatric pain assessment measures to be inclusive of other cues used to identify children's pain. The results enhance the discussion concerning the development of standardized nomenclature. Further research is warranted to determine whether there is congruence in interpretation across time, place and individuals.

Lateral epicondylalgia. A quantitative and qualitative analysis of interdisciplinary cooperation and treatment choice in the Swedish health care system

Interdisciplinary cooperation is essential to develop a broad range of knowledge and skills. The aim of this study was to describe health care professionals' treatment choices, their cooperation with other professionals and their perceptions of potential risks regarding treatments of acute lateral epicondylalgia (LE). A quantitative descriptive study design with a summative approach to qualitative analysis. The ethical committee was asked verbally for approval but, as this study was performed to develop an organised way to treat LE, it did not require approval. The four ethical aspects information, consent, confidentiality and the use of the study materials were all addressed. All orthopaedic surgeons, general practitioners, physiotherapists and occupational therapists in a county. Questionnaire with 18 dichotomous, multiple-response, multiple-choice questions and three open-ended questions were analysed using quantitative cross-tab and qualitative content analysis with summative approach. The most common treatment choices were Non Steroidal Anti Inflammatory Drugs (NSAID), corticosteroid injections, training programmes, braces and ergonomics. Advantages from interdisciplinary cooperation were higher rated than disadvantages. The qualitative findings dealt with perceptions of interdisciplinary cooperation and resulted in three categories; right level of care, increased quality of care and decreased quality of care. Almost half of the physicians felt potential risks associated with their treatment methods. The qualitative findings dealt with perceptions of the potential risks and resulted in two categories: side effects and inadequate treatment. The number of responses varied because some of the respondents did not answered all of the questions. Interdisciplinary cooperation in the treatment of patients with acute LE benefits the patients by shortening the rehabilitation period and provides health care professionals the opportunity for an improved learning and exchanging experiences. These basic conditions must be met to improve health care quality.

Coping with Death: Perceptions of Health Care Professionals Working in a Pediatric Intensive Care Unit and in a Geriatric Service

Many health care professionals have to deal regularly with their patients' deaths and relatives' bereavement, but frequently they have not been trained in this area, and therefore the psychological cost is very high. The authors' principal aim in this work is to describe health care professionals' perceptions about death. A group of health care professionals who worked with children was compared with a group who worked with elderly people. Results showed that emotional aspects were perceived as more important than biomedical aspects in the death process. Between the groups, some differences were detected relating to the perception of the proximity of members' own deaths, and the authors could also observe that the death of a loved one was perceived as more important than their own death. These results should be taken into account to design training programs for health care professionals to minimize psychological costs and increase the quality of care.

A description of health care professionals' experiences of encounters with patients in clinical settings.

The aim of this study was to describe health care professionals' way of experiencing their encounters with in- or outpatients, while working in acute medical care hospitals. One main question was addressed: What are the experiences which health care professionals have of their encounters with in- or outpatients in clinical settings? Eleven health care professionals (physicians, registered nurses and enrolled nurses) were interviewed and a phenomenographic approach was used, where data were analysed qualitatively. The results indicate that the health care professionals' way of experiencing their encounters with patients in acute medical care hospitals could be separated into three categories of description: a gain in personal knowledge and understanding of the patients' different 'ways' of communicating experienced suffering; making the patient feel confident and; focusing on the medical problems, not understanding the patient's different 'ways' of communicating their experienced suffering. The first two categories of description showed encounters where the health care professionals felt that they could understand the patients' expressions of suffering. The third showed encounters where the health care professionals experienced difficulty in understanding the patients' expressions of suffering. There is a need therefore to support health care professionals in improving their understanding of patients' suffering.