Enhance Quality Of Care Research Articles

Barriers and Factors Affecting Nursing Communication When Providing Patient Care in Jeddah

Background/Objectives: Effective communication between nurses and patients plays a crucial role in the delivery of quality healthcare services, especially when caring for patients from diverse cultural backgrounds. It fosters trust, understanding, and collaboration and contributes to better health outcomes and satisfactory nurse–patient relationships. The aim of the study is to assess the factors and barriers affecting nurses’ communication when providing care for patients from diverse cultural backgrounds in Jeddah, Saudi Arabia. Methods: A cross-sectional quantitative descriptive design is used with an online survey instrument. The study involved registered nurses employed in Jeddah’s hospitals. The study utilized a convenience sample for data collection and used the latest version of the statistical package for the social sciences (SPSS version 21) for data entry and analysis. Results: A study of 367 participants found significant barriers to nurse–patient communication, with a mean score of 2.84 on a three-point scale. Key challenges included language differences between nurses and patients with a mean score of 2.87, and cultural and religious differences with a mean score of 2.83 and 2.81, as well as nurses’ communication skills, attitudes, and self-confidence and patients’ awareness, attitudes, and resistance to communication. The multifaceted nature of these barriers emphasizes the need for targeted interventions to improve nurse–patient interactions and enhance care quality. Conclusions: The study highlights the impact of various factors on effective communication between nurses and patients, emphasizing the need for nurses to develop their communication skills and to receive adequate training from nursing officials.

Determinants of Prolonged Hospitalization in Children and Adolescents: A Retrospective Observational Study.

Ensuring an appropriate length of stay (LOS) is a primary goal for hospitals, as prolonged LOS poses clinical risks and organizational challenges. Children and adolescents are particularly susceptible to prolonged LOS due to frequent hospitalizations and unique vulnerabilities, including developmental disabilities that may necessitate additional care and monitoring. This study aims to describe the LOS of children and adolescent patients and identify the sociodemographic, organizational, clinical, and nursing care factors contributing to prolonged LOS in this population. Observational, retrospective, monocentric study. A sequential sampling approach was used to select the clinical records of 1538 children and adolescent patients admitted to an Italian university hospital in 2022. The study included all children and adolescents aged 3-18 who were hospitalized for a minimum of 2 days. Patients from outpatient units and those with LOS shorter than 2 days were excluded. The Neonatal Pediatric Professional Assessment Instrument (PAIped) and the Hospital Discharge Register were used to collect sociodemographic, organizational, clinical, and nursing care patient data, including nursing diagnoses (NDs) and nursing actions (NAs). A forward stepwise regression approach was used to identify predictors of LOS among the selected variables. A mediation analysis was conducted to explore the role of nursing predictors, identified in the stepwise regression, as mediators between the number of medical diagnoses and LOS. Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (rs = 0.262, p = < 0.001; rs = 0.114, p = < 0.001; rs = 0.384, p = < 0.001, respectively). Longer hospital stays were associated with an increased number of medical diagnoses, NDs, and NAs. The number of NAs emerged as an independent predictor of LOS (β = 0.516; p < 0.001). Other significant determinants of LOS included a higher number of NAs and medical diagnoses, the presence of a medical DRG category, increased DRG weight, emergency admissions, residency in rural areas, and older age (F = 122.222, p < 0.001, R2 = 0.361, adjusted R2 = 0.358). The mediation analysis showed that the number of medical diagnoses positively predicted the number of NAs (β = 2.774, p < 0.001), which, in turn, positively affected LOS (β = 0.162, p < 0.001). A significant indirect effect of the number of medical diagnoses on LOS through NAs was observed (β = 0.448, 95% CI [0.34, 0.55]), along with a significant direct effect of medical diagnoses on LOS, even with the mediator in the model (β = 0.633, p < 0.001), indicating partial mediation (F = 321.6892; R2 = 0.295; p < 0.001). These results highlight the influence of medical diagnoses on LOS through the mediating role of NAs. Our study highlights the significant interplay between determinants of LOS in children and adolescent patients, emphasizing the need for targeted interventions, resource planning, and the integration of clinical nursing information systems to enhance care quality and support evidence-based practices. Optimizing resource distribution and implementing specific interventions for patients at risk of prolonged LOS could help mitigate this negative outcome and enhance the quality of care. Incorporating nursing data into DRG systems could improve reimbursement accuracy and benefit the nursing profession, which may result in better patient outcomes and lower hospital expanses.

Integrating trauma-informed care in nursing practice and education: A hybrid systematic narrative review.

This study aims to synthesize and analyze a trauma-informed care (TIC) framework and its applications in nursing practice and education. This study employed a hybrid systematic narrative review. Eligible studies were reviewed following the hybrid systematic narrative review guidelines. Peer-reviewed articles published in English between January 2015 and June 2024 were included. These articles were retrieved from CINAHL, PubMed, Web of Science and Scopus databases. Quantitative, qualitative and mixed-methods studies were also included. All the included studies underwent data synthesis, analysis and quality assessment. Sixteen studies were included: twelve studies examined trauma-informed care (TIC) in nursing practice and four focused on nursing education. Four primary frameworks were identified, with the Substance Abuse and Mental Health Services Administration (SAMHSA) framework being the most referenced. Most nurses held positive attitudes toward TIC, although their knowledge levels were generally moderate. Educational interventions significantly improved the TIC skills of nursing students. Although TIC offers substantial benefits, its implementation remains challenging. These challenges include time constraints, limited resources and concerns regarding potential re-traumatization. Nurses generally showed positive attitudes toward TIC; however, significant knowledge gaps and implementation barriers remained. Addressing these challenges by incorporating TIC into nursing education could enhance nursing competencies. Standardized TIC education is essential for improving clinical practice and optimizing patient outcomes. Future research should evaluate the effectiveness of TIC in diverse healthcare settings and develop strategies to support nurses in high-pressure environments. Expanding and deepening TIC curricula holds significant potential for enhancing care quality and fostering a trauma-informed healthcare system.

Connected Healthcare System Technology Interventions to Improve Patient Safety by Reducing Medical Errors: A Systematic Review

ABSTRACT Medication or medical mistakes, the third highest cause of death in the United States, occur from prescription writing to administering the therapy, with serious clinical and cost repercussions. Digital health technologies, such as connected healthcare systems, have the potential to reduce pharmaceutical errors and increase patient safety. This systematic review was conducted to find literature evidence to improve patient safety and reduce medication errors with connected healthcare interventions. This systematic review was conducted using the PRISMA 2020 guidelines. PubMed, SCOPUS, EBSCO, and Google Scholar databases were searched from January 1, 2000 to June 30, 2024 using keywords: medication errors, patient safety, and connected healthcare. A qualitative narrative analysis was conducted for the review. The detailed search yielded 9524 papers in total. In the process of duplicate removal, 4856 duplicate articles were found. After the removal of duplicate articles, 4615 were found not suitable or relevant to the topic of this study and were removed. Finally, 53 articles were chosen for the review study after screening and duplication removal. Ten of the 53 articles were review articles (18.9%), and 43 (81.1%) were original. The research indicates that various connected healthcare system technologies are more effective in minimizing errors and enhancing care quality. Integrating computerized physician order entry and clinical decision support systems may further reduce medical errors. However, many areas require additional research, and the outcomes are mixed. A balanced strategy that combines innovation, practical safety, and outcome evaluation is preferable.

Exploring the application of machine learning to identify the correlations between phthalate esters and disease: enhancing nursing assessments

BackgroundHealth risks associated with phthalate esters depend on exposure level, individual sensitivities, and other contributing factors.PurposeThis study employed artificial intelligence algorithms while applying data mining techniques to identify correlations between phthalate esters [di(2-ethylhexyl) phthalate, DEHP], lifestyle factors, and disease outcomes.MethodsWe conducted exploratory analysis using demographic and laboratory data collected from the Taiwan Biobank. The study developed a prediction model to examine the relationship between phthalate esters and the risk of developing certain diseases based on various artificial intelligence algorithms, including logistic regression, artificial neural networks, and Bayesian networks.ResultsThe results indicate that phthalate esters exhibited a greater impact on bone and joint issues than heart problems. We observed that DEHP metabolites, such as mono(2-carboxymethylhexyl) phthalate, mono-n-butyl phthalate, and monoethylphthalate, leave higher residue in females than in males, with statistically significant differences. Monoethylphthalate levels were lower in individuals who exercised regularly than those who did not, indicating statistically significant differences.ConclusionsThis study’s findings can serve as a valuable reference for clinical nursing assessments regarding diseases related to osteoporosis, arthritis, and musculoskeletal pain. Medical professionals can enhance care quality by considering factors beyond patients' essential physical assessment items.Trial Registration: This study was registered under NCT05892029 on May 5, 2023, retrospectively.

Enhancing Team Dynamics and Patient Outcomes: A Critical Analysis of Collaborative Practices Among Medical Clinic Workers

This article critically examines the impact of collaborative practices among medical clinic workers on team dynamics and patient outcomes. As healthcare delivery becomes increasingly complex, the importance of interdisciplinary teamwork among physicians, nurses, pharmacists, administrative staff, and support personnel has grown significantly. The study explores effective strategies such as team meetings, digital communication tools, and cross-training while identifying challenges like communication barriers, resource limitations, and hierarchical structures. Drawing on theoretical frameworks and empirical studies, the analysis highlights the positive correlation between robust teamwork and improved patient outcomes, including reduced medical errors and enhanced care quality. The findings emphasize the need for systemic changes, including training programs, leadership initiatives, and the integration of technology to optimize collaboration and patient care in medical clinics.

Job Satisfaction Audit in Hospital: Qalitative Case Study

Introduction: The shortage of healthcare professionals, their turnover, and the risk of burnout are critical issues in healthcare organizations, impacting the quality and safety of care. This study, based on contractual research, aimed to identify factors influencing employee satisfaction in new hospital facilities. Aim: This article presents an audit of job satisfaction using the JD-R model in a healthcare facility to improve employee stability and well-being, thereby enhancing care quality and safety. It aims to showcase a methodological approach applicable in healthcare management and other services. Method: The extended JD-R model (Job Demands-Resources model) was used as the theoretical framework. The analysis of negative and positive factors that influence job satisfaction was based on data collected from anonymous semi-structured interviews. Thematic and narrative analysis, as well as the study of internal documents, was also used and evidence-based results were presented in a final synthesis. Results: The methodological approach delivered valuable findings for improving care. Key positive factors influencing job satisfaction included prospects of permanent employment and salary levels. Significant negative factors were concerns about personal safety and dissatisfaction with medical staffing. Conclusion: The study’s final report, presented to top management, outlined the positive and negative factors affecting job satisfaction and well-being. Management expressed willingness to act on the findings and provided specific examples during the results presentation. While the results’ transferability is limited, the methodological approach is inspiring and applicable in healthcare organizations.

The Application of Social Robots in Healthcare: Enhancing Care Quality and Addressing Ethics Challenges

The Application of Social Robots in Healthcare: Enhancing Care Quality and Addressing Ethics Challenges

Enhancing Paediatric and Strabismus Ophthalmology Departments in Spain Through the Inclusion of Orthoptists: Insights from a Nationwide Survey.

The absence of the orthoptic profession in Spain contrasts with its value and recognition in other countries. This study aimed to gauge Spanish ophthalmologists' interest in including and promoting orthoptists in paediatric and strabismus departments. Secondary objectives included assessing interest in requesting orthoptists, involvement in their training, and aligning their competencies with European standards. Participants were recruited via WhatsApp and flyers during the 30th SEEOP Congress in May 2023 and invited to review a report on orthoptists' significance followed by completing a 12-question online survey. Profile questions were asked via multiple-choice options. Opinions on integrating orthoptists to enhance care quality, training involvement, and alignment with European standards were rated using a Likert scale. Open-ended questions captured themes, and comments. Forty-two paediatric and strabismologists in Spain participated, mostly hospital-employed with advanced degrees, 90% supported integrating orthoptists into their teams, with 83% interested in having them in their workplace. Nearly 90% believed that collaboration between ophthalmologists and orthoptists would improve care quality and reduce waiting lists, and 83% supported promoting this within national medical organisations. Additionally, 90% advocated level 4 advanced European-standard training for orthoptists and 25% were neutral about participating in training orthoptists. Participants emphasised the importance of qualified orthoptists for treating eye movement abnormalities, distinguishing them from other eye healthcare professionals and advocating for collaboration rather than replacement. This initial survey of paediatric ophthalmologists and strabismologists in Spain highlights support for orthoptists as allied health professionals, though garnering support for their training could be challenging. These conclusions should be considered in light of methodological, sample size, and resource limitations. The survey serves as a pilot for the future, suggesting improvements to explore the feasibility of introducing orthoptists in Spain.

Support workers knowledge, skills and education relating to dementia - a national survey.

Dementia affects over 55 million people globally, projected to double by 2050. In the UK, non-registered staff, including healthcare assistants (HCAs) and clinical support workers, provide a significant portion of dementia care, yet receive limited training. This study explores the knowledge, training, and attitudes of support workers towards dementia. A cross-sectional web-based survey was conducted from February 1 to April 1, 2024, targeting support workers in England. The survey included demographic information, dementia knowledge (using the Dementia Knowledge Assessment Scale, DKAS), and attitudes (using the Dementia Attitudes Scale, DAS). Data were analysed using descriptive statistics, ANOVA, t-tests, and Pearson's correlation. One hundred and nine support workers responded, predominantly female (90%) and white British (76.4%), from various NHS settings and occupational groups. The majority (79.8%) had received dementia training, primarily from their organisations. Challenges included managing behavioural and psychological symptoms and communication difficulties. There was no significant correlation between years of experience and dementia knowledge (r = -0.019) or attitudes (r = -0.057). However, higher occupational grades were associated with greater dementia knowledge (p = <0.01). A moderate positive correlation was found between dementia knowledge and attitudes (r = 0.35, p = <0.01).Despite high levels of knowledge, support workers often feel inadequately prepared to provide optimal dementia care, indicating a need for more comprehensive training. Challenges in communication and managing symptoms highlight areas for improvement. The study suggests that better training can improve both knowledge and attitudes, enhancing care quality for people living with dementia. Support workers play a crucial role in dementia care but require more robust training programs to meet the growing demands. Enhanced training can improve their knowledge and attitudes, leading to better care outcomes for people with dementia.

Implementing laboratory internal audit to improve compliance and quality of care in the municipal public health system-based ambulatory care health clinics in New York city.

System-wide laboratory internal audits are useful to help laboratories prepare for external audits in addition to being part of the ongoing program for compliance improvement and quality assurance in the laboratory to track and enhance care quality. A formal plan was developed and a modified audit checklist was prepared by our laboratory management team, applicable and uniquely tailored for our ambulatory care clinic settings to track operational, quality, and compliance metrics according to the New York State Department of Health Clinical Laboratory Evaluation Program. Two audits were conducted 6 months apart and the conformity documented. An overall 84% increase in compliance and conformity was observed between first and second audits, which ranged from 63% to 100% across different categories, with 100% improvement (0% nonconformity) in 75% of the sites in the second audit. A system-wide laboratory internal audit was created and carried out. Staff shortages, rapid turnover, and lack of retraining were found to be contributing factors to sites that did not achieve 100% conformance. Continuous assessment and monitoring are key elements to success in the laboratory quality management system, and through this scheduled audit process, we were able to achieve continual laboratory quality improvement.

Electronic Nursing Records: Importance for Nursing and Benefits of Implementation in Health Information Systems-A Scoping Review.

Introduction: The advancement of nursing science and practice necessitates the documentation of information, which is increasingly being recorded in electronic mediums due to the progress of information technology. Various countries around the world have implemented electronic nursing records (ENRs) or are in the process of implementing them. This study aims to ascertain the significance of electronic nursing records and consolidate their primary benefits for nursing. Methods: The study utilized an established scoping review methodology (Arksey and O'Malley protocol; JBI method; PRISMA ScR (2018)). Results: Out of 6970 initial articles extracted from four databases, 36 were included in the study. Several essential elements for structuring, introducing, and emphasizing the importance of ENRs have been recognized, including the availability of standardized terminology, enhancement of nursing care quality, advancement of research activity, integration with electronic systems, optimization of healthcare, and conditions for ENR integration. Conclusions: Electronic nursing records are indispensable and beneficial for enhancing care quality, improving patient safety, and affirming the autonomy of the nursing profession.

Compliance evaluation in post-anesthesia care units at teaching hospitals in Alborz Province, Iran

BackgroundThe post-anesthesia care unit (PACU) is a critical care unit where postoperative patients are monitored and cared for until full recovery. Evaluating standards in different domains is crucial for providing quality care. This study aims to assess the compliance of design, equipment, drugs, and staff performance standards in PACUs of teaching hospitals of Alborz Province, Iran. MethodsThis cross-sectional study was conducted between January 2023 and September 2023. Data were gathered using a 40-item checklist covering physical structure, equipment/drugs, and staff performance. For the latter, a 360-degree appraisal (self-assessment, internal evaluator, external evaluator) was done. ResultsAmong the three standard domains, performance had the highest average compliance at 80.72 %, followed by equipment/drugs at 75.33 %. Design/structure had the lowest compliance at 54 %. ConclusionGiven the lack of full compliance in PACU design, equipment, and certain aspects of patient care, healthcare managers and policymakers must prioritize improving post-anesthesia care unit infrastructure, equipment provision, and staff training. Implementing continuous education programs with effective teaching methods is crucial for enhancing care quality and preparing future healthcare professionals in these teaching hospitals.

Basics of Orthopedic Commercial and Government Bundling

The health care system is transitioning from fee-for-service models to value-based care frameworks, with bundled payments emerging as a promising approach to improve cost efficiency and patient outcomes. Bundled payments consolidate costs for multiple services into a single payment for specific treatments or conditions. This study reviews the development and implementation of bundling models in orthopaedics, comparing government and commercial approaches and discussing their benefits and challenges. A review of the literature was conducted to examine existing bundling programs in orthopaedics, including Medicare initiatives like the Bundled Payments for Care Improvement and Comprehensive Care for Joint Replacement model, as well as commercial programs from insurers such as Cigna and UnitedHealthcare. The review focused on published studies, reports, and case examples to identify trends, outcomes, and barriers associated with these models. Government programs such as Comprehensive Care for Joint Replacement have demonstrated improved care coordination and cost control but face challenges in engaging physicians and aligning financial incentives. Commercial models, with greater flexibility in their prospective payment structures, allow for customization and better financial predictability but require careful negotiation and compliance with quality metrics. Both approaches highlight the importance of robust data management, multidisciplinary collaboration, and innovative partnerships to improve care delivery. Condition-based bundling, though conceptually aligned with value-based care, remains in its early stages within orthopaedics. Bundled payment models represent a key strategy for advancing sustainable and efficient health care delivery in orthopaedics. Despite challenges like stakeholder alignment and resource demands, these models offer potential to enhance care quality and reduce costs. Future directions should prioritize collaboration, technology integration, and the resolution of implementation barriers to fully realize the benefits of bundling in orthopaedic practices.

Patient Care Quality Management through Transformational Leadership: Literature Review

Background: Leadership is a central aspect of the nursing management process, with nurses serving as front-line personnel in providing services to patients. Inadequate quality of care has a significant impact on high mortality rates and substantial cost burdens. Purpose: This study aims to explore the relationship between the transformational leadership style of nurse managers and the quality of patient care. Method: Literature search was conducted in five database journals covering various disciplines. Original research and peer-reviewed methods published in English were included in the review criteria. The initial search yielded 4397 articles and only 24 articles met the criteria for analysis. The review process used the PRISMA system guideline. Results: The results of literature from various articles reveal that factors influencing the quality of care included job satisfaction, non-compliance with standard drug administration, high staff turnover, stress and fatigue, and organizational commitment. Conclusions: There was a significant correlation between transformational leadership and the quality-of-care outcomes. This leadership style provided inspiration to nursing managers enhancing care quality to the best level. Further study needs to provide evidence of adoption and implementation transformational leadership style.

The physician-AI relationship: partnering for precision medicine via clinical decision support

Abstract Background Clinical decision support systems (CDSSs) can enhance physician decision-making, but successful adoption depends on positive user attitudes. Understanding Israeli physicians’ attitudes toward CDSSs is crucial for overcoming implementation barriers and refining training. Methods Semi-structured interviews explored knowledge, experiences, perceived benefits/drawbacks, and potential barriers/facilitators to CDSS use among 25 Israeli physicians across specialties, roles, settings, and experience levels selected via stratified sampling. Individual 45-minute video interviews were conducted in January-July 2023. Results Familiarity and CDSS experience varied substantially across medical specialties. While risk calculators, information systems, and expert systems disseminating contemporary research insights are widespread, AI-based system adoption is relatively low outside radiology. Physicians expressed positive attitudes, recognizing CDSSs’ potential to enhance clinical work, reduce errors, and alleviate burdens. However, concerns included AI systems’ impact on workload, patient relationships, skill erosion, and overreliance. Key implementation barriers involved technological infrastructure, organizational processes, physician perceptions, and system features. Facilitating factors included tailored design, focused training, continuous accuracy/reliability validation, and clear autonomy/liability guidelines. Conclusions Addressing key concerns around transparency, trustworthiness and responsible use is crucial for AI-CDSS to fulfill its promise of enhancing quality and outcomes. Insights from Israeli clinicians provide guidance on priorities like transparency of data and algorithms as well as ensuring AI behaves ethically. Collaboration among technology designers, healthcare professionals and stakeholders can help develop systems that physicians trust to improve care while safeguarding patients. Ongoing evaluation is also needed to optimize AI-CDSS over time. Key messages • Understanding physician attitudes is key to overcoming barriers to clinical decision support system adoption and optimizing training protocols. • Addressing transparency, trustworthiness, and ethical considerations around AI clinical decision support systems is crucial for enhancing quality care.

Holistic Patient Care: A Narrative Review on the Synergy of Internal Medicine, Anesthesiology, and Surgical Practices

Introduction: holistic patient care, which integrates the efforts of Internal Medicine, Anesthesiology, and Surgical Practices, has been shown to improve patient outcomes across the continuum of care. This review aimed to explore the synergy between these specialties and highlight how their collaboration contributes to comprehensive, patient-centered care.Method: a narrative review was conducted using peer-reviewed literature from databases such as PubMed, Scopus, and Google Scholar. The search focused on articles published in the last 15 years, using terms related to interdisciplinary collaboration in healthcare. Data from relevant studies were synthesized and grouped into preoperative, intraoperative, and postoperative phases, with emphasis on how each specialty contributes to holistic care.Results: the review demonstrated that collaboration between these specialties is essential for optimizing preoperative risk management, ensuring intraoperative stability, and enhancing postoperative recovery. Internal Medicine played a key role in managing chronic conditions preoperatively, while Anesthesiology tailored anesthesia plans and managed perioperative pain. Surgical Practices, guided by insights from the other specialties, executed patient-centered surgeries. Despite the benefits, challenges such as communication barriers and resource limitations were identified.Conclusion: this review highlighted the critical role of interdisciplinary collaboration in holistic patient care. While the synergy between Internal Medicine, Anesthesiology, and Surgical Practices improved patient outcomes, addressing communication challenges and resource constraints is essential for further enhancing care quality.

Nurse-Led Medication Management for Older People in Home Care: A Systematic Review of Evolving Nurse Responsibilities in Technology-assisted Care

Technology-assisted care is transforming the home care landscape for older people requiring medication management. With evolving roles and responsibilities, nurse-led interventions are shaping the future of nursing practice in home care. This review aimed to identify and describe nurse-led roles in medication management in home care for older people within the context of technology-assisted care. A systematic review employing an integrative approach was conducted on the PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest, and Embase, targeting studies published in English over the past decade, from 2014 to 2024. The initial database search identified 1629 studies, which were subsequently narrowed down to 20 studies selected for data analysis and narrative research synthesis. The review findings were classified into 3 categories: “fundamental principles,” “nurses and their role identities,” and “enhanced care quality and medication safety.” Given the effectiveness of nurses as leaders in technology-assisted home care for enhancing medication management safety, it is essential to implement policies that support and improve their involvement in multidisciplinary healthcare teams. Additionally, continuous education and training focused on technology-assisted care competencies are necessary to ensure nurses are well-prepared to enhance patient safety in home care.

Experiences of Indonesian nurses as Hajj health personnel in caring for Hajj pilgrims: A qualitative study.

Investigating the experiences and roles of nurses during Hajj is vital due to the unique public health challenges posed by the mass gathering of diverse pilgrims. Nurses play a crucial role in disease surveillance, infection control, and managing emergencies like heat stroke and injuries. Their insights can improve emergency preparedness and public health management. This study aimed to explore the experiences of Indonesian nurses as Hajj health personnel caring for Hajj pilgrims during the 2023 Hajj season. This study employed a qualitative descriptive design and selected participants through purposive sampling from hospitals, public healthcare centers, and clinics in Yogyakarta, Indonesia. Nine nurses participated in the research, and data were collected through a focus group discussion in December 2023. Thematic analysis was used to analyze the data. Six themes emerged, including practicing ethical principles in providing health care during the hajj process, competency qualifications as a health worker, the health care process during Hajj, legal Requirements for Hajj, the importance of therapeutic communication skills to establish cooperation with various parties, and recognizing the role of duties and responsibilities during the hajj process. The study emphasizes the importance of competencies, ethics, communication, and strategic planning in Hajj healthcare. Effective online communication, especially via WhatsApp, was crucial for coordination. The findings emphasize the need for strategic workforce planning, resource allocation, and continuous training to enhance care quality for pilgrims, informing better planning and policy development for future Hajj seasons.

Barriers and facilitators to primary care for people living with HIV and diabetes in Harare.

People living with human immunodeficiency virus (HIV) and comorbid diabetes mellitus (DM) face significant challenges owing to the complex interplay between these chronic conditions and the need for comprehensive and integrated care. Service availability and readiness for primary care are essential for the health of individuals and populations. This study aimed to explore barriers and facilitators to the provision of care to the patients with HIV and T2DM comorbidity. The study was conducted at Primary health centres in Harare, Zimbabwe. A mixed-methods design was applied. An audit of primary care facilities identified that there was adequate infrastructure and equipment for HIV and T2DM diagnosis and treatment. However, there are gaps in the availability of essential medicines and supplies, such as test strips for blood glucose monitoring. The assessment also showed that the centres had a chronic shortage of healthcare providers, including doctors, nurses and counsellors, and there was a need for additional training and support for healthcare providers in the management of HIV and T2DM. The study concludes that the delivery of health services to patients with HIV and T2DM at primary care centres in Harare, Zimbabwe, faces significant challenges. Suggestions included improved resource allocation and multisectoral collaboration to improve the delivery of healthcare services.Contribution:The research contributes insight into disparities between urban and rural primary care facilities in providing services, emphasizing the need for targeted interventions to bridge gaps and enhance care quality.