Health Care Providers Research Articles

Analyzing and Mitigating the Risks of Patient Harm During Operating Room to Intensive Care Unit Patient Handoffs.

Patients continue to suffer from preventable harm and uneven quality outcomes. Reliable clinical outcomes depend on the quality of robust administrative systems and reliable support processes. Critically ill patient handoffs from the operating room to the intensive care unit are known high-risk events. We describe a novel perspective on how risk factors associated with the process of patient handoff communication between the operating room (OR) and the intensive care unit (ICU) can lead to flawed communication, degraded team awareness, medical errors and increased patient harm. Data was collected from two semi-structured focus groups using a five-step risk management approach at a tertiary hospital in São Paulo, Brazil. We conducted a failure modes, effects and analysis (FMEA) with multidisciplinary healthcare providers consisting of attending physicians, anesthesiologists, nurses, and physiotherapists involved in patient handoffs. We analyzed the results using a similitude analysis to evaluate the effectiveness of implementing this novel risk management approach. We identified the handoffs risks associated with patients, staff, institution, and potential financial risks. The FMEA identified 12 process failures and 36 causes that generated 12 consequences and pointed to robust needed preventive measures to mitigate handoff risks. The clinical teams reported that this approach allowed them to see the process more completely as a whole not only in their narrow siloes, thus understanding the enablers and difficulties of the other team members and how this understanding can shed light on their mental models, actions and the process reliability. Teams identified key steps in the OR to ICU handoff process that are prone to the highest hazards to patients, hospital and staff and are currently targeted for process improvement. Evidence driven recommendations intended for reducing the risks associated with patient handoffs are presented. Implementing a dynamic risk management, interdisciplinary approach was used to redesign the OR to ICU patient handoff approach around the patient's and clinician's needs. The risk management program helped healthcare providers identify handoff steps, highlighting risky handoff process failures, making it possible to identify actionable failures, consequences, and define preventative action plans for mitigating the risks to improve the quality and safety of patient handoffs.

How can effective communication help radiographers meet the expectations of patients-COMMUNICATION-a joint statement by the ESR & EFRS.

The Patient Advisory Group (PAG) of the European Society of Radiology, in collaboration with the European Federation of Radiographer Societies (EFRS), aims to highlight, in this short paper, the important role that communication plays when trying to meet patients' expectations throughout their imaging journey in a radiology department. The interactions with radiography professionals carrying out diagnostic or interventional procedures are critical in supporting high-quality patient care and patients' expectations. The key areas of consideration have been summarised in an easy-to-remember mnemonic: COMMUNICATION. There are different healthcare systems and medical imaging services across Europe, and healthcare providers should be mindful, when setting up new operational procedures, of the need for processes and systems to support the delivery of patient-centred care. At times when new or improved technology is being introduced, such as artificial intelligence applications, telemedicine, robotisation of interventional procedures, and digitised records, the impact on patient-radiographer communication and interactions should be considered. CRITICAL RELEVANCE STATEMENT: Effective communication helps radiographers meet patients' expectations by ensuring clear explanations, reducing anxiety, fostering trust, and improving cooperation during procedures. This enhances patient satisfaction, safety, and the overall quality of care, aligning with professional standards and patient-centred healthcare. KEY POINTS: Patient-centred imaging services are key to meeting patients' demands. Radiography professionals in radiology departments and medical imaging services should always communicate effectively with patients. This ESR-Patient Advisory Group publication attempts to summarise the key areas that should be embedded in patient communication. The 'COMMUNICATION' statement can be used as a reminder to all radiography professionals to work to improve patient-radiographer interactions and provide patient-focused services.

Length of stay and its associated factors in the neonatal intensive care unit of Gadarif Hospital, Eastern Sudan: a retrospective study

BackgroundAttention is increasingly paid to length of stay (LOS) in neonatal intensive care units (NICUs) across countries. Few published data on neonatal LOS exist in Africa, where there is a high burden of neonatal morbidity and mortality. Thus, this study investigated the factors associated with neonatal LOS in the NICU of Gadarif Hospital, Eastern Sudan.MethodsA hospital-based retrospective study was conducted at Gadarif Hospital in Eastern Sudan from May to December 2020. Sociodemographic, maternal, and neonatal data were obtained from the hospital records. Poisson regressions were used to determine the adjusted relative risk (aRR) values and 95.0% confidence intervals (CIs).ResultsThis study enrolled 333 neonates admitted to the NICU and discharged alive. The median (interquartile range [IQR]) of maternal age and parity was 27.0 (23.0‒30.0) years and 3 (2‒5), respectively. Of the 333 neonates, 160 (48.0%) were males; 136 (40.8%) were delivered via cesarean section; 258 (77.5%) had low Apgar scores, and 74 (22.2%) had birth asphyxia. There were 140 (42.0%) low birth weight (LBW) neonates and 133 (39.9%) preterm neonates. The LOS range was 1–29 days (mean = 5.1 days), and its median (IQR) was 4 (2‒7) days. The multivariate Poisson analysis showed that increasing maternal age (aRR = 1.02, 95% CI = 1.01‒1.05), LBW (aRR = 1.48, 95% CI = 1.16‒1.90), preterm delivery (aRR = 1.27, 95% CI = 1.01‒1.61), a low Apgar score (aRR = 1.32, 95% CI = 1.06‒1.42), and an increasing white blood cell (WBC) count (aRR = 1.001, 95% CI = 1.001‒1.002) were associated with LOS. Parity (aRR = 0.85, 95% CI = 0.80‒0.91) was inversely associated with LOS. However, neonatal jaundice and mode of delivery were associated with LOS only in the univariate analysis.ConclusionIncreasing maternal age, preterm newborn, LBW, and a low Apgar score prolonged the LOS in this region of Sudan. Healthcare providers could leverage these identified factors to predict extended neonatal LOS in Eastern Sudan, enabling proactive interventions to enhance neonatal outcomes.

Improving asthma care in children: revealing needs and bottlenecks through in-depth interviews

Asthma affects 7% of Dutch children and poses an increasing challenge, highlighting the need for effective paediatric asthma care. Achieving optimal asthma control is crucial given the potentially negative long-term effects of bad asthma control on lung development and quality of life in young children. The aim was to understand the challenges and requirements of existing asthma management practices in children. In a qualitative explorative study design, semi-structured, in-depth interviews were held among 37 Dutch stakeholders. A total of 15 patients/parents, 10 general practitioners (GPs), 5 paediatricians/paediatric pulmonologists and 7 nursing specialist/pulmonary nurses participated. Analysis was based on a thematic inductive analysis, using open and axial coding. GPs tended to emphasise the treatment of patients/parents with acute symptoms and underestimate the diagnosis and management of chronic symptoms, leading to possible over- and undertreatment. Asthma care between primary and secondary healthcare is fragmented and worsens these challenges. Moreover, the absence of well-established follow-up structures in primary care contributes to insufficient self-management skills among patients. Shared Decision-Making in children lacks a tailored approach, with variable engagement levels among healthcare providers. Limited focus on preventive strategies leads to little attention to, for example, promoting healthy lifestyles. Moreover, children are often not actively involved in decision-making. The study provides valuable insights to improve the quality and continuity of care for children with asthma and their parents. It underlines the need for a comprehensive and integrated care pathway to minimise the long-term negative effects of uncontrolled asthma.

Adaptation of meaning-centered psychotherapy for healthcare providers to buffer work-induced distress and improve wellbeing.

Healthcare providers (HCPs) face high rates of distress, experienced as burnout, moral distress, compassion fatigue, and grief. HCPs are also experiencing a crisis in meaning whereby distress is associated with disconnection from meaning in work and, in turn, a lack of meaning in work can furtherperpetuate distress for HCPs. Although scalable systems-level solutions are needed to tackle multidimensional HCP distress, it is also necessary to address HCP suffering at individual, team, and institutional levels. Targeted interventions to alleviate HCP distress are limited. Meaning-centered psychotherapy (MCP), a brief, evidence-based, intervention first developed for persons with advanced cancer, holds promise to mitigate HCP distress. This study adapted MCP for HCPs through feedback from a multidisciplinary sample of clinicians trained in MCP and working in healthcare settings. A survey was distributed electronically between November and December 2023 to HCPs previously trained in MCP assessing quantitative and qualitative feedback on the appropriateness of MCP for HCPs, the relevance of MCP session topics and exercises, and implementation barriers and facilitators. Descriptive statistics on relevant participant ratings were calculated; a matrix analysis approach was used for qualitative data. Forty participants, primarily mental health providers, expressed that MCP principles were highly relevant for HCPs and offered key insights on appropriate intervention modifications, including the need for a primary focus on meaning in professional life, reduced interventionlength, and delivery in group format. Feedback informed critical adjustments to promote appropriateness and acceptability of MCP-HCP which is poised for pilot testing to determine its feasibility and preliminary efficacyfor HCPs.

From applause to disappointment – appreciation among healthcare providers that provided end-of-life care during the COVID-19 pandemic and its impact on well-being – a longitudinal mixed methods study (the CO-LIVE study)

BackgroundThe healthcare sector is facing increasing work pressure, making a healthy workforce essential. Appreciation is a factor influencing well-being, and the COVID-19 pandemic offers valuable insights into this. This study aims to: 1) describe to what extent end-of-life care providers felt appreciated and understood during the first 18 months of the pandemic, 2) examine the impact of appreciation on their well-being, and 3) explore their perceptions of what appreciation should look like.MethodsA longitudinal mixed methods study among healthcare providers in the Netherlands delivering end-of-life care during the COVID-19 pandemic. Surveys were conducted at four timepoints (n = 302), and interviews were conducted at three timepoints (n = 17) during the first 18 months of the pandemic. Generalized Estimating Equations analysis was performed on the quantitative data and thematic analysis was conducted on the interview data.ResultsThis study shows that feeling of appreciation among healthcare providers peaked in the first wave of the pandemic, but significantly dropped in the second wave, with only about half of the healthcare providers feeling appreciated. This slightly improved afterwards. Furthermore, nearly half of healthcare providers felt misunderstood during the first 18 months of the pandemic. Additionally, this study shows that between September 2020 and September 2021 about 1 in 3 healthcare providers had a score on the Well-Being Index indicating higher risk for burnout. Feeling appreciated and not feeling understood were both significantly associated with worse well-being. Interviews revealed that nurses did not always feel understood and appreciated by society, employers, patients and their families, as well as their own friends and family, leading to feelings of sadness, anger, and frustration. Three major themes emerged: ‘recognizing real needs, ‘we are not in this together’ and ‘short-lived appreciation that failed to lead to structural changes’.ConclusionsThis study shows that during the COVID-19 pandemic, healthcare providers often felt neither appreciated nor understood, which is associated with lower scores of well-being. The expressed appreciation often did meet their needs or expectations, from both employers and society. With healthcare provider well-being still under strain, sustained attention to appreciation and understanding is important for retaining the workforce.

Healthcare Providers' Experiences With and Perspective on Delivering the Enhanced Recovery After Elective Caesarean Birth Pathway With Next-Day Discharge: Qualitative Analysis.

To understand the perspectives and experiences of healthcare providers who have experience working with an enhanced recovery care after elective caesarean birth pathway with next-day discharge and home midwifery. This study applies a qualitative study design with a pragmatic realist approach. The realist framework was used while also taking a post-positivist philosophy. The work was conducted in South Australia, Australia between May and October 2019. Twenty-three semi-structured interviews were completed with 5 doctors and 18 midwives who had occupational experience working with the pathway. Interviews were analysed using following the six-phase qualitative thematic analysis process outlined by Braun and Clarke. COREQ guidelines were followed. Four main themes and 11 sub-themes were identified. Main themes identified were as follows: The pathway is more than just early discharge; experiences with the process; staff engagement with the pathway; and the impact of the pathway within the health system. Healthcare providers generally accepted the pathway and found enhanced recovery care to be a positive and beneficial model of care. Staff identified five main challenges with implementing the pathway: early discharge; eligible women's automatic inclusion on the pathway; engaging women; change for staff and organisational constraints and procedures. Elements that support integration include the following: education for women; reassurance and communication with women and families; prepared care and supports including home midwifery; staff education and communication of the evidence; clear guidelines and protocols; defined staff roles; enough clinical time and clinical flexibility. Knowledge from staff in this study would be useful for other health services to consider when looking to deliver similar models of care. The health service and health providers were involved with the initiation and development of the research aims and design.

Factors Influencing Medication Adherence in Heart Failure Patients-A Survey among Cardiac Healthcare Providers.

Adhering to medication regimens is key behavior to alleviate symptoms and slow disease progression in heart failure (HF). This study explores cardiac healthcare providers' perceptions and experiences of factors influencing medication adherence (MA) in HF patients, with findings contributing to developing a HF-specific MA assessment scale. Using a cross-sectional, mixed methods design, we conducted an online survey with both closed and open-ended questions distributed to cardiac healthcare providers, working at the National University Hospital in Iceland. The survey consisted of 103 questions divided into 18 themes. Analysis included descriptive statistics of the participants' responses to closed responses with simplified scoring. Free-text responses were grouped into thematic categories and then into subthemes. Of 104 healthcare providers invited, 73 (70%) participated. Key factors identified as most beneficial for supporting MA included supportive patient-provider relationships (97%), selecting suitable drug formulation (96%), healthcare support at home (95%), and multi-dose dispensing from pharmacies (93%). The youngest and oldest HF patients were believed to be at the highest risk of medication non-adherence, particularly among males. Other patients estimated at increased risk included those with alcohol and/or substance abuse (89%), those with limited knowledge of medication effects (89%), those perceiving medication as useless (88%), and those with cognitive impairment (86%). Most participants (73%) agreed that healthcare providers should assess and document MA in clinical care. These findings provide a comprehensive overview of factors that cardiac healthcare providers believe influence non-adherence in HF patients, contributing to the development of a HF-specific MA scale.

Unveiling the role of DHIS2 in enhancing data quality and accessibility in primary healthcare facilities: Evidence from Ethiopia.

The implementation of DHIS2 in healthcare systems has transformed data management practices worldwide. However, its specific impact on data quality, availability, and performance in Primary Health Unit (PHU) facilities in Ethiopia remains underexplored. Therefore, we investigated the contribution of DHIS2 to enhancing data quality, availability, and performance within PHU facilities in Ethiopia. We employed qualitative methods, specifically Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs), to gather insights from stakeholders, including healthcare providers and administrators at PHCUs across Ethiopia. Convenience sampling was used for FGDs, while purposive sampling targeted key informants with relevant expertise. Data were systematically analysed thematically, identifying patterns and themes related to DHIS2's impact on data management within PHUs. This approach offered a comprehensive understanding of the system's effectiveness and the factors influencing its implementation, highlighting both successes and challenges in integrating DHIS2 into healthcare practices. Participants from various regions reported significant enhancements in the timeliness, completeness, accuracy, and accessibility of health data following the implementation of DHIS2. While some concerns were raised regarding variations in reporting intervals, the consensus indicated marked improvements in data management processes. DHIS2 standardized data collection methods, enabling healthcare providers to input and access data in real-time. This advancement fostered greater accountability and transparency within the healthcare system. Additionally, unexpected benefits arose, including increased digital literacy among staff, equipping them with necessary skills for effective data management, and the creation of job opportunities, particularly for youth. Ultimately, DHIS2 emerged as a pivotal tool for enhancing data quality and promoting health service equity across Ethiopia. DHIS2 has significantly improved data quality and accessibility in Ethiopia, enhancing healthcare management and accountability across facilities. Healthcare providers should continue to leverage its robust features and prioritize ongoing staff training to improve digital literacy and data management skills. Establishing consistent reporting practices and regular audits will further maintain data integrity and foster a culture of accountability within the healthcare system.

Guiding Graduate Student Recognition of Implicit Bias Using Interactive Simulation.

Assisting graduate nursing students to recognize implicit bias and racism is imperative when providing health care with culturally diverse groups. The article describes an interactive simulation between graduate students and a standardized patient designed to raise awareness of implicit bias and racism. Students in the Doctor of Nursing Practice and PhD programs participated in interviews with a standardized patient; in team interactions; in content analysis of simulated communications; and in reflection, debriefing, and evaluation sessions. Self-awareness education may help reduce health disparities within disparate racial, ethnic, socioeconomic, or undocumented peoples.

The impact of a narrative medicine program on obstetrics and gynecology residents’ empathy ability

BackgroundEmpathy is essential in medical practice, particularly in obstetrics and gynecology. Narrative Medicine, which involves storytelling and reflective writing, has been shown to enhance empathy among healthcare providers. Despite its benefits, there is limited research on the impact of narrative medicine on empathy among obstetrics and gynecology residents.MethodsThis study is a prospective controlled trail aimed at investigating the impact of a narrative medicine-based curriculum on the empathy levels of obstetrics and gynecology residents. The subjects of this study are obstetrics and gynecology residents undergoing standardized training at Hangzhou First People’s Hospital in 2023, which was divided into two groups: one receiving narrative medicine training and the other, traditional training. The Chinese version of the Jefferson Empathy Scale was used to measure empathy levels before and after the intervention. A self-developed questionnaire was distributed to Group A residents at the end of the narrative medicine course to evaluate the curriculum.ResultsBefore the intervention, there was no significant difference in empathy scores between the two groups. However, after the narrative medicine intervention, Group A showed a significant improvement in empathy scores compared to Group B (P < 0.0001). Residents in Group A also rated the narrative medicine curriculum highly, with 92% considering it “great” or “excellent”; 87% finding it effective in improving empathy and doctor-patient communication; and 91% feeling that this course promoted their self-reflection in medical practice.ConclusionsThe integration of narrative medicine into the training of obstetrics and gynecology residents significantly enhanced their empathy levels. Most residents perceive narrative medicine as a valued and effective means of enhancing doctor-patient communication and reflection capability.

Comparative effectiveness of different interventions on adherence to exercise-based CR among patients after percutaneous coronary intervention: a network meta-analysis of randomized controlled trials

BackgroundExercise-based phase II cardiac rehabilitation is critical for post-PCI patients, but adherence to exercise-based phase II cardiac rehabilitation remains low. Many studies aimed at improving adherence have been conducted in recent years, but the most effective interventions remain unclear. Hence, the objective of this study was to evaluate the effectiveness and ranks of various interventions in enhancing adherence to exercise-based phase II cardiac rehabilitation for post-PCI patients.MethodsA network meta-analysis employing random effects was utilized to evaluate the effectiveness of different interventions. Bias evaluation was performed via the revised Cochrane risk of bias tool, with data analysis performed using STATA v15.0. The surface under the cumulative ranking was used to estimate the rankings among different interventions.ResultsIn the final analysis, 30 RCTs with 4267 patients across 17 different interventions were included. The results showed that patients who received home-based cardiac rehabilitation combined with mobile health intervention had the best adherence to exercise-based phase II cardiac rehabilitation (83.8%), followed by hospital-based cardiac rehabilitation combined with mobile health intervention (79.9%).ConclusionsThis network meta-analysis identified home-based CR + mobile health intervention and hospital-based CR + mobile health intervention as the top two ranked interventions for improving adherence to exercise-based phase II CR in post-PCI patients. Healthcare providers may consider prioritizing the use of home-based cardiac rehabilitation combined with mobile health intervention in clinical practice, but still need to evaluate factors such as patient preference and Medicare reimbursement availability to develop customized interventions that are not only safe and effective but also satisfying to the patient.

Policy Versus Practice: Facilitators and Barriers of Chronic Care Integration in Dutch General Practice &amp;ndash; a Survey Study

Introduction: Multimorbidity challenges quality and sustainability of healthcare systems. Care groups were introduced in the Netherlands to promote integration of chronic primary care, but it remains unknown to which degree they facilitate this. This study therefore aims to determine whether Dutch general practices perceive themselves to be capable of delivering integrated chronic care and uncover the role of care groups. Methods: We performed a survey study amongst 39 care groups and 65 healthcare providers within general practices (GPs and nurse practitioners). Results: 43% of healthcare providers within general practices are (very) dissatisfied with capabilities for chronic care to patients and 56% do not feel capable of delivering integrated care. Care groups and providers show alignment in their perception of some of the most important facilitators and barriers such as motivation and lack of time, but other factors are valued differently at both levels. Discussion: Our findings show inability of general practices to deliver integrated chronic care despite a health system that is inherently supportive of care integration and point to a mismatch between barriers and facilitators amongst practices and care groups, resulting in providers partly relying on their motivation in accommodating integrated chronic care. Conclusion: General practices are not sufficiently supported by care groups and national policies in delivering integrated chronic care. The identified mismatch between policy and practice warrants redesign of support from care groups to align policies with identified barriers and facilitators at the provider level.

A benchmarking and evidence-informed gap analysis of the hemodialysis care provision in Iran

BackgroundPatients with end stage renal disease (ESRD) are increasing worldwide. This is especially paramount in low and middle income countries in which ESRD patients are struggling to access specialist services e.g. hemodialysis (HD). Benchmarking analysis of the offered healthcare packages in several countries and comparison of the utilized alternative healthcare models for ESRD patients may be auspicious for institutional capacity-building in the existing healthcare facilities. Main aim of this study was to perform a benchmarking and evidence-informed gap analysis of the ESRD care provision in Iran and recognize the gaps that cause diversification in care quality for ESRD patients that hinder efforts for care quality improvement in the Iranian National Healthcare System.MethodsDimensions of the Australian Anglicare Southern Queensland Clinical and Care Governance Framework (ASQCGF) were utilized as corner stones of a comprehensive clinical care plan that is essential in responding to HD patients’ needs in Iran. An extensive literature search was performed at the next stage to recognize the gold standard core elements. The ascertained components were assigned to the five separate dimensions of the ASQCGF and a preliminary draft (comprehensive package of care for HD patients) was prepared. A checklist was developed at a later stage which was sent to a panel of expert consisting professional healthcare providers in nephrology and hemodialysis wards for their opinions. A gap analysis was conducted to evaluate current care processes of the Iranian HD patients align with the elements of the gold standard framework.ResultsThe identified deficits were classified in five areas in accord with the elements of ASQCGF as follow: A) supply of resources, medical devices and equipment support B) recruitment and endorsement of clinics and general work force C) infection prevention and controlling procedures D) care effectiveness monitoring and quality improvement E) provision of safe environment for both HD patients and hospitals’ staff.ConclusionsThe study findings revealed considerable gaps in providing quality HD services to the Iranian HD patients that herald their therapeutic unmet needs and the shift that is needed to narrow down the widening organizational failure which fuels the current disenchantment among the both healthcare providers and HD patients.

Evaluating maternal death surveillance and response system in Sunyani Municipality of Bono region in Ghana from 2017-2021

IntroductionMaternal death rates in Ghana have decreased overall but remain high in rural areas. The Maternal Death Surveillance and Response System (MDSR) aims to eliminate preventable maternal deaths effectively. However, its effectiveness is less pronounced at district and subdistrict levels than at national and regional levels. Despite the requirement for periodic evaluation, there is a lack of evidence supporting these assessments. This study focuses on evaluating the MDSR in Sunyani Municipal.MethodsThe evaluation was conducted using a cross-sectional design, using both qualitative and quantitative approaches. Data from the District Health Information Management Systems (DHIMS) and the maternal death line list from January 2017 to December 2021 on maternal deaths were reviewed. Stakeholders, including health professionals, were interviewed. The means, proportions, and other statistical measures were calculated using Epi Info Version 7. Qualitative data underwent content analysis, and the results were visually presented in tables and flowcharts to illustrate the flow of surveillance information.ResultsMost respondents were female, constituting 51.4% (19/37), with midwives comprising the largest group at 32.4% (12/37). Approximately 75.7% (28/37) were able to explain how the surveillance data has been used for public health action. The notification and reporting process was clear to 85% (17/20) of respondents. Although 94.6% (35/37) expressed willingness to notify and participate in audits at facility and community levels, the audits remained facility-based. All facilities consistently reported maternal deaths, but data storage equipment was lacking. Approximately 80% (20/25) of forms were reported within 24 h, and 88% (22/25) were investigated within seven days. Only 68% (17/25) of forms were filled out correctly, with no municipal and facility-level line list. All reported deaths came from healthcare facilities, with no community-reported maternal deaths.ConclusionsThe MDSR system in Sunyani Municipal demonstrates high awareness and willingness to participate among healthcare providers but faces challenges in data accuracy and community engagement. Death audits remain facility-based, and the lack of community-reported maternal deaths and municipal-level line lists indicates gaps in comprehensive reporting and data management. To improve the system, it is recommended that community case searches be enhanced for better reporting and to address data management issues by ensuring proper data quality assessment.

Japanese patients’ preferences regarding disclosure of patient safety incidents: A survey study

Background Incident disclosure has proved its cultural sensitivity. To meet patient needs, this study aims to investigate Japanese preferences regarding incident disclosure. Methods An online panel questionnaire survey was conducted in Japan, and 840 valid responses were collected. A total of 191 (23%) respondents or their family members had incident experience. The respondents were asked to indicate their preferences regarding disclosure practice, specifically for incidents entailing moderate and severe harm. The chi-squared test was applied to examine preference differences. Results Mostly similar preferences were identified among Japanese respondents, regardless of their incident experience, age, and sex. For instance, they wished to be disclosed through face-to-face communication (92% in moderate and 92% in severe harm incidents), immediately after detection (63%; 65%), at the bedside, or in a consultation room (50%; 46%). The incident was likely to be disclosed by the healthcare provider most responsible/directly involved in the patient's care at the time of the incident (48%; 45%), accompanied by the team/department leader (50%; 56%) and patient safety manager (50%; 59%). If the incident entailed severe harm, top management members were also expected to be involved (45%); all details about the incident were expected to be informed (57%). Conclusions The findings reveal that Japanese patient preferences regarding incident disclosure are partly shared with Western countries and partly with other Asian countries. The unique Japanese preference for disclosure places is also identified. Recommendations for incident disclosure are then suggested and we believe this could be the first step toward supporting disclosure in Japanese healthcare organizations.

Gender-based violence among women and girls in conflict-affected areas of Northeast Amhara, Ethiopia

BackgroundGender-Based Violence (GBV) is one of the major problems that women and girls encountered during the conflict between the Ethiopian federal government and the Tigray People's Liberation Front (TPLF). However, there is a gap in evidence regarding gender-based violence resulting from the ongoing conflict in these areas. Therefore, this study assessed the prevalence of GBV and its contributing factors in the conflict-affected northeastern Amhara region of Ethiopia.MethodsA community-based cross-sectional study was conducted from July 7th to September 30th, 2023, among 597 women and girls who lived in the three most conflict-affected districts (Wadla, Lay-Gaynt, and Meket) in northeastern Amhara regional state of Ethiopia. GBV was assessed using the WHO multi-country study on women's health and domestic violence against women questionnaire, which has 13 items and measures three violence domains (emotional, physical, and sexual). A binary logistic regression analysis was conducted. We used Adjusted Odds Ratios (AOR) with their respective 95% Confidence Intervals (CI) and a p-value of &amp;lt;0.05 to identify statistically significant factors.ResultsThe overall prevalence of gender-based violence was 39.0% (95%CI: 35.2–43.6); 36.7% were experienced emotional, 15.4% physical, and 8.9% sexual violences. The burden is higher among individuals who are divorced, substance users, have low social support, or have participated in the war.ConclusionsTwo-fifths of women and girls in conflict-affected areas of the northeastern Amhara region experienced violence. Thus, collaboration between healthcare providers and policymakers is needed to enhance care for victims, including the provision of social support and substance use mitigation.

Barriers and supports for Indigenous youth and young adults with childhood- onset chronic health conditions transitioning from pediatric to adult healthcare: a qualitative study

BackgroundThis study examined the experiences of Indigenous youth and young adults with pediatric onset chronic health conditions who had or were about to transition from pediatric to adult healthcare services. Transition is the process by which youth develop the knowledge and self-management skills needed to manage their health condition, ideally beginning around age 12–13 and continuing until the mid-20s. There is a growing body of literature on healthcare transition, but there is an absence of literature on Indigenous youth, who face additional barriers to accessing healthcare relative to non-Indigenous Canadians. The primary objective of this study was to identify the supports and barriers for Indigenous youth with childhood-onset chronic health conditions transitioning from pediatric to adult healthcare services.MethodsThe research was done in the province of Alberta, Canada, in collaboration with a Community Advisory Committee comprised of Indigenous healthcare providers, Elders and Knowledge Keepers and guided by a community-based participatory research approach. Semi-structured qualitative interviews (n = 46) were conducted with Indigenous youth, caregivers, and healthcare providers. There were three Talking Circles, two for youth (9 participants) and one for caregivers (6 participants). Three research assistants coded the transcripts thematically using NVivo. The key findings were presented to the Community Advisory Committee for feedback to validate the interpretation of the qualitative data.ResultsThe thematic findings include: (1) systemic inequalities exacerbate gaps in healthcare; (2) intergenerational trauma created unique barriers for Indigenous youth; (3) long-term relationships with care providers as a protective factor; (4) the incorporation of Indigenous worldviews into healthcare services to aid transition; and (5) assuming new responsibilities as an adult. The participants provided recommendations to improve healthcare service delivery including the need for Indigenous transition supports in community and improving education for healthcare practitioners about transition and Indigenous worldviews.ConclusionThis study demonstrates the complexity of the transition experience for Indigenous youth with pediatric onset chronic health conditions. The identified barriers to successful transition could be addressed through systems level changes and the development of Indigenous specific transition support services. Such approaches need to be Indigenous-led and incorporate Indigenous culture, language, and teachings.

Interventions for family involvement enhance end-of-life care for hospitalized patients: an integrative review

BackgroundIntegrating family members into the care of hospitalized end-of-life patients enhances patient–family-centered care and significantly influences the experiences of patients and their families. This study used the integrative review methodology to assess the scope and effectiveness of interventions designed to facilitate family involvement in end-of-life care. It identified gaps and consolidated existing knowledge to improve nursing practices.MethodsThis integrative review encompasses both experimental and non-experimental studies. The process included problem identification, literature search, data evaluation, analysis, and integration. The literature search targeted studies describing interventions for family involvement in EOLC using databases such as PubMed, CINAHL, Embase, and Web of Science. Data evaluation was conducted by assessing the quality of the studies using the Mixed Methods Appraisal Tool. Data analysis and integration were conducted by synthesizing the results of the selected studies and identifying the elements of family involvement using the 'Components of Family Involvement' framework.ResultsOf the 8,378 identified studies, 26 were eligible for inclusion. Interventions involving the families of patients with terminal illness varied, including programs to enhance communication among patients, families, and healthcare providers; family meetings; decision-making support; and digital visits and rounds. The findings show that these interventions improve patients’ psychological and physical comfort, family satisfaction, and communication. However, some families reported increased distress. The most frequently addressed elements of family involvement were communication and receiving information, followed by decision-making and meeting care needs. Family presence and contribution to care were the least addressed elements in the interventions.ConclusionsThis integrative review highlights the effectiveness of interventions to increase family involvement in end-of-life care, demonstrating positive impacts on patient comfort, family satisfaction, and communication. Despite progress in incorporating families into communication and decision-making, further efforts are needed to ensure their presence and direct care involvement. Future research should focus on improving these interventions to enhance scalability and support comprehensive family involvement, including digital tools for participation.

Exploring Iranian men’s experiences of infertility through qualitative content analysis

BackgroundInfertility affects men and women differently; however, there is a scarcity of studies focusing specifically on men’s perspectives. Given the importance of understanding men’s experiences in infertility treatment, this study aimed to explore the experiences of Iranian men facing infertility.MethodsA qualitative descriptive approach was employed, utilizing purposive sampling to recruit 12 Iranian men dealing with infertility. In-depth, semi-structured interviews were conducted in Persian, the native language of the participants, to facilitate ease of communication and ensure the richness of data. The data were analyzed using conventional content analysis, following Lincoln and Guba’s criteria for trustworthiness to ensure rigor. The entire content of the interviews was transcribed in Persian and analyzed in the same language to maintain the original meaning of the participants’ expressions. After the analysis was completed, the manuscript, including the summarized findings, was translated into English. MAXQDA software version 0.9.5 was used for data management.ResultsThe findings were organized into five main themes: psychological, social, sexual, cultural, and coping dimensions. The study reveals that infertility profoundly impacts men’s psychological well-being, leading to reduced self-confidence and increased societal and familial pressures. Participants expressed feelings of inadequacy and challenges in sexual intimacy, exacerbated by cultural stigma. The social pressures included external societal expectations and dynamics within spousal relationships. Additionally, cultural beliefs significantly influence men’s experiences of infertility, affecting their mental health and treatment choices. Coping strategies such as acceptance, faith, and optimism are crucial in helping men navigate these challenges.ConclusionOverall, the results highlight the need for comprehensive support addressing the psychological, social, sexual, and cultural dimensions of infertility. This study underscores the importance of tailored interventions that consider the unique experiences of men facing infertility, emphasizing the role of coping strategies and the influence of cultural factors on mental health and treatment decisions. By fostering an understanding of these complexities, healthcare providers can better assist men in navigating the challenges of infertility.