Healthcare Environment Research Articles

Beyond Depression and Anxiety in IBD: Forging a Path Towards Emotional Healing.

Inflammatory Bowel Diseases (IBD) are chronic, often debilitating diseases characterized by inflammation of the digestive tract. IBDs affect up to 1% of the world's population and tend to be diagnosed in the second and third decades of life. In addition to physical burdens, IBDs have significant psychological manifestations stemming from bidirectional inflammatory and coping pathways and thus, are best understood from a biopsychosocial perspective. Though previous IBD literature has predominantly focused on traditional psychological comorbidities, such as anxiety and depression, recent studies have uncovered adjustment disorders, post-traumatic stress, and disordered eating as prevalent manifestations of the disease. This review will summarize the rates and postulated biopsychosocial mechanisms underlying these conditions to frame how cultivating resilience can protect against IBD symptoms and help forge a path towards emotional healing. We will also provide guidance to aid clinicians in screening for these conditions and creating a trauma-informed healthcare environment.

Exploring barriers to and facilitators of infection prevention and control practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital, Ethiopia

BackgroundAdherence to infection prevention and control (IPC) standards and guidelines by healthcare workers is essential for reducing the spread of healthcare-associated infections (HAIs). However, IPC practices among healthcare workers in low- and middle-income countries (LMICs), including Ethiopia, are generally inadequate. This research aims to identify the barriers to and facilitators of IPC practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital (TASH) in Ethiopia.MethodsWe employed a rapid ethnographic assessment (REA) approach for this study, using focus group discussions (FGDs), in-depth interviews (IDIs), and observations to collect data. Participants were selected from the Pediatrics and Child Health Department of TASH, and data collection took place in March and April 2022. Two FGDs and eight IDIs were conducted in the participants’ workplace within the department. Unstructured guides were used to facilitate the FGDs and IDIs. Nvivo version 10 software was used for data organization and analysis. The data were coded deductively through thematic analysis to identify similar ideas and concepts, based on the Systems Engineering Initiative for Patient Safety (SEIPS) model.ResultA total of 23 healthcare workers participated, with 15 in FGDs and 8 in IDIs. The study identified several barriers to IPC practices, including nonadherence to IPC practice protocols, lack of pre-employment training, space constraints, insufficient maintenance and repair of equipment, limited management engagement and support, shortage of resources and budget, incidents of needle stick injuries and infections, high workloads for healthcare workers, shortages of personal protective equipment and water supply, and inadequate waste management. We also identified some facilitators, including the existence of an IPC team and committee, a health education schedule for patients and visitors, morning sessions for healthcare providers, and the presence of television screens in waiting areas. By addressing the identified barriers and leveraging the facilitators, department heads, IPC team leaders, and decision-makers can develop targeted strategies and interventions to improve infection control, reduce the spread of HAIs, and ultimately enhance the quality of healthcare services.ConclusionThis study explored several barriers that contribute to inappropriate and suboptimal IPC practices in the study area. These barriers create significant challenges for healthcare workers and hindering their ability to effectively implement IPC practices. The findings highlight the complex and multifaceted nature of the problems, which not only affect the current working environment but also compromise the overall quality of care. The hospital administrator should address these critical issues to improving IPC practices and ensuring a safer healthcare environment.

Lessons Learned from the Experiences of Domestic Violence Service Providers in Times of Crisis: Insights from a Central Asian Country.

Domestic violence is a widespread problem in both stable and crisis contexts. During crisis-driven periods, such as environmental, economic, political, and health emergencies, existing gender inequalities are exacerbated, and the risks of violence against women (VAW) are amplified. This qualitative study explores the experiences of professionals working in VAW organisations in a Central Asian country during the COVID-19 pandemic. By interviewing 45 professionals from social care organisations in Kazakhstan, this study aims to understand the impact of COVID-19 on the ability of VAW organisations to assist victims of domestic violence and comprehend the adjustments they made to support victims. The findings shed light on the challenges faced by VAW organisations, including reduced capacity, increased service demand, the shift to remote services, and funding cuts. The study highlights the critical role of these organisations in crises and urges the consideration of lessons learned to prevent VAW in emergency and non-emergency situations. In the Central Asian region, where domestic violence is persistent, this research offers valuable insights for interventions during and after crises. The study offers effective strategies for achieving Sustainable Development Goal 5.2, which aims to eliminate violence against women, and SDG 3.8, ensuring access to healthcare, psychological support, and safe environments.

Internal Audit of an Oral Pathology Laboratory: Perspectives on Finances and Operational Management.

Background Internal audits are essential tools for enhancing the operational efficiency, quality, and effectiveness of healthcare departments. Audits enable the departments and laboratories to meet the changing needs of the healthcare environment by giving a detailed picture of the department's operations and highlighting areas for possible growth and development. Aims and objectives This study focuses on the biopsies received in the Oral Pathology Department at Saveetha Dental College, aiming to evaluate biopsy trends, financial performance, and resource utilization over one year. Materials and methods The oral pathology department audit covered the period from 1st April 2023 to 31st March 2024. The institutional human ethical committee and scientific review board approved the retrospective audit. It involved a comprehensive analysis of biopsy data, financial records, and material usage. Data on different biopsy types (excisional, incisional, frozen sections), immunohistochemistry, cytology, and special stains were collected and analyzed across four quarters. Financial performance was assessed by comparing total income and expenses, while resource utilization was examined through the use of histopathological blocks and other consumables. Statistical analysis (chi-square) was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). A P-value less than 0.05 was considered statistically significant. Results We received 1100 cases during the study period. Excisional biopsies were the most common, with 474 (43.09%) cases, followed by incisional biopsies with a total of 432 (39.27%). Out of total cases of 1100, the second quarter (July-September 2023) had the highest case volume of 305 (27.72%), while the third quarter (October-December 2023) recorded the lowest of 250 (22.72%) cases. A financial audit revealed an annual deficit of ₹1,03,321 primarily due to higher expenses towards laboratory reagents. The overall expense incurred per case was ₹448.5. Tissue blocks cost ₹85.23 per case (19.00%) of the average cost per case. The chi-square test analysis was insignificant among the different types of biopsies and the reagent consumption across the four quarters. Conclusion The audit identified critical areas for improvement in both clinical workload and financial management. High volumes of biopsies, but net financial deficits highlight the need for better cost management and resource utilization strategies to maintain sustainability without compromising diagnostic quality.

The Nursing Theory of Complex Adaptive Systems: A New Paradigm for Nursing.

This article explores the theoretical and practical implications of the meaning of thinking, living, and acting within the framework of nursing in Complex Adaptive Systems. The Nursing Theory of Complex Adaptive Systems is grounded in the principles of Complex Adaptive Systems (CASs). It seeks to offer a new paradigm for nursing practice that addresses healthcare's dynamic and evolving nature. The Nursing Theory of Complex Adaptive Systems represents a new nursing paradigm capable of addressing the challenges of a constantly evolving healthcare environment. This theory promotes personalized care plans adaptable to patients' changing needs by emphasizing a holistic and interactive approach to care. It also underscores the importance of interprofessional collaboration and effective communication in improving the quality of care. The Nursing Theory of Complex Adaptive Systems has significant implications for nursing practice, education, and research. It provides a robust framework for developing adaptive and resilient nursing practices that can respond to the complexities of modern healthcare. By integrating the principles of CASs into nursing, the Nursing Theory of Complex Adaptive Systems fosters a more flexible, interdependent, and holistic approach to patient care, ultimately enhancing patient outcomes and improving healthcare systems. This theory has practical applications in various healthcare settings, offering a framework for personalized and adaptable care plans that respond to the dynamic needs of patients while improving overall system efficiency. Future research should focus on the empirical validation of the Nursing Theory of Complex Adaptive Systems and its practical implementation in various healthcare settings.

Design and Implementation of an IoT-Based Intravenous Infusion Monitoring System Using Wireless Sensor Network

This research presents a Wireless Sensor Network (WSN) based infusion monitoring system that utilizes Internet of Things (IoT) technology to enhance infusion management in healthcare. Manual supervision often lacks the necessary accuracy and control, making automated solutions crucial. Our system employs optocoupler and load cell sensors to calculate the infusion drop rate per minute and assess the remaining fluid percentage. Tests conducted demonstrated that optocoupler sensors effectively measured the drop rate, while load cell sensors accurately determined fluid levels. Measurement results are easily monitored via smartphone, granting healthcare professionals rapid access to vital data. A key innovation of this system is its ability to enable remote monitoring through WSN, allowing a single nurse to oversee multiple infusions with just one smartphone. The test results indicate impressive accuracy, achieving an average precision rate of 97% for drop rate measurements and 93% for remaining fluid percentage measurements. Overall, this system offers an efficient and controlled approach to infusion fluid management, ensuring optimal care for patients. By integrating IoT and WSN technologies, this research lays the groundwork for developing more advanced and interconnected infusion monitoring systems, ultimately enhancing patient care in today's globalized healthcare environment.

Following up on "Alarming sound: A case study of noise in an emergency department"

Building on "Alarming Sound: A Case Study on Noise in an Emergency Ward," this follow-up study aims to explore the outcomes of a redesigned floorplan on the Jeroen Bosch Hospital in the city of Den Bosch (NL), it's emergency department staff experiences and workplace dynamics focusing on sound. Leveraging both qualitative and quantitative research methodologies, the study seeks to investigate anticipated changes in staff satisfaction, communication efficiency, and the overall work environment following the implementation of spatial modifications. While the outcomes of these interventions are yet to be determined, the research aims to contribute to the existing body of knowledge on the impact of physical workspace changes on healthcare delivery and staff well-being. This research aims to help develop healthcare environments that improve working conditions and better patient care outcomes.

An Overview of the Prevalence and Effects of Back Pain among Nurses in Zambia

Topic: This mini-review addresses the critical issue of back pain among nurses in Zambia, highlighting the occupational health challenges they face within a resource-limited healthcare system. Type of Review: This is a literature mini-review synthesizing recent research findings and theoretical frameworks relevant to back pain in nursing. Main Focus: The review focuses on the prevalence, causes, and potential interventions for back pain among Zambian nurses, emphasizing the need for culturally relevant health messaging and systemic changes within the healthcare environment. Gaps Identified: While existing literature outlines various factors contributing to back pain, there is a notable lack of longitudinal studies assessing the long-term effectiveness of proposed interventions, as well as limited exploration of broader systemic issues within the Zambian healthcare infrastructure. Conclusions: Addressing back pain among Zambian nurses requires a comprehensive approach that includes tailored educational initiatives, effective workload management, and improvements in ergonomic support within healthcare settings. Practical Implications: The findings suggest actionable strategies for healthcare institutions to enhance nurse well-being, which in turn can improve patient care quality. Policy Implications: Policymakers are encouraged to implement systemic changes that address staffing shortages and improve workplace ergonomics, thereby fostering a healthier work environment for healthcare professionals. Relevance: This mini-review contributes to the ongoing discourse on occupational health in resource-limited settings, offering insights that are valuable for researchers, healthcare practitioners, and policymakers striving to enhance the working conditions and health outcomes for nurses worldwide.

Eco-Friendly and Biocompatible Material to Reduce Noise Pollution and Improve Acoustic Comfort in Healthcare Environments

Noise pollution negatively impacts people’s mental and physiological health. Unfortunately, not only is noise present in hospital environments, but its level frequently exceeds recommended thresholds. The efficacy of passive acoustic absorbers in reducing indoor noise in these scenarios has been well-documented. Conversely, given their inorganic composition and their origin in the petrochemical industry, most of these materials present a risk to human health. Over the last few years, there has been a notable increase in research on eco-friendly, low-toxicity, and biocompatible materials. This work outlines a methodology for fabricating recycled acoustic panels from plastic bottles and PET felt composites. This study encompasses three key objectives: (i) a comprehensive biocompatibility assessment of the panels, (ii) an evaluation of their thermal and acoustic properties, and (iii) their applicability in several case studies to evaluate potential acoustic enhancements. Specifically, antifungal resistance tests, Volatile Organic Compound (VOC) emission assessment, and cell viability experiments were conducted successfully. Additionally, experimental procedures were performed to determine the thermal conductivity and thermal resistance of the proposed material, along with its sound absorption coefficients in diffuse field conditions. Finally, the potential benefits of using this biomaterial in healthcare environments to reduce noise and improve acoustic comfort were demonstrated.

B-025 Revolutionizing NGS-driven Laboratory Developed Tests: The impact of automated liquid handling on plate-based bead clean-up

Abstract Background Automated liquid handling systems are proving to be a transformative technology in the landscape of Laboratory Developed Tests (LDTs), especially those utilizing Next-Generation Sequencing (NGS). By enhancing accuracy, boosting efficiency, and offering scalable solutions, these systems enable labs to meet current and future challenges more effectively. The right system not only improves the quality of diagnostics but also positions labs to be agile and adaptive in a rapidly advancing healthcare environment. firefly® is a well-suited liquid handling solution for diagnostics labs developing LDTs due to its compact footprint, user-friendly software and exceptional versatility. Validated protocol templates that support NGS library preparation are readily available from the firefly cloud and can be adapted to meet specific lab needs. For example, automated bead-based clean-ups designed for 96- and 384- NGS applications are available on firefly. These remove DNA fragments of undesirable sizes, enzymes or primers rom the amplified DNA after a PCR reaction. Automating this process facilitates higher throughput and scaling. firefly has a unique combination of 6 positive displacement dispense heads and a 96/384-well air-displacement pipetting head, making it ideal to distribute the reagents required for bead clean-ups. Methods firefly protocols were developed and optimized to be compatible with a range of elution volumes and bead ratios. Protocol performance was tested using library DNA (∼300bp). The same input DNA was plated out and quantified using the QuantiFluor dsDNA system (Promega) before and after running the protocol. This data was used to assess any reduction in DNA concentration and uniformity across the plate. The protocol's ability to successfully modulate the fragment size distribution was demonstrated using a 50bp DNA ladder and different bead ratios. Data was obtained using a Fragment Analyzer (Agilent, DNF-474 HS NGS Fragment Kit). Well-to-well contamination was assessed by running no-template-controls (NTCs) in wells adjacent to library DNA, then analyzed by qPCR using a LightCycler 480 System (Roche, KAPA Library Quantification kit). Results 96 format has a setup time of 10 minutes, run time of 43 and %CV library concentration of <6%. 384 format has a setup time of 10 minutes, run time of 47 and %CV library concentration of <8%. Uniformity of concentration and fragment sizes was seen across the plates. Comparison of the library concentration before and after the clean-up showed a 5% reduction in DNA concentration after the 96-well plate clean-up and an 11% reduction in library concentration when using the 384-well plate clean-up. Fragment size analysis showed that fragment sizes can be successfully modulated on firefly by changing the bead ratio of the firefly run and no detectable well-to-well contamination was detected by qPCR. Conclusions We have demonstrated that automated bead clean-ups on firefly are uniform show uniformity across both 96- and 384-well plates, with no detectable well-to-well contamination, to deliver the consistent and robust results required for an LDT. Bead-based cleanups on firefly offer a fast, 100% walkaway solution. By running 96-samples at once on firefly, we see approximately a 6-fold increase in throughput than when performed manually by a single user.

Developing Spice-healthcare: Supporting Personalized and Inclusive Cuisines in Environments for Healthcare

Developing Spice-healthcare: Supporting Personalized and Inclusive Cuisines in Environments for Healthcare

Digital Certificate Management for Medical Devices

As the healthcare environment becomes increasingly digitally connected and cyber threats to healthcare technologies evolve, cybersecurity controls are necessary to ensure the safety and effectiveness of medical devices. Digital certificates are one such security control commonly utilized to secure various technologies and systems including medical devices. However, few academic resources describe the use of digital certificates in the unique context of medical devices. Additionally, digital certificate issues have the potential to impact the safety and effectiveness of medical devices and to negatively hinder the delivery of patient care. This article provides an introduction on the role of digital certificates to secure and manage access to medical devices, including potential issues and digital certificate management considerations.

Microbial Contamination in Reusable Healthcare Bath Basins: An Observational Descriptive Study

The relationship between pathogens in the healthcare environment and healthcare-acquired infection has been well-documented in the literature. No study has been published since 2012 regarding the contamination of reusable bath basins. This brief report aims to determine if basin contamination remains a reservoir for bacteria that may contribute to the risk of spreading microorganisms to vulnerable patients. We address this question with data from multiple sites over ten years.

Change pattern relationships in event logs

Process mining utilises process execution data to discover and analyse business processes. Event logs represent process executions, providing information about the activities executed. In addition to generic event attributes like activity name and timestamp, events might contain domain-specific attributes, such as a blood sugar measurement in a healthcare environment. Many of these values change during a typical process quite frequently. We refer to those as dynamic event attributes. Change patterns can be derived from dynamic event attributes, describing if the attribute values change from one activity to another. So far, change patterns can only be identified in an isolated manner, neglecting the chance of finding co-occuring change patterns. This paper provides an approach to identifying relationships between change patterns by utilising correlation methods from statistics. We applied the proposed technique on two event logs derived from the MIMIC-IV real-world dataset on hospitalisations in the US and evaluated the results with a medical expert. It turns out that relationships between change patterns can be detected within the same directly or eventually follows relation and even beyond that. Further, we identify unexpected relationships that are occurring only at certain parts of the process. Thus, the process perspective reveals novel insights on how dynamic event attributes change together during process execution. The approach is implemented in Python using the PM4Py framework.

Pre-hospital and hospital treatment of febrile seizures

Given that febrile seizures are a common reason for both hospital and pre-hospital visits to physicians, and in the absence of a clear consensus on guidelines for treatment, especially for complex febrile seizures (CFS), we aim to examine their characteristics and treatment in order to improve the approach to the issue. This is an observational, retrospective, single-centre study including paediatric patients seen after a seizure associated with a febrile illness in the emergency department of a second-level hospital between September 2021 and December 2023. Epidemiological, clinical and treatment variables were collected. A total of 266 febrile seizures were included in the study: 188 (70.7%) were simple, and 78 (29.3%) were complex. Most benzodiazepines were administered during pre-hospital treatment (82%), and the transmucosal route was used in 70.3% of cases, despite the patient being in a healthcare environment. Complementary tests were performed in 70.6% of cases, blood tests in 65.6%, and nasopharyngeal swabs for viruses in 79.3%. A total of 73.6% of the tests requested were for patients with a focus of the fever. Extensive use of complementary tests persists, despite the identification of a focus of the fever in most patients. Our results show that systematic complementary tests and the admission of patients who have presented a CFS would not be justified, and each individual case should be considered.

The Development of a Comprehensive Dimensions Scale for Assessing Clinical Teachers' Occupational Well-Being.

In Taiwanese clinical and healthcare environments, there is a dearth of appropriate and effective tools to evaluate clinical teachers' occupational well-being. Therefore, this study aimed to develop a culturally adapted scale, a Taiwanese version of the Clinical Teachers' Occupational Well-Being Dimensions Scale (CTOWDS), to accurately measure the occupational well-being of clinical teachers in Taiwan. Following a comprehensive literature review and expert panel discussions, the study developed the CTOWDS and conducted exploratory factor analysis (EFA) with 346 participants using SPSS to identify its underlying dimensional structure and psychometric properties. Confirmatory factor analysis (CFA) was then performed with 255 participants using AMOS to validate the EFA results. The study also assessed internal consistency, convergent and discriminant validities, and goodness-of-fit indexes to ensure that the scale was valid and reliable in the Taiwanese cultural setting. The EFA refined the scale from 51 to 29 items across five dimensions: personal qualities (11 items), academic research and career development pressure (6 items), teaching experience (4 items), learning experience (4 items), and teaching and communication pressure (4 items). These five dimensions explained 65.279% of the total variance. The CFA confirmed the five dimensions and 29 items, with good convergent and discriminant validities, goodness-of-fit indexes, and Cronbach's alpha values exceeding 0.70. The findings affirm the utility of the developed CTOWDS as a reliable and culturally relevant instrument for assessing the occupational well-being of clinical teachers.

Conceptual Considerations for Understanding Resilience in Healthcare Students.

Increasing attention has been given to the concept resilience in the context of healthcare especially during and post the COVID pandemic. Much of the inquiry and evidence reported has focused on promoting or enhancing resilience in healthcare for improving the quality of care and reducing medical negligence. This discursive paper aims to highlight how resilience is conceptualised and identify any potential limitations or gaps in the context of healthcare students, acknowledging considerations for further development and research into this topic. This discursive discussion draws on relevant theoretical underpinnings from the fields of adjustment and coping psychology, and research and evidence from health sciences, for facilitating an understanding of resilience in supporting healthcare students to adapt into professional practice. Investigation of resilience in healthcare students is mainly identified at an individual level as personal traits or skills for working within complex healthcare systems and clinical environments. Less attention has been given to examining resilience at the organisation or systemic level. This is primarily because of limited frameworks for investigating resilience from a multidimensional perspective recognising a wider systemic level influenced by external factors including socioecological determinants, for example, available support services for healthcare students. The link between resilience and its function to mitigate against associated neuropsychological distress and subsequent pathopsychological disorders in healthcare student cohorts is recognised; however, greater understanding of resilience as a multidimensional construct is warranted. A multidimensional investigation of resilience is critical for the preparation and readiness of healthcare structures and organisations in facilitating the needs of healthcare students entering challenging and diverse healthcare working environments. No patient or public contribution.

Functional Medicine in Nursing.

Functional medicine is a patient-centered approach that seeks to address the underlying causes of disease rather than focusing on managing the symptoms. This article explains the core principles of functional medicine and explores the potential for nurses to learn and incorporate functional medicine into their practice. By adopting a functional medicine approach, nurses can promote a more personalized and collaborative health care environment that can improve patient outcomes and empower patients to take an active role in their own health journey.

Reframing covenant for nursing: From individual commitments to covenant with society.

Today's constrained healthcare environment can make it very difficult for nurses to provide compassionate, competent, and ethical care, and yet their continued commitment to care is viewed as requisite. Nurses' commitment to care of patients, enmeshed with professional identity, may be understood as heroic. A few nursing scholars have advanced the concept of a nurse-patient covenant to explain or inspire nurses' commitment to care. Covenant describes an enduring relationship characterised by mutual promises and generous responsiveness. However, recent critique has revealed a general misunderstanding and misuse of the term covenant in much of the nursing literature whereby individual nurses are improperly and impossibly idealised as holding sole responsibility in the commitment to care. Such an interpretation obscures society's responsibilities in caring for both patients and nurses and contributes to the idealisation of nurses' commitment to extend themselves to fill in healthcare system gaps. Yet, the concept of a covenant relationship, when reframed as occurring between society and the profession of nursing, may lead us toward solutions to the very problems the originally misused concept sustained. Evidence within healthcare systems globally suggests that nurses' commitments are fragile or fragmented under duress due to increasing pressure, demands, and even risks. A reframing of covenant has the common good for society and nursing at its core and, we argue, may lead to a more sustainable nursing identity. We present the results of an exploratory project, undertaken to examine the utility and suitability of covenant as a relational framework for nursing. We explore a reframing of a covenant of care as a relationship between nursing and society, which may provide a fruitful path toward a sustainable, shared commitment for healthcare. This covenant of care re-centres shared work-a joint responsibility between society and nursing-as necessary for the common good.

Twelve tips for medical teachers to facilitate effective discussion among students to engage in reflective interpretation of Museum Arts

Integrating arts and humanities into medical education is a pragmatic approach that significantly enriches students’ learning experiences by enhancing their observational, interpretative, and empathetic skills. Engaging students in thoughtful dialogue become crucial at it not only enriches their understanding of human experiences and cultural contexts but also sharpens their communication skills – essential for effective patient interactions and collaborative healthcare environments. This article outlines twelve essential tips for medical teachers aimed at effectively facilitating discussions among students within the context of museum arts. These strategies are carefully designed to create a safe and inclusive learning environment, promote active and equitable participation, and encourage deep, reflective interpretation of artworks. By implementing these tips, educators can not only foster a more conducive educational landscape but also significantly enhance their own teaching practices by pushing the boundaries of traditional medical curricula with new ways to integrate empathy, critical thinking, and cultural awareness.