Health Care Professionals Deal Research Articles

From prescribing dilemma to knowledge in practice: The ontological politics of benzodiazepines and Z-drugs

The discrepancy between official guidelines and clinical practice is hardly more pronounced than in the case of benzodiazepines and Z-drugs, also known as benzodiazepine receptor agonists (BZRA). Using social-constructionist positioning theory, we unravel how health care professionals deal with the dilemma of prescribing this medication. Our results reveal a prescribing spectrum that is discursively organised around four different storylines used by professionals. The storylines are organised along three axes that are related to a) prescribers' opinions on prescribing and the negotiation of the related risks, b) the power dynamics between provider and patient in the prescribing process and c) the rhetorical use of arguments. The discerned storylines allow us to explore the emotional and moral side of prescribing and demarcate clinical mindlines -internalised tacit guidelines-that professionals adhere to when they prescribe. By relying on Annemarie Mol's conceptualisation of ontological politics, we explain how these storylines enact multiple versions of this class of medication and justify seemingly contradictory prescribing practices.

The dual role dilemma of liver transplantation health care professionals

BackgroundSimilar to many other countries, in Germany patients with alcohol-related liver disease are obliged to prove their abstinence before being accepted on a waitlist for liver transplantation. Health care professionals (HCPs) must both treat patients and ensure that patients have proven their abstinence. The aim of this exploratory study was to develop a deeper understanding of how HCPs deal with this dual role.MethodsThe study used semi-structured interviews as the source of data. 11 healthcare professionals from ten of the 22 German transplant centers were interviewed. After transcription, a qualitative content analysis was performed.ResultsWe found that these HCPs faced an ethical dilemma, as they must balance the roles of being both a treatment provider (the therapist role) and an assessor (the monitoring role). To solve this dilemma, the strategy seems to be a tendency for the HCPs to take on one dominant role amongst these two roles. HCPs who prefer to take on the therapist role seem to feel burdened by the 6-month abstinence rule and the obligation to monitor their patients. HCPs who prefer to take on the monitoring role tend to have negative assumptions about the patients. HCPs also reported the impression that patients perceive HCPs as more involved in monitoring and less open to the therapeutic role. From this it can be deduced that current regulations and structures lead both to stress for HCPs and to suboptimal therapy for those affected.ConclusionsThe results showed that current transplantation guidelines can have a negative impact on both patient care and the burdens on the HCPs. From our point of view, there are various changes that could be made to the current clinical practice that would help solve this dilemma. For instance, integrating other assessment criteria that are more closely adapted to the health status trajectory and psychosocial background of the individual patient would be both possible and would lead to improvements in practice.

Refusal of care in vulnerable people: Case of the elderly

Within the framework of the hospital, a medical act “can only be performed with the free and informed consent of the patient”. . . What are the levers for the healthcare professionals in order to have the care accepted? The problem that emerges from these first reflections is: “How can the healthcare professionals deal with a patient’s refusal of care?” The patient has the right to withdraw his consent, such as refusing an act, treatment or care. The refusal of care questions professionals even about the very meaning of their mission. It challenges them on the Health professionals-patient relationship, on its foundation and raises many ethical questions: when should we or not accept not to provide care to a patient who refuses it? How to obtain the consent of a patient who refuses care? Am I mistreating when I give a patient treatment that is essential to him? For this work, certain aspects and or dimensions of the refusal of care in the elderly from the healthcare professional’s point of view and the role of Health professionals in dealing with this refusal but also on the legislation, ethics, deontology, law, the patient- healthcare professionals relationship, public health, as well as the contribution of multi-professional care in this context . Health care professionals will have to take into account these dimensions based on the patient's autonomy, dignity and vulnerability. while respecting their consent or non-consent to care despite their illness, with the aim of adherence to the care of their patient, maintaining a relationship of trust, engaging in dialogue will make it possible to find a compromise, and ultimately respect the patient's autonomy.

Descriptions of long-term impact from inter-professional ethics communication in groups.

On a daily basis, healthcare professionals deal with various ethical issues and it can be difficult to determine how to act best. Clinical ethics support (CES) has been developed to provide support for healthcare professionals dealing with complex ethical issues. A long-term perspective of participating in inter-professional dialogue and reflective-based CES sessions is seemingly sparse in the literature. The aim was to describe experiences of impact of Inter-professional Ethics Communication in groups (IEC) based on Habermas' theory of communicative actions, after 6months from the perspective of an inter-professional team. A qualitative inductive approach was chosen, and individual interviews (n = 13) were conducted. Interview data were analysed using qualitative content analysis. The participants, 10 females and two males, represented assistant nurses, registered nurses, physicians, occupational therapists, physiotherapists, welfare officers and psychologists. Each had attended at least four IEC sessions. The study was approved by the Regional Ethical Review Board in Umeå, Sweden, and it has been undertaken in accordance with the Helsinki Declaration. Overall, the descriptions expressed a perceived achievement of a deepened and integrated ethical awareness that increased the participants' awareness of ethically difficult situations as well as their own ethical thinking, actions and approaches in daily work. Perspectives were shared and the team become more welded. They carried the memories of the reflections within them, which was perceived as supportive when encountered new ethically situations. Putting words to unarticulated thoughts may stimulate repeated reflections, leading to new insights and alternative thoughts. The outcome of IEC sessions 6months following the last session can be described as an incorporated knowledge that enables actions in ethically difficult situations based on an ethical awareness both at a 'We-level' and an 'I-level'.

Islamic Jurisprudence on Harm Versus Harm Scenarios in Medical Confidentiality.

Although medical confidentiality is widely recognized as an essential principle in the therapeutic relationship, its systematic and coherent practice has been an ethically challenging duty upon healthcare providers due to various concerns of clinical, moral, religious, social, ethical and legal natures. Medical confidentiality can be breached to protect the patient and/or others if maintaining confidentiality causes serious harm. Healthcare professionals may encounter complicated situations whereby the divulgence of a patient's confidential information may pose a threat to one party whereas the concealment of such information may cause harm to another. After deliberating on the Islamic concept of harm (ḍarar), this paper focuses on the dual duty and conflicts of interests faced by healthcare professionals in the practice of medical confidentiality. Referring to serious infectious diseases with a special mention of AIDS, this study also provides discourse on how healthcare professionals deal with difficult scenarios of conflicts of interests and ethical dilemmas.

Влияние психологической обстановки на риск развития эмоционального выгорания в коллективе медицинских работников

Healthcare professionals deal with the greatest prevalence of burnout syndrome (BS). The object of this paper is to study the effect of psychological climate and working conditions on risks of burnout in a team of healthcare professionals. Working conditions of 136 healthcare workers from the Saratov region who underwent little training were examined according to Regulation 2.2006–05. The level of burnout was estimated in accordance with the method of V. V. Boyko, and the psychological climate in a team was analyzed using A. F. Fiedler’s questionnaire. The results were processed with the help of Microsoft Еxcel 10 for Windows. Based on the research results, the BS signs were recorded in 52.3% of healthcare workers. Physical and emotional symptoms were predominant BS signs. Factors predisposing to BS in healthcare workers have been determined. It is established that there is a dependence between a harmful factor of working conditions and probable BS. The dependence acquires significance at 3.2 level of working conditions. It is determined that the risk of BS was 74.3% in the most unfavorable psychological climate, and didn’t reach 21% if the climate was favorable.

Narrating care during the COVID-19 pandemic in a paediatric emergency department

ABSTRACT The first wave of the COVID-19 pandemic led to high patient loads in many hospitals. However, paediatric emergency departments (EDs) saw a dramatic decrease in admissions, mainly due to the fear of contracting COVID-19 in hospitals. Moreover, paediatric EDs were required to reorganise their services rapidly to deal with the pandemic. We aimed to describe the experiences of healthcare professionals (HPs) working in a paediatric ED in Italy during the first wave of the COVID-19 pandemic through reflective practice. Twenty-six HPs (16 attending paediatricians, 5 residents, 5 paediatric registered nurses) wrote a single, comprehensive text, in which they reflected on their experiences of care during the first wave of the pandemic. The study was framed within narrative medicine as a means for reflective practice. We identified six main themes: the enemy is about to burst in and to sweep us away, raised fences against the enemy, the meaning of time, getting caught in the storm, being and staying in spaces, and the work unrecognisably transformed. Our findings reflect how profoundly HPs’ lives changed, inside and outside the hospital, during the first wave of the pandemic. Narration was useful in helping HPs deal with personal issues brought on by the pandemic.

Cognitive Behavioral Crisis Intervention Model for Health Care Professionals in Pakistan

The health care professionals (HCPs) in Pakistan are vulnerable to the negative psychological impact of the current COVID-19 pandemic. The shortage of trained HCPs in Pakistan coupled with vulnerable infrastructure and depleted resources make the situation a source of psychological reactions like fear, anger, anxiety, and depression for HCPs during COVID-19 outbreak. These psychological reactions are produced by the preceding thoughts and emotions according to the cognitive behavioral model. Therefore, a cognitive behavioral crisis intervention model (CBCIM) is proposed with aim of helping HCPs deal with these psychological reactions efficiently. The common components of CBCIM include the cognitive restructuring of the negative thoughts, teaching of relaxation and mindfulness exercises, the teaching of ACT-ADD approach and use of coping cards, district wise team-based action plan and the provision of these services to HCPs regularly even after the end of COVID -19 pandemic.

Post COVID- 19 protocol of treatment, radiologic examination and infection control in dentistry

The COVID-19 is an utmost challenge to the health care profession. The medical professionals and system and has recommended different reaction and sorts of solutions found all over the world. As the dental health care professionals deal directly with the oral cavity, their responsibility in avoiding the spread of COVID-19 proves significant. All the usual dental treatment and procedures put on hold into countries which come across COVID-19. During this pandemic, there is a need for planned crucial care which might be delivered by dental professional and auxiliary they should be provided with proper PPE on priority. Dental health care professionals should also be trained to contribute to health care. Quick re-organization of significant health care support is not simple. Dental health care professionals have an ethical duty to lessen the fear of spreading COVID-19 for routine care in dental patients. But they were and are worried concerning the monetary issues. The huge data is online accessible and over societal media, but still, it is hard to recognize research confirmation and supervision; however, ethical conclusions should be made.

Clinical Ethics Support Services Are Not as Well-Established in Forensic Psychiatry as in General Psychiatry.

Background: Mental health care professionals deal with complex ethical dilemmas that involve the principles of autonomy, justice, beneficence, and non-maleficence. Such dilemmas are even more prominent in forensic mental health care, where the restriction of personal rights is legitimated not only by patient well-being but also by public safety interests. Little is known about either the use of formal ethics support services or specific ethical needs in forensic mental health care. Knowledge about the current structures and how they compare with those in general psychiatry would help to identify the most important ethical issues and to analyze whether there are unmet needs that might require specific ethics support.Methods: We performed a survey study in all general psychiatric and forensic psychiatric inpatient departments in Germany. The aims were to compare the availability and functioning of clinical ethics structures and to identify specific ethical needs in inpatient forensic and general mental health care.Results: Clinical ethics support was available in 74% of general psychiatric hospitals but in only 43% of all forensic psychiatric hospitals and 25% of those offering treatment for offenders with substance use disorders. Most ethics support services were interdisciplinary. The most frequently requested retrospective and prospective ethics consultations were on issues of omission and termination of treatment, coercive measures, and advance directives. Among the hospitals without access to ethics support, 71% indicated a need for training in ethics.Discussion: Our results show that ethics consultation is well established in general psychiatry, but less so in forensic psychiatry. Mental health care professionals in forensic psychiatry seem to have a need for ethics support and training in clinical ethics. We also found a difference in access to ethics structures between hospitals that treat mentally disordered offenders and those that treat offenders with substance use disorders. Further research should focus on how ethics support can be comprehensively implemented in forensic mental health care and how this might improve treatment quality and patient and staff well-being.

Unequal Consumers: Consumerist healthcare technologies and their creation of new inequalities

This article examines how consumerist technology creates new inequalities among patients in healthcare. More specifically, we analyse a communication technology that presents a case of consumerization of patients. Using critical diversity literature, we theorize how consumerism embedded in technology assumes a ‘universal individual’, creating a tension for healthcare professionals between acknowledging differences among patients while aiming for equal treatment of all patients. Based on our empirical analysis of so-called personal online health communities, we explore, at the micro level, how healthcare professionals deal with this tension. We identify four different practices: lacking awareness of differences, downplaying differences, discomfort around acknowledging differences and actively accommodating differences. We theorize how they ultimately all create new inequalities.

Dealing with ethical challenges: a focus group study with professionals in mental health care.

BackgroundLittle is known about how health care professionals deal with ethical challenges in mental health care, especially when not making use of a formal ethics support service. Understanding this is important in order to be able to support the professionals, to improve the quality of care, and to know in which way future ethics support services might be helpful.MethodsWithin a project on ethics, coercion and psychiatry, we executed a focus group interview study at seven departments with 65 health care professionals and managers. We performed a systematic and open qualitative analysis focusing on the question: ‘How do health care professionals deal with ethical challenges?’ We deliberately did not present a fixed definition or theory of ethical challenge.ResultsWe categorized relevant topics into three subthemes: 1) Identification and presence of ethical challenges; 2) What do the participants actually do when dealing with an ethical challenge?; and 3) The significance of facing ethical challenges.Results varied from dealing with ethical challenges every day and appreciating it as a positive part of working in mental health care, to experiencing ethical challenges as paralyzing burdens that cause a lot of stress and hinder constructive team cooperation. Some participants reported that they do not have the time and that they lack a specific methodology. Quite often, informal and retrospective ad-hoc meetings in small teams were organized. Participants struggled with what makes a challenge an ethical challenge and whether it differs from a professional challenge. When dealing with ethical challenges, a number of participants experienced difficulties handling disagreement in a constructive way. Furthermore, some participants plead for more attention for underlying intentions and justifications of treatment decisions.ConclusionsThe interviewed health care professionals dealt with ethical challenges in many different ways, often in an informal, implicit and reactive manner. This study revealed nine different categories of what health care professionals implicitly or explicitly conceive as ‘ethical challenges’. Future research should focus on how ethics support services, such as ethics reflection groups or moral case deliberation, can be of help with respect to dealing with ethical challenges and value disagreements in a constructive way.

Overcoming job demands to deliver high quality care in a hospital setting across Europe: The role of teamwork and positivity

Health care professionals deal on a daily basis with several job demands – emotional, cognitive, organizational and physical. They must also ensure high quality care to their patients. The aim of this study is to analyse the impact of job demands on quality of care and to investigate team (backup behaviors) and individual (positivity ratio) processes that help to shield that impact. Data was collected from 2,890 doctors and nurses in 9 European countries by means of questionnaires. Job demands have a negative impact on the quality of care delivered by health professionals. Backup behaviors had a mediating effect between job demands and quality of care. Also, the positivity ratio of professionals (ratio of positive and negative emotions experienced) was also found as a significant mediator between most job demands and quality of care dimensions. Finally, we found a double mediation between most job demands and quality of care, where backup behaviors influenced the positivity ratio. Quality of care in hospitals is closely related to job demands. Hospital managers should consider the importance of cooperation within health care professionals’ teams and ought to find ways to develop teamwork in order to promote patients’ safety.

How do primary health care professionals deal with pregnant women who are victims of domestic violence?

Objectives to determine how Family Health Strategy professionals recognize and deal with domestic violence in pregnant women. Method qualitative study based on the Theory of Praxis Intervention in Collective Health Nursing (TIPESC). Fourteen professionals at a Basic Health Unit in the east side of Sao Paulo/Brazil were interviewed. Empirical data were categorized and discussed in thematic groups. For data analysis was used the technique of Discourse Analysis. Results we identified low number of reported cases of domestic violence; lack of education and training of health care professionals; failure in the identification and intervention process due to bias on their personal problems, moral attitudes and prejudice against these women. In addition, the study showed that their labor process was based entirely on the biological aspects of the women and to overcome this, they need of proper rapport between health care professionals and pregnant women to deal with of domestic violence. Conclusion professionals should develop skills to intervene in violence against pregnant women and also modify labor processes considering women in their totality and part of society.

Introducing incident reporting in primary care: a translation from safety science into medical practice

In this article, we examine how incident reporting procedures become part of the way primary health care professionals deal with safety problems. Between 2006 and 2010, we studied documents, observed incident reporting committee meetings and conducted formal and informal interviews in five Dutch primary health care centres and one general practitioner's out-of-hours service to describe the introduction of incident reporting procedures. In this article, we distinguish two approaches towards patient safety, the logic of risk management and the logic of medical practice. In the logic of risk management, safety is seen in terms of the prevention of recurrence of specific well-defined incidents. In the logic of medical practice, safety involves recognising uncertainties and strengthening implicit initiatives that underpin patient safety. Care providers alternated between the two logics and aligned them. Most reported incidents in primary care concern non-clinical incidents with no or limited impact on the patient. We observed that both physicians and medical assistants changed the significance of a particular incident by frequent reporting. By reporting apparently insignificant risks, those providing care were able to deal with these risks more explicitly and actively. The alignment of the two logics was different for clinical, more harmful incidents. Care providers rarely reported serious clinical incidents and we could find little evidence that they actively engaged with recommendations following the investigation of serious incidents. Both logics mutually shaped and informed each other. Incident reporting procedures made implicit initiatives explicit and the two logics ensure that safety involved multiple and different actions.

Comparison of Knowledge and Performance between Faculty Members and PhD Students in Personal Information Management: Presenting an Instructional Model based on Lifelong Learning

Introduction: Health care professionals deal with a large amount of information as they usually have various educational, scientific, clinical and administrative responsibilities. In this study we tried to investigate the knowledge of Iranian faculty members and PhD candidates of Tehran University of Medical Sciences about Personal Information Management (PIM) in order to present an instructional model to improve PIM skills. Methods: We conducted semi-structured interviews with a purposive snowball sample of 40 Iranian faculty members and PhD candidates of Tehran University of Medical Sciences. We used N8 to codify and analysis interview concepts. Results: Participants had little knowledge about how to manage their personal information. The use of PIM was in low rate among participants. Faculty members were more successful in organizing and retrieving personal information; while PhD candidates were more skilled in acquiring and keeping personal information. Conclusion: PIM is the missing link in the medical education in which various spectrums of instructional techniques is needed for the prosper implementation and usage of PIM in the medical field. We suggested an instructional model based on learning theories to educate and improve participants’ knowledge and skills in PIM.

How healthcare professionals respond to parents with religious objections to vaccination: a qualitative study.

BackgroundIn recent years healthcare professionals have faced increasing concerns about the value of childhood vaccination and many find it difficult to deal with parents who object to vaccination. In general, healthcare professionals are advised to listen respectfully to the objections of parents, provide honest information, and attempt to correct any misperceptions regarding vaccination. Religious objections are one of the possible reasons for refusing vaccination. Although religious objections have a long history, little is known about the way healthcare professionals deal with these specific objections. The aim of this study is to gain insight into the responding of healthcare professionals to parents with religious objections to the vaccination of their children.MethodsA qualitative interview study was conducted with health care professionals (HCPs) in the Netherlands who had ample experience with religious objections to vaccination. Purposeful sampling was applied in order to include HCPs with different professional and religious backgrounds. Data saturation was reached after 22 interviews, with 7 child health clinic doctors, 5 child health clinic nurses and 10 general practitioners. The interviews were thematically analyzed. Two analysts coded, reviewed, discussed, and refined the coding of the transcripts until consensus was reached. Emerging concepts were assessed using the constant comparative method from grounded theory.ResultsThree manners of responding to religious objections to vaccination were identified: providing medical information, discussion of the decision-making process, and adoption of an authoritarian stance. All of the HCPs provided the parents with medical information. In addition, some HCPs discussed the decision-making process. They verified how the decision was made and if possible consequences were realized. Sometimes they also discussed religious considerations. Whether the decision-making process was discussed depended on the willingness of the parents to engage in such a discussion and on the religious background, attitudes, and communication skills of the HCPs. Only in cases of tetanus post-exposure-prophylaxis, general practitioners reported adoption of an authoritarian stance.ConclusionGiven that the provision of medical information is generally not decisive for parents with religious objections to vaccination, we recommend HCPs to discuss the vaccination decision-making process, rather than to provide them with extra medical information.

Access to Health Care for Undocumented Migrant Children and Pregnant Women: The Paradox Between Values and Attitudes of Health Care Professionals

Access to health care for undocumented migrant children and pregnant women confronts human rights and professional values with political and institutional regulations that limit services. In order to understand how health care professionals deal with these diverging mandates, we assessed their attitudes toward providing care to this population. Clinicians, administrators, and support staff (n=1,048) in hospitals and primary care centers of a large multiethnic city responded to an online survey about attitudes toward access to health care services. Analysis examined the role of personal and institutional correlates of these attitudes. Foreign-born respondents and those in primary care centers were more likely to assess the present access to care as a serious problem, and to endorse broad or full access to services, primarily based on human rights reasons. Clinicians were more likely than support staff to endorse full or broad access to health care services. Respondents who approved of restricted or no access also endorsed health as a basic human right (61.1%) and child development as a priority (68.6%). A wide gap separates attitudes toward entitlement to health care and the endorsement of principles stemming from human rights and the best interest of the child. Case-based discussions with professionals facing value dilemmas and training on children's rights are needed to promote equitable practices and advocacy against regulations limiting services.

Bridging Physician-Patient Perspectives Following an Adverse Medical Outcome

Mark Montijo, PhD; Kathleen Nelson, RN, MPA; Mark Scafidi, JD; Dave St Pierre, MHROD; Dorothy Tarrant, LCSW, MPA; Jocelyne Vistan, MA; Maureen Whitmore, MA Fall 2011 - Volume 15 Number 4 “Human error and systems conditions periodically align and

Ownership of Uncertainty: Healthcare Professionals Counseling and Treating Women from Hereditary Breast and Ovarian Cancer Families Who Receive an InconclusiveBRCA1/2Genetic Test Result

The aim of this study was to understand more fully how healthcare professionals deal with the uncertainty intrinsic in counseling and treating women from hereditary breast/ovarian cancer families who receive inconclusive BRCA1/2 genetic test results (genetic tests that do not find a mutation to account for the family history). We conducted a small, qualitative, exploratory study using open-ended semistructured interviews of 12 geneticists, genetic counselor/nurses, oncologists, gynecologists, and breast surgeons at a major UK cancer center. We asked questions about how these professionals dealt with the large amount of uncertainty raised by an inconclusive result, how they communicated the uncertainty involved, their feelings about presenting medical management options based on information fraught with uncertainty, the role of the media, differences in perspectives by specialty, and personal feelings about the uncertainty. Based on themes generated by the data, we proposed the concept "ownership of uncertainty" (sole, shared, diffused, normalized, transferred) to explain how the professionals in this study dealt with this high degree of uncertainty. A shared ownership of uncertainty was the dominant model during the presentation of information given by the professionals as part of their consultation with their patients. However, the final decision for management was left primarily to the woman seeking advice, even though several of the professionals reported feeling uneasy about this. The concept "ownership of uncertainty" helps advance the understanding of how the healthcare professionals deal with the uncertainty intrinsic to an inconclusive BRCA1/2 genetic test result within the current social context.