Fear Of Repercussions Research Articles

Barriers to help-seeking from healthcare professionals amongst women who experience domestic violence\xa0-\xa0a qualitative study in Sri Lanka

BackgroundDomestic violence (DV) is a major global public health problem which is associated with significant adverse consequences. Although Sri Lankan women who experience DV receive treatment from healthcare professionals (HCPs) for DV related physical and psychological problems, disclosure of DV within health services is quite low. This study explored barriers to disclosure of DV to HCPs among Sri Lankan women who experience DV.MethodThis qualitative study took place in the Central Province of Sri Lanka. Twenty women who had experienced DV were recruited from Gender Based Violence Centers (Mithuru Piyasa Centers) and a toxicology unit of the two selected hospitals. Participants were purposefully selected using maximum variation sampling technique. In-depth interviews were conducted until data saturation was reached. Interviews were recorded, and analyzed using thematic analysis.ResultsSurvivor related barriers to help seeking included women’s lack of knowledge and perceptions about the role of HCPs, lack of confidence in HCPs, fear of repercussions, personal attitudes towards DV, and their love and loyalty towards the perpetrator. Women preferred it if HCPs initiated discussions about DV, and they valued it when HCPs could be confidential and protect their privacy, and give enough time for DV related issues during consultations. A perpetrator related barrier was the controlling behavior of the perpetrator. Social stigma and social and cultural norms about the role of women emerged as the socio-cultural constraints to disclosure.ConclusionsBarriers to help seeking for DV from HCPs exist at individual, healthcare level, and societal level. Community programs are needed to increase women’s access to healthcare services and interventions should be implemented to develop effective, preventive, and supportive strategies at the healthcare system level.

Workplace Assertiveness of Filipino Hospital Staff Nurses: A Cross-sectional Study

Background: Several studies have demonstrated the significance of assertiveness in the nursing profession. However, there is a lacuna in the literature regarding the level of workplace assertiveness of Filipino nurses.Purpose: This study determined the workplace assertiveness towards nursing colleagues, nursing management personnel, medical doctors, and other members of the health team among hospital staff nurses.Methods: The data in this cross-sectional study were collected from randomly selected staff nurses (n=223) involving two tertiary hospitals in the Philippines using the Workplace Assertive Behavior Questionnaire. Descriptive statistics and tests for differences were used to analyze the data.Results: Results showed that staff nurses had moderate workplace assertiveness. They were less assertive towards the nursing management personnel, and were less likely to provide constructive criticisms and say no to requests. Assertiveness significantly varied based on employment status (p=.001), age (p=.046), years of nursing work experience (p=.037), and years in the present organization (p=.022). A sense of responsibility to patients was the main facilitator while reprimand and fear of repercussions from the nursing management personnel were the major barriers to assertive behaviors.Conclusion: Personal and work environmental factors can inhibit or support assertiveness. This study highlighted some gaps in Filipino staff nurses’ assertiveness at work. Nursing management plays a pivotal role in nurses’ assertiveness. Efforts should be made to address the barriers and improve the assertiveness of staff nurses.

The promotion of injury and illness prevention and reporting in the fire service

Injury prevention interventions are limited in the fire service due to a lack of widespread implementation and underreporting. This creates a significant challenge to improving occupational health. To determine how fire chiefs are promoting reporting and the prevention of physical and mental injuries and illnesses. We used an open-ended, qualitative instrument to assess the presence of prevention programs and actions to promote injury and illness reporting in the fire service. The instrument contained six content validated items related to the promotion of prevention interventions and reporting. A total of 54 fire chiefs (age = 51±8y; females = 4, males = 50, years of experience as fire chief = 7±6y) responded to the instrument. A majority (n = 37/54, 68.5%) of the fire chiefs indicated their department had an established health and wellness program. Most fire chiefs reported using established guidelines, education, and a supportive culture to promote prevention and reporting. The cultural stigma of being a firefighter and fear of repercussions were barriers to the promotion of reporting of illness and injury. Fire chiefs stated that they struggled to find ways to effectively promote reporting and prevention strategies. The success of a fire chief's promotional efforts was greater in instances where multiple factors were addressed.

دور القيادات التربوية في مواجهة التحديات والتغيرات الحديثة في ظل جائحة کورونا The role of educational leaders in facing recent challenges and changes in light of the Covid-19 pandemic

هدفت الدراسة التعرف على دور القيادات التربوية في مواجهة التحديات والتغيرات الحديثة في ظل جائحة کورونا. لتحقيق أهداف الدراسة استخدم الباحث المنهج الوصفي، فقد تم استخدام الإستبانة کأداة لجمع المعلومات، وقد تکونت الاستبانة بصورتها النهائية من (25) عبارة موزعة على أربع محاور: وهي (الدور المعرفي، والدور الإداري، والدور التقني، والدور الإشرافي) وقد تم استخراج معايير الصدق والثبات لاداة الدراسة حسب الأصول العلمية، وتم اختيار عينة الدراسة بالطريقة العشوائية والتي تکونت من (100) قائد تربوي في مدينة جده. توصلت النتائج إلى أن المتوسط الحسابي لمجال الدور المعرفي جاء بدرجة مرتفعة جدا والذي حصل على 4.33، کما أظهرت نتائج الدراسة عدم وجود فروق ذات دلالة احصائية في جميع مجالات الدراسة تبعا لمتغير الجنس، والعمر، والمؤهل العلمي، کما أظهرت عدم وجود فروق ذات دلالة احصائية في جميع مجالات الدراسة تبعا لمتغير سنوات الخبرة في المجال الثاني والثالث والخامس، بينما أظهرت ان هناک فروق ذات دلالة احصائية لبعد الدور المعرفي ولبعد الدور الإشرافي لصالح فئة اکثر من 10 سنوات . وأوصت الدراسة بضرورة تعزيز القيادات الإدارية للأمان النفسي حتى يتمکن الجميع من مناقشة الأفکار والأسئلة دون الخوف من التداعيات، وضرورة حرص القيادات الإدارية على تعزيز قوة التواصل بين فرق العمل من أجل مواجهة جائحة فيروس کورونا. The study aimed to identify the role of educational leaders in facing modern challenges and changes in light of the Covid-19 pandemic. To achieve the goals of the study, the researcher used the descriptive analytical approach, the questionnaire was used as a tool to collect information, it consisted of (25) paragraphs distributed on three variables: namely (the cognitive role, the administrative role, the technical role, and the supervisory role). The researcher checked the validity and reliability of the study tool, the study sample was chosen randomly, which consisted of (100) educational leaders . The results of the study showed that the arithmetic average for the cognitive role variable was very high, which got 4.33, and the results of the study showed that there were no statistically significant differences in all variables of study according to the sex, age, and academic qualification variables, it also showed that there are no statistically significant differences in all fields of study according to the years of experience variable in the second, third and fifth variables, while it showed that there are statistically significant differences for the “cognitive role” and “supervisory role” variable in favor of the “more than 10 years” variable. The study recommended the necessity of strengthening administrative leaderships for psychological safety so that everyone can discuss ideas and questions without fear of repercussions, and the need for administrative leaderships to enhance the strength of communication between work teams in order to confront the Covid-19 pandemic

Levelling the playing field: students\u2019 motivations to contribute to an amnesty of assessment materials

Background‘Exam recall’ is a recognised phenomenon whereby students recall and record questions after leaving the examination hall. This poses two main problems. First, as these questions are only available to peers of the students who recall the questions, these individuals have an unfair advantage. Secondly, the distribution of these recalled questions poses a threat to the validity and defensibility of assessments.To address the first of these problems, we developed an amnesty enabling students to submit assessment material to an on-line site. This study sought to explore which factors influence students’ contributions to an amnesty of assessment material.MethodsWe conducted a qualitative study using semi-structured focus groups. We used convenience sampling and recruited participants from all years of our undergraduate medical programme. The focus groups were facilitated by a medical student peer to reduce the power imbalance and encourage participants to discuss candidly. The focus groups were audio recorded and transcribed verbatim.Two researchers independently analysed all transcripts using thematic analysis and the research team met regularly to discuss emergent findings. Nvivo was used to assist with thematic analysis of the transcripts.ResultsTwenty-six individuals participated in six focus groups. Six themes were identified through the analysis, which were categorised into motivating factors and de-motivating factors.Motivating factors were a perception that this would overcome inequity, a fear of repercussions, and the perceived usefulness of resources. Factors that prevented students contributing were a culture of competition, a lack of incentives, and mistrust of the medical school.ConclusionsThe establishment of an amnesty was acceptable to students and they were motivated to contribute materials. The competitive nature of medical careers and the stakes of summative assessments meant that students felt that some peers might still not contribute their materials. Students felt that the school were listening to their concerns and this led to a better dialogue between students and faculty.

Workplace Bullying in Healthcare: A Qualitative Analysis of Bystander Experiences

Bystander action has been proposed as a promising intervention to tackle workplace bullying, however there is a lack of in-depth qualitative research on the direct experiences of bystanders. In this paper, we developed a more comprehensive definition of bullying bystanders, and examined first person accounts from healthcare professionals who had been bystanders to workplace bullying. These perspectives highlighted factors that influence the type and the extent of support bystanders may offer to targets. Semi-structured telephone interviews were conducted with 43 healthcare professionals who were working in the UK, of which 24 had directly witnessed bullying. The data were transcribed and analysed using Thematic Analysis. The analysis identified four themes that describe factors that influence the type and extent of support bystanders offer to targets of bullying: (a) the negative impact of witnessing bullying on bystanders, (b) perceptions of target responsibility, (c) fear of repercussions, and (d) bystander awareness. Our findings illustrate that, within the healthcare setting, bystanders face multiple barriers to offering support to targets and these factors need to be considered in the wider context of implementing bystander interventions in healthcare settings.

Medical students’ attitudes towards mental health disclosure: a qualitative study

Purpose In 2013, the General Medical Council conducted research into best practice for supporting medical students with mental health concerns, producing a document outlining University’s duty of care. It also outlined reasons as to why medical students are susceptible to mental illness. The purpose of this paper is to explore what factors affected medical students' disclosure of mental health problems and their help-seeking behaviour today and if these differed from the GMC’s findings from 2013. Design/methodology/approach A questionnaire was issued to all University of Glasgow medical student year groups. In total, 72 people responded. All responses were then analysed by the primary researcher using Mayring’s six-step approach of systematic, rule guided qualitative text analysis. Findings Four main barriers to disclosure were revealed: fear of repercussions, medical student “expectations”, judgement and lack of support. Respondents feared being deemed unfit to practise, displaying “weakness” or being treated differently. They believed support provided was inadequate or inaccessible. Less than half felt the Medical School made mental health support easily available and only 11% were even aware of the GMC document. Respondents believed medical students were psychologically vulnerable due to Medical School environment, work load, “expectations” and course content. They perceived the Medical School was “a pressure cooker” for mental health problems and yet student well-being was not prioritised. Originality/value The research highlighted some key areas that universities should address, such as promoting support services available, recognising the unique stresses of the medical curriculum and the need for provision of resources that can be accessed without fear, stigmatisation or uncertainty.

\u201cThey haven\u2019t asked me. I haven\u2019t told them either\u201d: fertility plan discussions between women living with HIV and healthcare providers in western Ethiopia

BackgroundDespite the importance of women living with HIV (WLHIV) engaging in fertility plan discussions with their healthcare providers (HCPs), little research exists. This study explored perceptions surrounding fertility plan discussions between WLHIV and their HCPs in western Ethiopia, from the perspectives of both women and providers.MethodsThirty-one interviews (27 with WLHIV and 4 with HCPs) were conducted at four healthcare facilities in western Ethiopia in 2018. Data were transcribed verbatim and translated into English. Codes and themes were identified using inductive thematic analysis.ResultsThere was a discordance between HCPs and WLHIV’s perception regarding the delivery of fertility plan discussions. Only nine of the 27 WLHIV reported they had discussed their personal fertility plans with their HCPs. When discussions did occur, safer conception and contraceptive use were the primary focus. Referrals to mother support groups, adherence counsellors as well as family planning clinics (where they can access reproductive counselling) facilitated fertility discussions. However, lack of initiating discussions by either HCPs or women, high client load and insufficient staffing, and a poor referral system were barriers to discussing fertility plans. Where discussions did occur, barriers to good quality interactions were: (a) lack of recognizing women’s fertility needs; (b) a lack of time and being overworked; (c) mismatched fertility desire among couples; (d) non-disclosure of HIV-positive status to a partner; (e) poor partner involvement; (f) fear of repercussions of disclosing fertility desires to a HCP; and (g) HCPs fear of seroconversion.ConclusionsOur findings highlight the need for policies and guidelines to support fertility plan discussions. Training of HCPs, provision of non-judgmental and client-centered fertility counselling, improving integration of services along with increased human resources are crucial to counselling provision. Enhancing partner involvement, and supporting and training mother support groups and adherence counsellors in providing fertility plan discussions are crucial to improving safer conception and effective contraceptive use, which helps in having healthy babies and reducing HIV transmission.

COVID-19: Compounding the health-related harms of human trafficking.

Those affected by human trafficking are exposed to multiple severe health risks, including physical, sexual, and psychological violence, occupational hazards, and deprivation, and usually require urgent medical care to address the physical and psychological consequences of extreme exploitation [[1]Oram S. Stöckl H. Busza J. et al.Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: systematic review.PLOS Med. 2012; 9 (https://dx.doi.org/10.1371%2Fjournal.pmed.1001224)e1001224Crossref PubMed Scopus (242) Google Scholar]. COVID-19 threatens to exacerbate the health disparities faced by this vulnerable group. Existing inequalities are being globally compounded by the pandemic's widespread socio-economic impacts, representing an international crisis that disproportionately affects society's most vulnerable groups. COVID-19 has increased job insecurity and unemployment, informal and unskilled labour, food and housing insecurity, poverty, and healthcare unaffordability. These drivers of enslavement increase the risk of sexual and labour exploitation, and are being used by criminal groups to scale-up modern slavery activities [[2]UN News. COVID-19 crisis putting human trafficking victims at risk of further exploitation, experts warn. 06 May 2020. https://news.un.org/en/story/2020/05/1063342[accessed 19 May 2020]Google Scholar]. Simultaneously, as health systems and law enforcement refocus on COVID-19, and governments impose strict physical distancing policies, efforts to identify trafficking are significantly undermined, as healthcare providers, labour inspectors, social workers, and third sector actors are limited in their actions and contact with at-risk groups. The resulting rise in trafficking is similar to previous outbreaks [[3]Worsnop C.Z. The Disease Outbreak-Human Trafficking Connection: A Missed Opportunity.Health Security. 14 June 2019; 17 (https://doi.org/): 181-192https://doi.org/10.1089/hs.2018.0134Crossref PubMed Scopus (6) Google Scholar], reflecting a significant burden of unmet physical and psychological needs in an invisible group of all genders and ages. Victims of trafficking are disproportionately at risk of COVID-19 infection due to pre-existing health needs, unregulated and unsafe working environments, over-crowded living conditions, poverty, malnutrition, and substance misuse. They also face significant barriers to healthcare both during and post-trafficking, including controls imposed by exploiters, fear of repercussions from traffickers, law enforcement, or immigration authorities, language barriers, lack of knowledge of healthcare availability or entitlements, and lack of identity documentation [[4]Westwood J. Howard L.M. Stanley N. et al.Access to, and experiences of, healthcare services by trafficked people: findings from a mixed-methods study in England.British Journal of General Practice. November 2016; 66: e794-e801https://doi.org/10.3399/bjgp16X687073Crossref PubMed Scopus (27) Google Scholar]. Restrictive public health strategies exacerbate these barriers, while health systems worldwide are redesigned to prioritise COVID-19, significantly reducing the availability of services, and inequitably transferring them online. This further prevents timely or confidential access to healthcare, increasing morbidity and mortality due to untreated acute and long-term conditions including communicable diseases, physical injuries, mental illness, substance misuse, and suicide attempts [[5]Kiss L. Pocock N.S. Naisanguansri V. Health of men, women, and children in post-trafficking services in Cambodia, Thailand, and Vietnam: an observational cross-sectional study.The Lancet Global Health. 01 March 2015; 3 (https://doi.org/): 154-161https://doi.org/10.1016/S2214-109X(15)70016-1Summary Full Text Full Text PDF Scopus (134) Google Scholar], while opportunities are missed for healthcare workers to screen, identify, and disrupt trafficking activity. The rights and health needs of those who have experienced trafficking must be urgently prioritised during COVID-19. Health workers must be educated to expect a rise in trafficking, and health services preserved, equitable care facilitated, and access barriers removed. This will require reimagining approaches to identifying and appropriately responding to trafficking, and strengthening coordination between healthcare providers, statutory services, and third sector organisations. We declare no competing interests.

Are they ideological renegades? Fathers' experiences on taking parental leave and gender dynamics in Korea: A qualitative study

Despite their fear of repercussions on career advancement and gender identity, Korean fathers taking parental leave have continually increased. Why do Korean fathers take parental leave in spite of the risk of being stigmatized as less masculine and less ideal workers? Are they willing to be ‘ideological renegades' to be new involved fathers? In‐depth interviews with fathers who took parental leave provide interesting answers. Overall, taking parental leave does not make fathers become ideological renegades since it is mainly utilized in a manner that accommodates the work devotion schema, deviating from the formal policy objectives. This deviant utilization is encouraged and even valued by organizations. This may be part of a psychological contract between organizations and employees, ensuring that employees are dedicated to their career even during parental leave. Furthermore, beyond the legal eligibility of uptake, informal but powerful ‘organizational eligibility' such as high performance or their contribution to the organization, makes not only the likelihood but also the aftermath of taking up different across fathers. As a result, a hierarchy among fathers with class connotations emerges. This hierarchy among fathers, combined with the traditional gender hierarchy, may reinforce the masculine fabric of ideal workers as the norm.

An exploration of medical student attitudes towards disclosure of mental illness

ABSTRACT Background: Medical students are reluctant to access mental health services, despite having high rates of anxiety and depression. This reluctance persists through residency and into practice. Physicians and trainees who are unwell deliver lower quality patient care, behave less professionally, communicate less effectively and are at an increased risk for burnout and suicide. Little is known about whether students would disclose a mental health diagnosis on a state board medical license application. Objectives: The objectives of this study were to determine whether University of New Mexico School of Medicine (UNM SOM) students would be willing to disclose a mental health diagnosis on a medical licensing application if prompted to do so, and, if not, to identify the reasons for their unwillingness to do so. Design: We electronically invited all UNM SOM students enrolled in the Classes of 2019, 2020, 2021, and 2022 to participate in a confidential RedCap survey about mental health diagnoses and treatment. Four e-mail invitations and reminders were sent to students over a one-month period. Results: Response rate was 50.1%. Thirty-six percent of all respondents considered themselves to have had a mental health condition prior to medical school, and 47% of all respondents perceived a decline in mental health during medical school. The majority of respondents who perceived they had a mental health diagnosis (51%) stated they would not disclose this information on a New Mexico Medical Board (NMMB) license application. Fear of stigmatization, fear of repercussions, and a belief that such disclosure was irrelevant were the top reasons for non-disclosure. Conclusion: Students who perceive themselves to have mental health diagnoses are unlikely to disclose their mental health status on state medical board licensing applications when asked to do so. Addressing barriers to disclosure of mental health diagnoses is necessary for building a healthier physician workforce.

Reliability of residents\u2019 assessments of their postgraduate medical education learning environment: an observational study

BackgroundEven in anonymous evaluations of a postgraduate medical education (PGME) program, residents may be reluctant to provide an honest evaluation of their PGME program, because they fear embarrassment or repercussions from their supervisors if their anonymity as a respondent is endangered. This study was set up to test the hypothesis that current residents in a PGME program provide more positive evaluations of their PGME program than residents having completed it. We therefore compared PGME learning environment evaluations of current residents in the program to leaving residents having completed it.MethodsThis observational study used data gathered routinely in the quality cycle of PGME programs at two Dutch teaching hospitals to test our hypothesis. At both hospitals, all current PGME residents are requested to complete the Scan of Postgraduate Education Environment Domains (SPEED) annually. Residents leaving the hospital after completion of the PGME program are also asked to complete the SPEED after an exit interview with the hospital’s independent residency coordinator. All SPEED evaluations are collected and analysed anonymously. We compared the residents’ grades (on a continuous scale ranging from 0 (poor) to 10 (excellent)) on the three SPEED domains (content, atmosphere, and organization of the program) and their mean (overall department grade) between current and leaving residents.ResultsMean (SD) overall SPEED department grades were 8.00 (0.52) for 287 current residents in 39 PGME programs and 8.07 (0.48) for 170 leaving residents in 39 programs. Neither the overall SPEED department grades (t test, p = 0.53, 95% CI for difference − 0.16 to 0.31) nor the department SPEED domain grades (MANOVA, F(3, 62) = 0.79, p = 0.51) were significantly different between current and leaving residents.ConclusionsResidents leaving the program did not provide more critical evaluations of their PGME learning environment than current residents in the program. This suggests that current residents’ evaluations of their postgraduate learning environment were not affected by social desirability bias or fear of repercussions from faculty.

Debriefing in critical care

Debriefing after critical events is a well-known practice in medicine, utilized in both simulated and real-life situations. In addition to reviewing the medical aspects of the care, debriefing allows for examination of team performance and human factors involved in the event. Various methods, locations, and time intervals can be utilized to debrief to meet the team's needs. Some proven methods of debriefing include plus-delta, directive feedback, the Socratic Method, and advocacy and inquiry.1 Each method has its benefits and limitations and can be applied during various segments of a debriefing to achieve the debriefer's goals. These goals usually include identifying and addressing knowledge gaps, uncovering participants' beliefs and thought processes, reflecting on the team's performance, and synthesizing the information to improve future performance.2 Debriefing should be a planned follow-up to every critical event. This standardizes the process and expectation for teams to share their experiences and work towards an improved performance. The debriefing environment should be a safe space for team members to express their emotions while sharing successes and challenges without fear of repercussion or blame. Allowing team members to share their decision-making process and knowledge level lets the debriefer tailor learning points to address appropriate deficits rather than assuming and targeting areas that may not need improvement. In addition, involving team members from all involved disciplines can enhance the outcomes of the debriefing. There is evidence that handoffs with more team members can improve efficiency, documentation, and future patient outcomes.3 The timing of these debriefs can be varied based on the clinical scenario and even the emotional state of the team members. Immediately debriefing after an event, also known as the “hot” debrief, allows most team members to participate and capitalizes on a clear memory of events to identify successes and opportunities for improvement. In addition to performance improvements, these sessions may help team members express their emotions and offer some coping skills to deal with unfortunate outcomes including the death of a patient. However, sometimes the debriefer may assess the emotional state of the team and deem it not appropriate to conduct the debriefing immediately after the event. In these settings a delayed debriefing session, or “warm” or “cold” debrief, may allow team members to process their emotions and reflect on the clinical event prior to coming together as a group to discuss their performance.Despite the well described benefits of debriefing, there continues to remain a disconnect between knowing to conduct debriefs and their actual implementation. This can be due to various circumstances including, time pressures, patient care, or limited training in how to debrief a team. These failures to debrief can lead to communication breakdowns within the team.4 The absence of a debriefing can also lead to improper or inadequate documentation, which can result in clinical error and increased litigation.5 Organizations such as the Agency for Healthcare Research and Quality advocate for clinical event debriefing; this attention and effort on research and training can hopefully increase the frequency of and comfort with clinical event debriefing.

Barriers and enablers for the implementation of a hospital communication tool for patient participation: A qualitative study.

To investigate potential barriers and enablers prior to the implementation of the Tell-us card. Patient participation has the potential to improve quality of care and has a positive effect on health outcomes. To enhance participation of patients, adequate communication between patients, their relatives and healthcare professionals is vital. Communication is considered as a fundament of care according to the Fundamentals of Care Framework. A strategy to improve patient participation is the use of the Tell-us card; a communication tool that patients and relatives can use during hospitalisation to point out what is important for them during their admission and before discharge. Investigating barriers and enablers is needed before implementation. A qualitative study. Semistructured, individual interviews with (head)nurses, nurse assistants and midwifes. Interviews were audio-recorded, transcribed and analysed using the framework analysis method. The COREQ checklist has been used. The need to maintain control over care, reluctance to engage in in-depth conversations, fear of being seen as unprofessional by patients, fear of repercussions from physicians, the lack of insight in the meaning of patient participation and the lack of appreciation of the importance of patient participation appeared to be majors barriers. Participants also elaborated on several prerequisites for successful implementation and regarded the cooperation of the multidisciplinary team as an essential enabler. The identified barriers and enablers revealed that nurses and midwives are rather reluctant towards patient participation and actively facilitating that by using the Tell-us card communication tool. A number of issues will have to be factored into the implementation plan of the communication tool. Tailored implementation strategies will be crucial to overcome barriers and to accomplish a successful and sustainable implementation of the Tell-us card.

Child maltreatment and modifying factors in Shanghai, China

The risk of child abuse and neglect is greatest in early childhood and is associated with adverse psychosocial well-being over the lifespan. The true prevalence is difficult to quantify and there are often large discrepancies between actual maltreatment, reports to authorities, and confirmation by authorities. Shan et al attempt to determine the prevalence of maltreatment by collecting parental reports about 20 324 children aged 3-4 years who were enrolling into 191 kindergartens in Shanghai, China. Previous reports of child maltreatment in China were based on victim reports, which limited the sample to older children, adolescents, and adults. Parents completed an online survey that entailed a single-item question about whether their child had ever experienced abuse (physical, mental, or sexual) or neglect (emotional or physical). This question was examined in relationship to parental responses to the Strengths and Difficulties Questionnaire and the Chinese Parent-Child Interaction Scale. With 97.3% of 20 899 invited parents participating, the authors found that 2.7% of parents reported child maltreatment with only 1.3% of respondents failing to answer the question. Demographic characteristics associated with child maltreatment included lower socioeconomic status, father as the primary caregiver, and having a sibling. The negative impact on child psychological development and well-being was modified by the frequency of positive parent-child interactions. The likelihood of under-reporting is significant due to cultural factors, parental denial, and/or fear of repercussion. Furthermore, as the authors note, harsh parenting behavior in China is perceived positively as a sign of “concern and love,” which would reduce the probability that parents describe their actions as maltreatment in self-reports. The positive take away is to promote frequent positive parent-child interactions, which can reduce the adverse outcomes associated with child maltreatment, benefitting the child, the family, and society at large. Article page 180▸ Association between Maltreatment, Positive Parent–Child Interaction, and Psychosocial Well-Being in Young ChildrenThe Journal of PediatricsVol. 213PreviewTo explore the prevalence of maltreatment and the combined effect of maltreatment and frequency of positive parent–child interaction on psychosocial well-being in young children in China. Full-Text PDF

Palliative Care–Related Knowledge, Attitudes, and Self-Assessment Among Physicians in Vietnam

ContextPalliative care is rarely accessible in low- and middle-income countries, and lack of adequate training for health care providers is a key reason. In Vietnam, the Ministry of Health, major hospitals and medical universities, and foreign physician-educators have partnered to initiate palliative care training for physicians. ObjectivesTo measure the baseline palliative care–related knowledge, attitudes, and self-assessment of Vietnamese physicians as a basis for curriculum development and to enable evaluation of training courses. MethodsBefore palliative care training courses in Vietnam from 2007 to 2014, we collected data on the participating physicians' demographics, self-assessed competence in palliative care, and palliative care–related knowledge and attitudes. Scores were calculated in three outcome categories—knowledge, attitudes, and self-assessment—and in two subcategories related to physical and psychological symptoms. Associations between the demographic, education, and practice factors and these scores were assessed using linear regression. ResultsAmong the 392 physicians surveyed, concern about untreated suffering was highly prevalent. 85% felt that most patients with cancer in Vietnam die in pain. On self-assessment, only 8% felt adequately trained in palliative care and the mean knowledge assessment score was 44%. Although 77% had prescribed an opioid in the past year and most had appropriate attitudes toward the use of morphine for pain, the majority reported explicit or implicit restrictions on prescribing morphine. ConclusionThere is a great need among Vietnam's physicians for training in palliative care and especially in nonpain and psychological symptom control. Rational, balanced, and clear opioid-prescribing policies are needed to enable physicians to treat pain without fear of repercussions.

Management of Leadership Roles among Third Line Managers of Educational Institutes

Leaders in today's "flat" organisations have more autonomy than in the past. Leadership is about inspiring others to work together towards a common goal, whereas authority is about getting others to do what you want them to do without question or fear of repercussions. Because it appeals to the intellect and logical behaviour rather than the potent existential forces at the core of motivation, authority is unable to create the conviction or emotional devotion that leadership generates. The most effective corporate executives are aware of this fact and are thus gentle when delegating authority. They serve as role models for actions that build trust and responsibility, and they make use of informal networks and channels to motivate others throughout the organisation to make a difference.

Why do women leave surgical training? A qualitative and feminist study

Women are under-represented in surgery and leave training in higher proportions than men. Studies in this area are without a feminist lens and predominantly use quantitative methods not well suited to the complexity of the problem. In this qualitative study, a researcher interviewed women who had chosen to leave surgical training. Women were recruited using a purposive snowball strategy through the routine communications of the Royal Australasian College of Surgeons and Royal Australasian College of Surgeons Trainee Association over a 3-week period, and were interviewed over the following 4 months in the past 4 years in person or by telephone. More specific details are available on request from the authors. Supported by male and female co-researchers, and in dialogue with study participants, she then coded the findings and defined themes. An explanatory model was developed by integrating findings with different theories and previous literature. The research team developed three aspects of the model into a visual analogue. 12 women participated in the study, with all Australian states and territories, and New Zealand, as well as five medical specialty streams, represented. The time spent in training ranged from 6 months to 4 years, and all participants, except two, had trained in both metropolitan and rural locations. The findings confirmed factors identified in earlier reports as reasons women leave surgical training, and contributed six new factors: unavailability of leave, a distinction between valid and invalid reasons for leave, poor mental health, absence of interactions with the women in surgery section of their professional body and other supports, fear of repercussion, and lack of pathways for independent and specific support. The relationships between factors was complex and sometimes paradoxical. The visual analogue is a tower of blocks, with each block representing a factor that contributed to the decision to leave surgical training, and with the toppling of the tower representing the choice to leave. The visual analogue indicates that effective action requires attention to the contributory factors, the small actions that can topple the tower, and the contexts in which the blocks are stacked. Women might be best helped by interventions that are alert to the possibility of unplanned negative effects, do not unduly focus on gender, and address multiple factors. This should inform interventions in surgical training, with attention to local social context, health-care setting, and training programme structure. Royal Australasian College of Surgeons Ian and Ruth Gough Surgical Education Scholarship.

Nursing Students' Experience of Sexual Harassment During Clinical Practicum: A Phenomenological Approach.

To describe nursing students' experience of sexual harassment during clinical practicum. An interpretive phenomenological qualitative approach was used to understand contextual experiences of participants. Individual in-depth interviews were conducted to collect data from thirteen nursing students who experienced sexual harassment during clinical practice in general hospitals at D metropolitan city. All interviews were recorded and transcribed into Korean and English. Transcripts were analyzed using the data analysis method described by Diekelmann, Allen, and Tanner. The following 12 themes emerged from the data: 'unprepared to respond', 'lack of education', 'unsure about when behavior crosses the line', 'power differential for nursing students', 'balancing self-preservation with obligations to patients', 'shame', 'feeling responsible for not being able to prevent the harassment', 'impact on patient care', 'fear of what might have happened', 'fear of repercussions', 'long term impact', and 'peer support'. Participants in this study described feeling an obligation to care for their patients. However, they seemed to be unable to balance this while feeling vulnerable to sexual harassment with strong negative feelings. Helping students recognize and effectively deal with sexual harassment is a critical element to assure quality learning for participants and maintain quality of care during clinical practice.

Commentary on Fazel et al. (2017): High levels of substance use disorders among correctional inmates-some implications for interventions of the review data from Fazel et al.

Commentary on Fazel et al. (2017): High levels of substance use disorders among correctional inmates-some implications for interventions of the review data from Fazel et al.