Frontline Healthcare Providers Research Articles

Sociodemographic Disparity Patterns of Perceived Stress and Resilience Among Advanced Registered Nurse Practitioners During the Prolonged COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic, 1 of the most prolonged and extensive global pandemics in history, ravaged the world. Advanced practice registered nurses (APRNs) played crucial roles as frontline health care providers in detecting and treating COVID-19–infected patients. The purpose of this study was to provide updated knowledge and sociodemographic disparity patterns in APRNs’ perceived stress and resilience during the prolonged pandemic period. A total of 2,412 APRNs completed the surveys. The results of this research showed that APRNs’ stress and resilience were significantly impacted by the prolonged pandemic. Significant sociodemographic disparity patterns of perceived stress and resilience among APRNs were also clearly identified.

Perinatal loss in Tanzania: Perspectives of maternal-child healthcare providers.

Over 98% of stillbirths and neonatal deaths occur in Low- and Middle-Income Countries, such as Tanzania. Despite the profound burden of perinatal loss in these regions, access to facility or community-based palliative and psychosocial care is poor and understudied. In this study we explore perinatal loss through the lens of front-line healthcare providers, to better understand the knowledge and beliefs that guide their engagement with bereaved families. A Knowledge Attitudes and Practices survey addressing perinatal loss in Tanzania was developed, translated into Swahili, and administered over a 4-month period to healthcare professionals working at the Kilimanjaro Christian Medical Center (KCMC). Results were entered into REDCap and analyzed in R Studio. 74 providers completed the survey. Pediatric providers saw a yearly average of 5 stillbirths and 32.7 neonatal deaths. Obstetric providers saw an average of 11.5 stillbirths and 13.12 neonatal deaths. Most providers would provide resuscitation beginning at 28 weeks gestational age. Respondents estimated that a 50% chance of survival for a newborn occurred at 28 weeks both nationally and at KCMC. Most providers felt that stillbirth and neonatal mortality were not the mother's fault (78.4% and 81.1%). However, nearly half (44.6%) felt that stillbirth reflects negatively on the woman and 62.2% agreed that women are at higher risk of abuse or abandonment after stillbirth. A majority perceived that women wanted hold their child after stillbirth (63.0%) or neonatal death (70.3%). Overall, this study found that providers at KCMC perceived that women are at greater risk of psychosocial or physical harm following perinatal loss. How women can best be supported by both the health system and their community remains unclear. More research on perinatal loss and bereavement in LMICs is needed to inform patient-level and health-systems interventions addressing care gaps unique to resource-limited or non-western settings.

Exploring Holistic Cancer Care and Survivorship in India Through the Kerala Model of Palliative Care: Role of Community Nurse and Outpatient Meetings.

Support groups and meetings are self-help gatherings that provide a unique sense of community, unconditional acceptance, and information on cancer and its treatment. This cross-sectional study examined 12 outpatient meetings within the Kerala model of palliative care, a community-based service provided to patients irrespective of disease, stage, or prognosis starting from the time of diagnosis. The study focused on the pivotal role of community nurses in facilitating these meetings, with participants including cancer patients and survivors. Using in-depth interviews (n = 52) and participant observations, this research used a qualitative approach and explored the dynamics and outcomes of outpatient meetings. Findings highlight the indispensable contributions of these community nurses serving as linchpins in providing support, guiding discussions, and offering crucial education. Outpatient meetings effectively addressed psychosocial concerns, combatted stigmas associated with cancer, and promoted informed decision making in cancer care. The study emphasizes the need for recognizing the role played by community nurses in improving psychosocial support and diminishing stigma, and ultimately the quality of life of patients and survivors through the palliative cancer care within the Kerala model. We also underscore the need for policy initiatives, resource allocation, and training programs tailored to support these frontline health care providers effectively.

The influence of COVID-19 pandemic on the mental health of pharmacists as frontline health care providers in Nepal

BackgroundDue to COVID-19, pharmacists have been exposed to a variety of dangers that have an impact on their mental health. The study highlights that impact of COVID-19 and work led to burnout among them. Thus, it is necessary to offer mental health services. AimsTo assess the impact of COVID-19 on the work of pharmacy professionals and ascertain the extent of the influence of burnout on mental health among pharmacists working as frontline health providers in Nepal. MethodsPharmacists from Province 2, 3, and 5 in Nepal participated in a self-administered questionnaire that assessed mental health and wellbeing and burnout using 16-item OLBI. Data was collected from January 2023–March 2023. Independent sample t-test, one-way ANOVA, Pearson's correlation, and linear regression were employed to identify any significant connections between burnout and mental health and wellbeing. ResultsOut of 243 participants, COVID-19 pandemic and work was found to have a negative impact on the mental health and wellbeing of a 33.7% of pharmacists. Participants reported having financial issues in 41.6% of cases and 9.5% considered leaving the profession and were concerned about the provision of service quality and making mistakes at work. A strong and meaningful positive relationship and linear regression were observed between exhaustion, disengagement, burnout, mental health and wellbeing. Pharmacists working part-time (p < 0.050) in hospital settings experienced burnout as a result of insufficient training, extended working hours, and stress both on and off the job. ConclusionsPharmacists are to prioritize a healthy work-life balance, which includes avoiding prolonged shifts >8 h, regular physical exercise and promote open communication among colleagues to address workplace concerns.

Mental Health Burden and Facilitators Among Frontline Healthcare Professionals in Nigeria Amid COVID-19 Pandemic: A Cross-sectional Study.

During the COVID-19 pandemic, the frontline healthcare providers faced significant mental health stressors. Previous pandemics have revealed the need for psychosocial support and healthy coping mechanisms to mitigate mental health risks. The study aimed to assess psychological impact and supportive mechanisms experienced by frontline healthcare workers treating COVID-19 patients in Kaduna State. This study involved 38 frontline healthcare providers mainly from Kaduna State Infectious Disease Treatment Center. Participants' mental health burden was captured through Hospital Anxiety and Depression Scale. Mental health facilitators were assessed through six tools: Ten-Item Values Inventory, healthy defense section of the Defense Style Questionnaire, Existential Anxiety Questionnaire, Brief Resilience Scale, Oslo Social Support Scale, and the Insomnia Severity Index. The mean age of the study participants was 35.5 ± 6.6 years, with the majority being males (68.4%) and doctors (39.5%). More than a quarter of the participants showed appreciable symptoms of depression and anxiety. Psychosocial facilitators such as moral values, openness to change, self-transcendence, sublimation, anticipation, and humor scored above average for more than half of the participants. Most participants demonstrated moderate resilience and social support, with few experiencing sleep challenges. Comparisons of variables indicated "openness to change" was significantly higher among males, whereas symptoms of depression and anxiety were associated with higher levels of existential concerns and sleep challenges. Our study finds that Nigerian frontline health workers experienced significant mental health challenges during the COVID-19 pandemic. It identified specific facilitators linked to gender and psychological burdens, informing the need for tailored support interventions.

Adaptive Stacking Ensemble Techniques for Early Severity Classification of COVID-19 Patients

During outbreaks of infectious diseases, such as COVID-19, it is critical to rapidly determine treatment priorities and identify patients requiring hospitalization based on clinical severity. Although various machine learning models have been developed to predict COVID-19 severity, most have limitations, such as small dataset sizes, the limited availability of clinical variables, or a constrained classification of severity levels by a single classifier. In this paper, we propose an adaptive stacking ensemble technique that identifies various COVID-19 patient severity levels and separates them into three formats: Type 1 (low or high severity), Type 2 (mild, severe, critical), and Type 3 (asymptomatic, mild, moderate, severe, fatal). To enhance the model’s generalizability, we utilized a nationwide dataset from the South Korean government, comprising data from 5644 patients across over 100 hospitals. To address the limited availability of clinical variables, our technique employs data-driven strategies and a proposed feature selection method. This ensures the availability of clinical variables across diverse hospital environments. To construct optimal stacking ensemble models, our technique adaptively selects candidate base classifiers by analyzing the correlation between their predicted outcomes and performance. It then automatically determines the optimal multi-layer combination of base and meta-classifiers using a greedy search algorithm. To further improve the performance, we applied various techniques, including imputation of missing values and oversampling. The experimental results demonstrate that our stacking ensemble models significantly outperform existing single classifiers and AutoML approaches, with improvements of 6.42% and 8.86% in F1 and AUC scores for Type 1, 9.59% and 6.68% for Type 2, and 11.94% and 9.24% for Type 3, respectively. Consequently, our approach improves the prediction of COVID-19 severity levels and potentially assists frontline healthcare providers in making informed decisions.

PHARMACY PRACTICE STANDARDS AND CHALLENGES IN NIGERIA: A COMPREHENSIVE ANALYSIS

Pharmacy practice standards and challenges in Nigeria constitute a critical area of concern due to their profound impact on healthcare delivery and patient outcomes. This comprehensive analysis delves into the multifaceted landscape of pharmacy practice in Nigeria, highlighting prevailing standards and the array of challenges faced by pharmacists in their professional endeavors. Nigeria, like many other developing countries, grapples with a complex healthcare system marked by resource constraints, regulatory ambiguities, and evolving patient needs. Within this context, pharmacists play a pivotal role as frontline healthcare providers, responsible for ensuring safe and effective medication use. However, the absence of robust regulatory frameworks and standardized practices poses significant hurdles to the delivery of quality pharmaceutical care. This analysis examines the existing pharmacy practice standards in Nigeria, emphasizing the role of regulatory bodies such as the Pharmacists Council of Nigeria (PCN) in setting guidelines and enforcing compliance. It also scrutinizes the challenges encountered by pharmacists, including inadequate infrastructure, limited access to essential medicines, counterfeit drugs, and insufficient professional development opportunities. Furthermore, the analysis explores the impact of socio-economic factors, cultural beliefs, and healthcare disparities on pharmacy practice in Nigeria. It underscores the need for collaborative efforts among stakeholders, including government agencies, healthcare institutions, pharmaceutical industry players, and professional associations, to address these challenges comprehensively. In conclusion, this study underscores the importance of enhancing pharmacy practice standards in Nigeria to promote patient safety, optimize medication therapy outcomes, and advance public health objectives. By addressing the identified challenges and fostering a supportive environment for pharmacists, Nigeria can harness the full potential of its pharmacy workforce to meet the healthcare needs of its population effectively.&#x0D; Keywords: Pharmacy, Standards, Nigeria, Practices, Review.

Healthcare simulation training for cutaneous anthrax presentation: improving readiness in frontline healthcare providers

Healthcare simulation training for cutaneous anthrax presentation: improving readiness in frontline healthcare providers

Frontline Providers’ and Patients’ Perspectives on Improving Diagnostic Safety in the Emergency Department: A Qualitative Study

Few studies have described the insights of frontline health care providers and patients on how the diagnostic process can be improved in the emergency department (ED), a setting at high risk for diagnostic errors. The authors aimed to identify the perspectives of providers and patients on the diagnostic process and identify potential interventions to improve diagnostic safety. Semistructured interviews were conducted with 10 ED physicians, 15 ED nurses, and 9 patients/caregivers at two separate health systems. Interview questions were guided by the ED-Adapted National Academies of Sciences, Engineering, and Medicine Diagnostic Process Framework and explored participant perspectives on the ED diagnostic process, identified vulnerabilities, and solicited interventions to improve diagnostic safety. The authors performed qualitative thematic analysis on transcribed interviews. The research team categorized vulnerabilities in the diagnostic process and intervention opportunities based on the ED-Adapted Framework into five domains: (1) team dynamics and communication (for example, suboptimal communication between referring physicians and the ED team); (2) information gathering related to patient presentation (for example, obtaining the history from the patients or their caregivers; (3) ED organization, system, and processes (for example, staff schedules and handoffs); (4) patient education and self-management (for example, patient education at discharge from the ED); and (5) electronic health record and patient portal use (for example, automatic release of test results into the patient portal). The authors identified 33 potential interventions, of which 17 were provider focused and 16 were patient focused. Frontline providers and patients identified several vulnerabilities and potential interventions to improve ED diagnostic safety. Refining, implementing, and evaluating the efficacy of these interventions are required.

Bringing experiences of healthcare in custody into quality improvement.

Patient experience is an essential component of safe and high-quality healthcare, yet rarely examined in the context of carceral settings. This article describes a project undertaken by the Ontario Ministry of the Solicitor General to collect evidence and perspectives on how to bring patient experiences of healthcare services delivered in provincial correctional facilities into ongoing quality improvement work. We first conducted a scoping review and jurisdictional scan to learn from existing processes and experiences. We then engaged frontline healthcare providers delivering services in custody and people with recent experience of incarceration regarding priority measures and processes for data collection and mechanisms for implementing evidence-based change. This article describes methods used to engage stakeholders, including a survey and focus groups, as well as key lessons learned. This work is relevant to readers experiencing barriers to patient engagement, interested in collaborative research processes, and developing services for people who have experienced incarceration.

Improving Safety Culture by Establishing Alarm Fatigue Performance in The Adult Intensive Care Unit, Dammam Hospital

Alarm fatigue is becoming a more significant global public health issue that compromises patient safety. Alarm fatigue is especially common among critical care nurses, who are the frontline healthcare providers that provide patients with the most direct care and round-the-clock patient monitoring. An excessive number of alerts, together with erroneous and ineffective alerts, can cause alarm fatigue and negatively impact the psychological well-being of nurses and patients during their recovery process. To find a way to lower the number of false alarms and assess the effectiveness of the measures put in place, a quantitative, descriptive cross-sectional approach was employed. In the adult ICU at NGHA Dammam, this pilot project was carried out from June 2019 to November 2020. In order to identify true alarms and false alarms, the Central Monitor Nurse Daily Checklist was utilized as a data collection tool in conjunction with education training and departmental policies and procedures. There are about 820 alerts per patient each day, including 104 telemetry and 716 bedside alarms. Three months into the project, the project's top alarm measurement was 1503 alarms per patient per day. The project has shown a constant trend in alarm declinations after this peak, largely as a result of project improvement activities. The lowest recorded alarm count in November 2020 was 226 alerts, a 72% decrease from the initial 820 alarms. Nonetheless, the declining trend over the previous three months showed a 22%, 42%, and 48% drop in the overall number of alarms. This study found that alarm fatigue, which is influenced by a number of variables, including safety culture practices, was more common among critical care nurses working in the Intensive Care Unit at NGHA Dammam. Overall, during the first two months of its deployment, this study effectively met its aim and had a considerable impact on the reduction of "false alarms". The results of this study, taken together with improved psychological health for nurses and the provision of a therapeutic environment for patients, offer crucial direction for future intervention programs aimed at reducing alarm fatigue among critical care nurses. Future studies should concentrate on the traits of adherence and management, as well as the obstacles that prevent ICU staff from continuing to implement interventions and false alarm reduction strategies.

Factors Associated with Self-Care Practice among Adult Diabetes Patients

Introduction: Diabetes mellitus is a major public health problem worldwide, and the prevalence of diabetes mellites is steadily increasing in developing countries including Ethiopia. Adherence to diabetes self-care activities is a vital strategy for the reduction in diabetes mellitus. This study aimed to assess the level of self-care practice and its associated factors among adult diabetes patients in Tercha Zonal diabetes center: A Southern Nation Nationality of Ethiopia. Methods: An facility-based cross-sectional study was conducted among 213 diabetes mellitus patients follow-up at Tercha Zonal diabetes center selected by systematic random sampling. Data were entered into Epi-Data version 4.6 and exported to SPSS version 25 for analysis. Both descriptive and inferential statistics were used to describe and test the association between selected variables. Statistical significance was declared at p-value &lt;0.05. Results: Out of the 213 study participants, only 84 (39.4%) had good self-care practices. The multivariate logistic regression analysis revealed that attending secondary education (AOR=16.015,(95%CI:1.925-133.251),P=0.01] and college and above [AOR=89.553, (95%CI:9.732–824.021),P&lt;0.001]and having diabetes complications [AOR=0.412, (95%CI:0.204 – 0.832), P=0.013] were significantly associated with good self-care practice. Conclusion: The study revealed that a significant number of the study participant have poor self-care practices in the prevention and control of diabetes mellitus. Educational level, and having diabetes complications were found statistically significantly associated with a good level of self-care practice. Therefore, all frontline healthcare providers should provide basic information and counseling regarding diabetes self-care practice.

A mixed-methods landscape assessment of supportive care for heart failure.

Aim: Understanding factors that shape leading health systems' (LHS) perspectives around heart failure (HF) treatment. Patients & methods: First of its kind study using a cross-sectional, descriptive, mixed-method design (from executives and frontline healthcare providers) with quantitative survey (n=35) and qualitative interview (n=12) data from 47 participants (41 different LHS). Results: 97% of LHS had dedicated HF programs, but variations in maturity highlights opportunities for care standardization. Treatment innovations continue, though practitioners may struggle to keep pace amid provider/patient barriers. HF programs strive to co-locate supportive care services to optimize treatment, but access can prove challenging. Conclusion: Opportunities exist, with external partner support, for LHS to become more comprehensive HF care providers, increasing standardization of care across LHS and improved HF treatment.

“It is because the treatment of this lady is a cascade”: Accumulation of delays and the occurrence of obstetric emergencies in an urban maternity unit in Tanzania

ObjectiveTo explore healthcare workers’ and women's experiences of providing and seeking childbirth care in a busy urban maternity facility in Tanzania. DesignA qualitative study with observations, in-depth interviews, and informal conversations, using thematic network analysis. SettingThis study was conducted in a busy urban maternity unit in Dar es Salaam, Tanzania which is a low-resource setting with a need to improve childbirth care. ParticipantsSix frontline healthcare providers and four hospital managers from the facility, along with six postpartum women who gave birth at the facility. FindingsDelays were observed throughout the childbirth care cascade, encompassing various stages. During antenatal care, timely provision of care was hindered by a high patientto-provider ratio, resulting in inadequate monitoring of risk factors. At the onset of labor, women delayed seeking care, sometimes, attempting a trial of labor after a previous Caesarean section. Within the facility, delays in care decision-making and patient management were evident due to insufficient resources. The accumulation of these delays over time influenced the quality of care provided and challenged the management of obstetric emergencies at the study facility. Key conclusionsThe study findings show that delays are prevalent throughout the entire childbirth care cascade. The accumulation of these delays over time has influenced the quality of care provided at the facility and increased the vulnerability of women experiencing obstetric emergencies. To effectively address the imperative of reducing maternal mortality in low-resource settings, it is essential to develop appropriate interventions that span the entire spectrum of childbirth care. Additionally, further research is needed to delve into the complexities of care decision-making and the quality of care delivered within urban maternal facilities. Implications for practiceOur findings stress the need for comprehensive childbirth interventions and contextspecific guidelines to address challenges across the care cascade, particularly in lowresource settings. Urgent attention is required to prioritize care during patient triage and address systemic challenges within the healthcare system to improve birth outcomes and ensure effective facility-based care provision.Trial registration number: NCT04685668Date of initial trial registration: December 28th, 2020

Diagnostic accuracy of foot length measurement for identification of preterm newborn in rural Sindh, Pakistan

IntroductionAssessing gestational age accurately is crucial for saving preterm newborns. In low and middle-income countries, such as Pakistan, where access to antenatal ultrasonography (A-USG) is limited, alternative methods are needed....

Third delay in care of critically ill patients: a qualitative investigation of public hospitals in Kenya

ObjectivesThird delay refers to delays in delivering requisite care to patients after they arrive at a health facility. In low-resource care settings, effective triage and flow of care are difficult...

‘COVID-19 is just another way to die…’: a qualitative longitudinal study of frontline COVID-19 response governance across Syria

IntroductionGovernance of COVID-19 responses has been challenging for all countries. Syria has been particularly challenged due to protracted multiparty conflict and debilitated health systems fragmented across different areas of control....

Preexposure Prophylaxis for HIV Prevention in the United States: An Overview and Update.

There were 36,136 new HIV diagnoses in the United States and dependent areas in 2021, despite a 12% reduction in estimated HIV incidence from 2017 to 2021. The burden of HIV remains disproportionately high among certain populations, including gay and bisexual men, Black/African American individuals, and Hispanic/Latino individuals, and racial and ethnic health care disparities persist. The Ending the HIV Epidemic initiative aims to significantly reduce new infections, with a focus on HIV prevention, particularly the use of preexposure prophylaxis (PrEP). However, challenges remain in achieving equitable PrEP distribution. As frontline health care providers, nurses play a pivotal role in this battle against HIV. This article provides an update on PrEP screening recommendations, the types of PrEP available, dosing, adverse effects, and the role of nurses in patient support and monitoring.

Harnessing In Situ Simulation to Identify Human Errors and Latent Safety Threats in Adult Tracheostomy Care

Tracheostomies are associated with high rates of complications and preventable harm. Safe tracheostomy management requires highly functioning teams and systems, but health care providers are poorly equipped with tracheostomy knowledge and resources. In situ simulation has been used as a quality improvement tool to audit multidisciplinary team emergency response in the actual clinical environment where care is delivered but has been underexplored for tracheostomy care. From July 2021 to May 2022, the study team conducted in situ simulations of a tracheostomy emergency scenario at Montefiore Medical Center to identify human errors and latent safety threats (LSTs). Simulations included structured debriefs as well as audiovisual recording that allowed for blind rating of these human errors and LSTs. Provider knowledge deficits were further characterized using pre-simulation quizzes. Twelve human errors and 15 LSTs were identified over 20 simulations with 88 participants overall. LSTs were divided into the following categories: communication, equipment, and infection control. Only 50.0% of teams successfully replaced the tracheostomy tube within the scenario's five-minute time limit. In addition, knowledge gaps were highly prevalent, with a median pre-simulation quiz score of 46% (interquartile range 36-64) among participants. An in situ simulation-based quality improvement approach shed light on human errors and LSTs associated with tracheostomy care across multiple settings in one health system. This method of engaging frontline health care provider key stakeholders will inform the development, adaptation, and implementation of interventions.

Political instability and hiv/aids response in the south west and north west regions of Cameroon: a qualitative study

BackgroundPolitically motivated violence and insecurity continue to be a major threat to progress in HIV epidemic control and a significant contributor to health inequality. Despite a decreasing HIV/AIDS disease burden, the Republic of Cameroon in West Africa is experiencing ongoing political instability in her North and South West Regions. Our study used qualitative methods to better understand key frontline health care providers’ (fHCP) perceptions of the effects of political instability on HIV/AIDS response gains in Cameroon since 2018, as well as lessons learned for overcoming them.MethodsBetween July and August 2022, semi-structured, in-depth key informant interviews involving 10 purposively selected participants were conducted in the two regions. Interviews were recorded and transcribed verbatim, coded thematically, and analyzed manually.ResultsSix overarching themes emerged from the transcribed key informant interviews. They were as follows: Challenge with access to and availability of health care services (HIV care, commodity supply chain) in the smaller communities; Impact on continuity of treatment; Increased risk of new HIV infections; The socioeconomic impact of the crisis on the quality of life; The impact of the crisis on fHCPs’ physical and mental health and the health system’; and Coping mechanisms.ConclusionsFrontline healthcare workers have acknowledged the significant impact the current political instability has had in hindering the development and advancement of a successful local response to HIV/AIDS in the two impacted regions of Cameroon. Coordinated efforts must be made to strengthen the health sector in areas such as HIV healthcare decentralization, supply chain, and protecting frontline healthcare workers from political quagmires in order to lessen the impact of the nation’s socio-political crisis on the HIV/AIDS response and, more generally, on the entire health sector.