Perspectives Of Healthcare Professionals Research Articles

Healthcare Professionals' Perspectives of Nonsurgical Care of Older Inpatients with Class II or III Obesity and Comorbidities: A Qualitative Study.

Older people with Class II or III obesity and comorbidities experience complex care needs with frequent hospital admissions. In 2019/20 the National Health Service in England reported a 17% increase in hospital admissions of patients with obesity compared to 2018/19. Gaps in care for this population have been identified. The purpose of this study was to understand the experiences and perspectives of healthcare professionals delivering non-surgical care to older people with Classes II or III obesity admitted to a tertiary care hospital. Healthcare professionals delivering non-surgical care to older people admitted with Class II or III obesity with comorbidities were recruited from an Australian tertiary referral hospital. Qualitative semi-structured interviews were conducted with 24 healthcare professionals from seven disciplines between August and December 2019. The interviews were audio-recorded, transcribed, and reviewed by participants for accuracy. Thematic inductive data analysis was deductively mapped to the Theoretical Domains Framework (TDF). Four major themes of Barriers, Facilitators, Current Practice, and Recommendations and 11 subthemes were identified and mapped to nine domains in the TDF. The Barriers subtheme identified perceived patient related factors, health system issues, and provider issues, while the Facilitators subtheme included a patient centred approach, knowledge, and resources in the subacute setting. The major Current Practice theme explored factors influencing clinical management, and the Recommendations subthemes included engaging patients, access to quality care, education and support, and obesity as a chronic disease. This novel application of the TDF provided broad insights related to the barriers and facilitators in delivering non-surgical care to this hospital population, from the perspective of healthcare professionals. Understanding how these barriers interact can provide strategies to influence behaviour change and assist in the development of a holistic multidisciplinary model of care.

Interventions to reduce interpersonal stigma towards patients with a mental dysregulation for ambulance and emergency department healthcare professionals: review protocol for an integrative review

IntroductionWorldwide, there is an increase in the extent and severity of mental illness. Exacerbation of somatic complaints in this group of people can result in recurring ambulance and emergency department...

Exploring factors affecting the timely transition of ventilator assisted individuals in Ontario from acute to long-term care: Perspectives of healthcare professionals.

Ventilator Assisted Individuals (VAIs) frequently remain in intensive care units (ICUs) for a prolonged period once clinically stable due to a lack of transition options. These VAIs occupy ICU beds and resources that patients with more acute needs could better utilize. Moreover, VAIs experience improved outcomes and quality of life in long-term and community-based environments. To better understand the perspectives of healthcare providers (HCPs) working in an Ontario ICU regarding barriers and facilitators to referral and transition of VAIs from the ICU to a long-term setting. We conducted semi-structured interviews with ten healthcare providers involved in VAI transitions. Perceived barriers included long wait times for long-term care settings, insufficient bed availability at discharge locations, medical complexity of patients, long waitlists, and a lack of transparency of waitlists. Facilitators included strong partnerships and trusting relationships between referring and discharge locations, a centralized referral system, and utilization of community partnerships across care sectors. Insufficient resourcing of long-term care is a key barrier to transitioning VAIs from ICU to long-term settings; strong partnerships across care sectors are a facilitator. System-level approaches, such as a single-streamlined referral system, are needed to address key barriers to timely transition.

Perspectives of Healthcare Professionals on the Management and Treatment of Advanced Ovarian Cancer in the UK: Results From the KNOW-OC Survey

AimsNew treatment options for advanced ovarian cancer have the potential to significantly change the treatment pathway in the UK. Understanding the structures and responsibilities of multidisciplinary teams/tumour boards (MDT) and regional variations will enable services to adapt more effectively to these changes. Materials and methodsThe KNOW-OC survey was conducted in 2020 to understand the views of a selected group of 66 healthcare professionals (HCPs) involved in advanced ovarian cancer care in UK hospitals. ResultsThe results showed that MDT involvement in the management of advanced ovarian cancer varied depending on pathway stage and line of relapse, with 98.5% of HCPs responding that the MDT was involved in decisions at initial presentation, but only 40.9% for patients with multiple relapses. The MDT was mostly responsible for determining whether the patients would undergo primary or interval cytoreductive surgery according to 75.8% of respondents, and most HCPs (80.3%) stated that tumour dissemination patterns were the most important factor influencing this decision. The most commonly assessed biomarkers at the time of the survey were CA125, gBRCA and tBRCA. Homologous recombination deficiency was viewed as the second most important factor for determining prognosis, but few centres had access to testing at the time of survey completion. The use of active surveillance was expected to decrease in favour of first-line targeted therapies. Nearly all (98.5%) HCPs agreed there is a role for secondary cytoreductive surgery for the treatment of recurrence (for carefully selected patients). ConclusionsThe results highlighted UK-specific geographical variation in the views of HCPs on MDT involvement and specific practices, such as molecular biomarker testing, and the overall treatment approach. Together, these findings improve the understanding of reported clinical practice across the UK for ovarian cancer and provide insight into decision-making associated with updates to recommendations for best practice (e.g. European Society for Medical Oncology/European Society of Gynaecological Oncology consensus statements) and the introduction of new treatment options.

Perceptions and attitudes of kidney supportive care among elderly patients with advanced chronic kidney disease and dialysis healthcare professionals in China: a qualitative study

PurposeKidney supportive care (KSC) represents a novel approach wherein a multidisciplinary team of nephrology experts offers active symptom management, advance care planning, shared decision-making, conservative treatment, and end-of-life care. This study is aimed at providing comprehensive insights and evaluations regarding the understanding and perspectives of Chinese healthcare professionals, including nephrologists and dialysis nurses, as well as elderly individuals aged 60 and above who are afflicted with chronic kidney disease. The primary goal is to furnish substantial information support for a better comprehension of KSC within the Chinese context, with the ultimate aim of facilitating its effective implementation in this region.MethodsEmploying a phenomenological framework, this qualitative research generated data using semi-structured interviews with 18 elderly patients diagnosed with advanced chronic kidney disease and 10 healthcare professionals across two Class III Grade A medical institutions. The Colaizzi’s analytical method was utilized for coding and analyzing the interview data.ResultsDistinct interviews were executed with patients and healthcare professionals to delineate specific themes for each group. For elderly dialysis patients, the following themes were formed: (1) Lack of understanding of KSC; (2) Concerns of how KSC is perceived; and (3) Perceived benefits of KSC. Within the healthcare professionals cohort, two salient themes emerged: (1) Prospective clinical merits of KSC ; and (2) Mltiple difficulties encountered.ConclusionsThis study goes some way in furnishing a holistic understanding of perceptions surrounding KSC among elderly patients undergoing dialysis and healthcare professionals in China. The overarching Chinese cultural ethos poses substantial challenges to the widespread assimilation of KSC. While healthcare professionals advocate for KSC, there remains a limit in the patients’ comprehension of this therapeutic paradigm. There is a compelling imperative to cultivate this strategy, grounded in the prevailing medical landscape.

The mental health of children and adolescents at Matosinhos: characteristics and obstacles to care

Abstract Background Mental health disorders are a public health issue. Most mental disorders begin during childhood and adolescence. Epidemiological studies regarding the diagnosis, prevalence, and access to treatment by children and adolescents are scarce, especially in Portugal. This research protocol aims to characterize the referral process and waiting times for these consultations at a Portuguese Local Health Unit between 2017 and 2022 (covering about 180,000 people); and to identify barriers to adequate health care for children and adolescents from the perspective of healthcare professionals from the hospital and primary care units. Methods We used a mixed methods study. Qualitative data allowed interpretation and reflection of quantitative data, with validation and integration of results. We conducted a descriptive analysis of the variables obtained through the local Health Information System and semi-structured interviews with a sample of healthcare professionals involved in mental health care for children and adolescents at the hospital and primary care unit levels. Results Preliminary results show a break in the number of consultations in 2018, due to the lack of professionals, and a yearly increase after COVID-19. Follow-up appointments and evaluation processes have long waiting times since there is a focus on ensuring shorter waiting times for the first consultation, and there is a shortage of professionals in mental health teams. The staff identified the need to integrate schools into care - referral and evaluation - and to promote community-based programs that train skills in children, adolescents, and caregivers. Conclusions Health indicators allow the assessment of epidemiological data and access to care, yet it is fundamental to listen to the professionals in the field to identify barriers, needs, and possible actions that more effectively promote mental health in this population. Key messages • Mental health disorders in children and adolescents are a significant public health issue in Portugal, yet there are scarce epidemiological studies on diagnosis, prevalence, and access to treatment. • There is a need to address the shortage of mental health professionals and integrate schools and community-based programs into mental health care to improve access and promote mental health.

Integrated care for older persons who live with complex health and social care requirements: a core set of indicators

PurposePerformance measures are an important mediating mechanism that influences the design and delivery of care. Unfortunately, it is still commonly the case that acute care indicators are employed to assess the efficacy of integrated care. This hinders the ability to accurately assess and continuously improve integrated care efforts for priority populations, including older persons who live with complex health and social care requirements. A core set of indicators is needed from which to assess the quality and impact of integrated care on these older persons and care partners.Design/methodology/approachA modified Delphi process was employed that comprised of the following steps: (1) selection of an indicator inventory (2) defining criteria for ranking and achieving consensus, (3) recruiting participants, (4) iterative voting rounds and analysis and (5) selection of a core indicator set.FindingsThe study produced a core set of 16 indicators of integrated care that pertain to older persons who live with health and social care requirements. The set can be applied by health and social care organizations and systems to assess the quality and impact of integrated care for this population across the continuum of care.Research limitations/implicationsAlthough the gap in the availability of relevant indicators was the impetus for the study, this also meant there was a dearth of validated indicators to draw from. There are significant gaps in commonly used data sets with respect to indicators of integrated care as it relates to older persons and care partner.Practical implicationsThe indicator set is intended to follow the older person and care partner throughout their health journey, enabling a whole systems view of their care. The set can be used in full or in part by health and social care systems and organizations across various primary, acute, rehabilitative and community settings for program development and evaluation purposes.Social implicationsThe core set of indicators that emerged out of this study is a first step toward ensuring that older persons who live with complex health and social care requirements and their care partners receive quality integrated care across the continuum of care.Originality/valueThe findings are informed by the perspectives of older persons, care partners and healthcare professionals. Future research is needed to test, validate and potentially expand the indicator set.

Access to health care for migrants in French Guiana in 2022: a qualitative study of health care system actors.

Access to health care is a major public health issue. The social determinants of health have a role in accessing health care and in meeting the health needs of populations. With 281 million international migrants around the world, population movements are another major issue. Migrants are particularly exposed to precariousness during their migratory journey and after their settlement. These vulnerabilities may have deleterious effects on their health status and on their social conditions. In French Guiana, 36% of the population is of foreign origin. The objective of this study is to explore the barriers and the facilitators to accessing health care for migrants in French Guiana in 2022, from the perspective of health care professionals, social workers and local NGO actors. This research is an exploratory qualitative study based on the experiential knowledge of health care professionals, social workers and local NGO actors in French Guiana. 25 semi-structured interviews were conducted with these professionals and actors between April and June 2022, using an interview guide to explore their practices, representations and beliefs of access to health care and accompaniment of migrants in their patient journey. The interviews were transcribed and analyzed using the thematic analysis method. A total of 25 health care professionals, social workers and local NGO actors were included in the study. Participants highlighted that migrants are exposed to many factors hindering their access to health care in French Guiana (administrative complexity, language barriers, financial barriers, mobility issues, etc.). With the situations of great precariousness and the inadequacies of the public authorities, associative support (social, health and legal accompaniment process provided by NGOs and associations) has an important role in providing close support to migrants. Moreover, health mediation supports migrants in their social and health care journey to lead them toward empowerment. Health mediators contribute to promote a better understanding between professionals and migrants. In French Guiana, associative support and health mediation promote access to health care and social accompaniment for migrants. This article highlights the issues surrounding access to health care, associative support and health mediation in the Guianese context, which is marked by significant socio-cultural diversity and precariousness. Considering the benefits of associative support and health mediation, as well as social inequalities in health, is essential for health care professionals, social workers, local NGO actors, associations, public health authorities and political decision-makers to initiate concrete and suitable actions in favor of access to health care and social support for migrants in French Guiana.

Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS

BackgroundThe Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service.MethodsAn online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis.ResultsKey factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations’ semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can’t completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers.ConclusionsRespondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.

Health literacy and shared decision-making in predictive medicine — professionals’ perceptions and communication strategies

Abstract Aim This contribution empirically analyses and theoretically reflects health literacy (HL) and shared decision-making (SDM) in the context of predictive medicine, taking in the perspective of healthcare professionals (HCPs). The aim is to identify ways to promote HL of persons dealing with disease risk, and to support SDM in predictive consultations. Methods The perspectives of HCPs consulting patients at early prediction centers and advising them with respect to preventive therapies or further diagnostic procedures were examined using semi-structured, qualitative expert interviews and a complementary survey. Results The data reveal resources and challenges regarding risk communication and the empowerment of patients for informed and health-literate decisions upon their disease risk. They also show potentially useful communication strategies and prerequisites for demand-oriented decision-making in the predictive setting. Furthermore, the findings highlight that risk communication and patient information in predictive medicine are considered to be underrepresented in medical education and training. Therefore, this contribution provides implications and suggestions for educational concepts and practical tools for medical education and predictive practice. Conclusion We emphasize communication and interaction between HCPs and patients as crucial for health-literate decision-making in the specific context of predictive medicine. This study’s results indicate relevant aspects of social and communicational skills that need to be considered in consultation guides and integrated into medical education and training, to provide individual-sensitive consultation and HL promotion for people at risk.

Perspectives of Renal Healthcare Professionals about Deceased Organ Donation

Little is known about the attitudes of renal healthcare professionals (HCPs) toward deceased donation. We surveyed 222 renal HCPs from 12 dialysis units in southeast Michigan about their attitudes toward organ donation as part of a cluster-randomized, intervention study. Factor analysis identified three subscales: general benefits (alpha .88), general barriers (alpha .80), and staff dialysis barriers (alpha .79). We compared subscale values with two variables: enrollment status in the state donor registry (DR) and intentions for future DR enrollment. Higher scores on all three scales were positively associated with DR enrollment. Mean scores varied by HCP role within the dialysis unit. Tailoring donation education to a role and focusing on the benefits may have an effective impact on HCP attitudes. Results from this study can inform future interventions to improve promotion of organ donation amongst professionals working in dialysis units.

Healthcare analytics: A techno-functional perspective

The use of data analytics, particularly Artificial Intelligence (AI), has significantly transformed decision-making in healthcare. However, academic scholarship has expressed concerns over the misalignment of research priorities and their impact on data usage and choice of analytics. On the one hand, an inadequate understanding of healthcare themes and algorithmic nuances has posed difficulty for healthcare professionals to evaluate AI solutions and understand their generalizability and potential biases. On the other hand, the abundance of analytical tools, their complexity, and a misalignment between data type and analysis methods have presented major challenges for analysts in selecting a suitable method. As a result, healthcare research has mostly developed in silos. We propose a techno-functional framework that combines the perspectives of analysts and healthcare professionals, identifies key research themes (i.e., healthcare delivery, patient engagement, data management, market design, and policy and governance), and presents critical research questions that can guide future studies. We also propose a schema for segmenting analysis techniques based on data type and analytical complexity. This schema may help analysts select a suitable analysis technique and data to solve a specific problem. Our study aims to improve the understanding of healthcare analytics among researchers, analysts, and healthcare professionals and present a roadmap for future research.

Transition of care in inborn errors of immunity.

This review outlines the principles of transition, summarizes current information about transition practices in inborn errors of immunity (IEI) and highlights general and specific considerations for transition of patients with these conditions. Recent surveys demonstrate the variability in access to and transition practices in IEI. Key challenges of transition in IEI from the perspective of healthcare professionals include lack of adult subspecialists, lack of access to holistic care and fragmentation of adult services. Limited research focused on IEI patient and carer perspectives highlight information gaps, poor coordination and difficulty adapting to adult healthcare structures as important challenges for smooth transition. Local policies and practices for transition in IEI are highly variable with limited assessment of outcomes or patient experience. There is a need for IEI-focused transition research and for development of national and international consensus statements to guide improved transition in IEI.

S1195 Communicating Needs and Features of IBD Experiences (CONFIDE) Survey: Patient and Healthcare Professional Perspectives on Communication Relating to Ulcerative Colitis Symptoms in Canada

S1195 Communicating Needs and Features of IBD Experiences (CONFIDE) Survey: Patient and Healthcare Professional Perspectives on Communication Relating to Ulcerative Colitis Symptoms in Canada

CN36 Current care for patients on oral anticancer therapy through a different lens: Assessment from a patient and healthcare professional perspective

CN36 Current care for patients on oral anticancer therapy through a different lens: Assessment from a patient and healthcare professional perspective

Knowledge, Implementation, and Perception of Enhanced Recovery After Surgery Amongst Surgeons in Pakistan: A Survey Analysis.

An increasing shift towards non-communicable diseases and an existing high surgical burden of disease in low-middle-income countries (LMICs), such as Pakistan, has driven the need for implementing Enhanced Recovery After Surgery (ERAS), a safe and cost-effective surgical service aimed at improving patient recovery and reducing post-operative complications. Despite countless benefits, there are few ERAS programs throughout Pakistan andsparse literature on healthcare professionals' views regarding ERAS. Without a deep understanding of healthcare professionals' perspectives on ERAS, underlying barriers and facilitators to a long-term ERAS implementation cannot be addressed and improved upon.Therefore, the purpose of this study is to better understand the knowledge, implementation, and perception of ERAS from the perspective of healthcare professionals across Pakistan. Upon receiving ethical approval from the McGill University Health Center (MUHC), a previously validated questionnaire was modified and a 29-question survey was developed and disseminated to healthcare professionals practising in Pakistan. Quantitative data was analyzed using descriptive statistics and potential correlations that exist between the implementation of ERAS and the participants' gender, employment setting, and surgical specialty were investigated using the chi-squared analysiswith a p-value of 0.05 as the cutoff. A total of 49 participants responded to this survey of whom 34 (69%) worked at a tertiary care teaching hospital whereas 15 (31%) worked at a private hospital. Surprisingly, 42 (85%) participants expressed being aware of the ERAS guidelines with only 30 (61%) either strongly agreeing or agreeing to successfully implementing ERAS into practice. The largest discrepancies in implementation were seen when discussing specific elements of the ERAS guidelines such as preoperative carbohydrate loading, practicing prolonged preoperative fasting, performing mechanical bowel preparation, performing active patient warming, and early postoperative removal of Foley's catheter. Surgeons employed at a private institution were more likely to discuss postoperative pain management and control, less likely to utilize prolonged fasting, more likely to perform regular body temperature monitoring, more likely to practice providing chewing gum to patients postoperatively, and more likely to perform early removal of the Foley's catheter. An understanding of ERAS, the implementation of various elements, and a positive attitude toward its benefits definitely seem to be prevalent among healthcare professionals in Pakistan. However, key barriers and enablers specific to the underlying healthcare environment seem to be hindering the long-term successful implementation of ERAS across Pakistan. It is crucial for future studies to explore these barriers in further detail and involve theperspective of these key stakeholders to help enhance long-term ERAS adoption.

Factors Influencing the Acceptability, Acceptance, and Adoption of Conversational Agents in Health Care: Integrative Review.

Conversational agents (CAs), also known as chatbots, are digital dialog systems that enable people to have a text-based, speech-based, or nonverbal conversation with a computer or another machine based on natural language via an interface. The use of CAs offers new opportunities and various benefits for health care. However, they are not yet ubiquitous in daily practice. Nevertheless, research regarding the implementation of CAs in health care has grown tremendously in recent years. This review aims to present a synthesis of the factors that facilitate or hinder the implementation of CAs from the perspectives of patients and health care professionals. Specifically, it focuses on the early implementation outcomes of acceptability, acceptance, and adoption as cornerstones of later implementation success. We performed an integrative review. To identify relevant literature, a broad literature search was conducted in June 2021 with no date limits and using all fields in PubMed, Cochrane Library, Web of Science, LIVIVO, and PsycINFO. To keep the review current, another search was conducted in March 2022. To identify as many eligible primary sources as possible, we used a snowballing approach by searching reference lists and conducted a hand search. Factors influencing the acceptability, acceptance, and adoption of CAs in health care were coded through parallel deductive and inductive approaches, which were informed by current technology acceptance and adoption models. Finally, the factors were synthesized in a thematic map. Overall, 76 studies were included in this review. We identified influencing factors related to 4 core Unified Theory of Acceptance and Use of Technology (UTAUT) and Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) factors (performance expectancy, effort expectancy, facilitating conditions, and hedonic motivation), with most studies underlining the relevance of performance and effort expectancy. To meet the particularities of the health care context, we redefined the UTAUT2 factors social influence, habit, and price value. We identified 6 other influencing factors: perceived risk, trust, anthropomorphism, health issue, working alliance, and user characteristics. Overall, we identified 10 factors influencing acceptability, acceptance, and adoption among health care professionals (performance expectancy, effort expectancy, facilitating conditions, social influence, price value, perceived risk, trust, anthropomorphism, working alliance, and user characteristics) and 13 factors influencing acceptability, acceptance, and adoption among patients (additionally hedonic motivation, habit, and health issue). This review shows manifold factors influencing the acceptability, acceptance, and adoption of CAs in health care. Knowledge of these factors is fundamental for implementation planning. Therefore, the findings of this review can serve as a basis for future studies to develop appropriate implementation strategies. Furthermore, this review provides an empirical test of current technology acceptance and adoption models and identifies areas where additional research is necessary. PROSPERO CRD42022343690; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343690.

7 Ethical Dilemmas Faced by Healthcare Professionals when Considering a Report to Child Protection: Experiences and Perspectives from a Tertiary Paediatric Centre

Abstract Background Child maltreatment is an important global problem that is increasingly being recognized as a public health issue as well as a violation of children’s fundamental rights. Mandatory reporting is a legislative attempt to decrease its prevalence and impacts. It is generally thought that these laws improve child maltreatment detection rates. However, the actual effects of such laws, as well as mandated reporters’ perspectives on them, remain unclear. Several studies have explored the many obstacles perceived in the reporting process, including some of which can be considered as moral dilemmas. Very few of these studies have explicitly adopted an ethical lens in the analysis of these situations. Objectives Through an exploratory study, our aim was to describe the experiences and perspectives of healthcare professionals from a large paediatric university centre when considering making a report to child protective services. We were interested in the reporting process rather than initial identification. We also explored how profession (nurse, doctor or resident), work environment (general paediatrics team, NICU or ED) and years in practice influenced participants' answers. Additional questions addressed the concept of disclosure of reports to families involved, training on child maltreatment and reporting, and perceived impacts of the COVID-19 pandemic on children’s safety. Design/Methods One hundred and thirty-five respondents answered an anonymous online survey constructed by the research team and based on a review of the available literature. Results Most participants (96%) had encountered situations of possible child maltreatment through their work and reported being committed to their mandated reporting obligations. However, only 44% of respondents had personally reported a situation to protective services. Teamwork and/or delegation of reporting duties seemed to contribute to the gap between exposure and reporting experiences. Sixty nine percent of participants felt that families should be told about healthcare professionals’ concerns at least as often as possible, but many expressed significant concerns, mostly related to their own safety and well-being. Training was lacking according to 88-89% of respondents. Regarding the COVID-19 pandemic and associated restrictions, participants were concerned for children’s safety in their homes. Conclusion Many ethical aspects of the reporting process should be considered when addressing a particular situation but also when teaching and training professionals in the identification and reporting of child maltreatment.

"I am Here"-The Importance of Caring Touch in Intensive Care. A Qualitative Observation and Interview Study.

Purpose: The purpose of the study was to illuminate the experience of caring touch in intensive care from the perspectives of patients, next-of-kin, and healthcare professionals. Design and Method: This study was explorative, and data were collected through qualitative observations (n = 9) with subsequent interviews (n = 27) at two general intensive care units. An inductive approach was embraced to be open-minded to the participants' experiences. Findings: The results are presented in one generic category-caring touch creates presence-which generated five subcategories: to touch and be touched with respect, touch as guidance and communication, touch causes suffering, touch creates compassion, and touch creates security. Conclusion: When the ability to communicate with words is lost, it is body language that reveals what a person is trying to express. Nurses create a way of being present with the patients by touching them, to communicate I am here for you. Caring touch is a tool to show compassion and respect and to protect the integrity of the lived body. The caring touch is soothing and comforting for the patient and next-of-kin and creates security. It also helps to awaken the motivation to get healthy, which is needed in an environment that is foreign.

Challenges in Achieving Optimal Warfarin Anticoagulation Control: A Comprehensive Exploration and Proposed Holistic Approaches

In Indonesia warfarin remains the most widely oral anticoagulation prescribed. However, the time in therapeutic range remain low in Indonesia and also in some countries in throughout the world. This study aimed to analyse the challenges of optimal warfarin control from the perspectives of healthcare professionals, patients, health system, and to propose strategies to address these challenges. This research consists of two stages. The first stage was a prospective observational study aiming to analyse the challenges and the second stage of the research was focus group discussion to propose strategies to overcome the challenges. The result of this study showed that the average of TTR was 49.4 ± 32.1, where only 37.5% patients had TTR ≥ 65%. The average dosing consistency obtained was 62.33 ± 32.42%. With regard to INR monitoring interval, almost all patient who had supraterapeutic INR had their INR monitoring interval set to 1 month after the dose adjustment. There were also identified that only 43.8% patients classified as adherent and only 39.5 % patients had good knowledge of warfarin, indicating that the level of medication adherence and knowledge was not optimal. In this study, 14.6% of patients received other drugs that potentially interacted with warfarin that cause fluctuate INR. In conclusion, this study's results showed that there were multiple challenges for optimal warfarin control including barrier for dosing consistency, INR monitoring, patients’ adherence and knowledge, as well as drug interactions. However, there will be still room for improvement. The proposed strategy that likely will achieve optimal benefit was a holistic approach that combine multifaceted strategies to address each barrier.