Health Care Situations Research Articles

The quality and safety paradox in the patients' rights Directive

Now that the Directive on the application of patients’ rights in cross-border health care has been finally adopted after more than 12 years of debate, the discussion can start as to its importance and impact. In some ways, it reminds us of the discussion that was triggered right after the first seminal rulings of the European Court of Justice on the cases Decker and Kohll back in 1998. The question then was to know whether these judgments were to be considered a revolution or rather an evolution in the slow but steady process of EU integration in the field of health care. Where it was generally held that the classification of health services as ‘economic’, falling under the scope of free movement principles, was a logical step from a legal point of view, it took Member States and stakeholders a long time to more or less come to terms with the implications of this characterization.1 As a result, the ambit of the Directive was gradually narrowed to only include cross-border health care, i.e. ‘healthcare provided or prescribed in a Member State other than the State of affiliation’ (Article 3.e). The Directive explicitly mentions that it ‘shall not affect laws and regulations in Member States relating to the organization and financing of healthcare in situations not related to cross-border healthcare’ (Article 1.4). That also includes the freedom of each Member State to decide what type of health care it considers appropriate (recital 5a) and wishes to reimburse (recital 11). Moreover, the Directive did finally not clarify as to the wider effects of internal market and competition rules on health care and health systems.2 Perhaps the revolutionary nature of this Directive does not lie so much in what Delnoij and Sauter are calling the ‘old’ patients’ rights, i.e. the social …

Moral Distress and Moral Courage in Everyday Nursing Practice

In this article the author examines the concepts of moral distress and moral courage within the context of nursing practice. Examples of challenging healthcare situations from the United Kingdom and Ireland are discussed in the light of the examination of these two concepts. The examples illuminate features of healthcare situations that need to be considered in relation to different organisational and cultural contexts. This requires an understanding of the complexity of clinical contexts and an appreciation of the fallibility and vulnerability of nurses and other practitioners. The goal of this article is to encourage healthcare organisations to create supportive structures and sensitive leadership that will enhance moral courage in the work setting.

Comment

Superficial interpretations of the ethics of care suggest that it is relevant only to the ‘care’ professions. For the journal of Nursing Ethics to produce a special issue on care ethics is therefore expected. However, developments have explored the relevance of care ethics and the underpinning notion of ‘relational ontology’ to politics, violence, war and cosmopolitan justice (see, for example, the special issue of Ethics and Social Welfare 2010). This collection of articles provided by philosophers and health care theorists engages with the challenge raised by combining philosophical underpinnings of theoretical developments in care ethics with their application to health care situations.

Mobile Medicine: semantic computing management for health care applications on desktop and mobile devices

In many health care situations, powerful mobile tools may help to make decisions and provide support for continuous education and training. They can be useful in emergency conditions and for the supervised application of protocols and procedures. To this end, content models and formats with semantic and intelligence have more flexibility to provide medical personnel (both in off-line and on-line conditions) with more powerful tools than those currently on the market. In this paper, we are presenting Mobile Medicine solution, which exploits a collection of semantic computing technologies together with intelligent content model and tools to provide innovative services for medical personnel. Most of the activities of semantic computing are performed on the back office on a cloud computing architecture for: clustering, recommendations, intelligent content production and adaptation. The mobile devices have been endowed with a content organizer to collect local data, provide local suggestions, while supporting taxonomical searches and local queries on PDA and iPhone. The proposed solution is under usage at the main hospital in Florence. The smart content has been produced by medical personnel, with the adoption of the new ADF-Design authoring tool, which produces content in MPEG-21 format. The mobile content distribution service is integrated with a collaborative networking portal, for discussion on procedures and content, thus suggestions are provided on both PC and Mobiles (PDA and iPhone).

Legal aspects of consent Legal Aspects of Consent Bridgit Dimond Quay Books £22.50 350pp 9781856423847 1856423840 [Formula: see text

THIS, THE second edition of Bridgit Dimond's book, describes situations in health care in which consent is required and how it should be applied in legal terms.

Information-seeking and decision-making preferences among adult orthodontic patients: an elective health care model

When it comes to their own health care, adult patients traditionally demonstrate strong information-seeking desire but a somewhat lower desire to make their own treatment decisions in nonelective situations. Little is known about these desires in patients facing elective health care situations. We used the well-tested Autonomy Preferences Index (API) as a base to construct and test our elective Autonomy Preferences Index (eAPI) for both information-seeking and decision-making and analyzed demographic variables on both. The eAPI was constructed to mirror the API but uses elective scenarios rather than the API's nonelective scenarios. It was validated using cognitive interviews to determine item intent and comprehension and by Cronbach's alpha. Both the API and eAPI were distributed to 188 active-treatment patients at the Division of Orthodontics, University of Minnesota. API and eAPI items were scored using a 1 (low) to 5 (high) Likert scale of desire. Mean information-seeking desire was universally high (>4, P < 0.001) for both API and eAPI instruments. Mean decision-making (DM) desire was universally low to moderate: API-DM = 2.84 and eAPI-DM = 2.6. Decision-making preferences for nonelective items (API-DM) decreased as the condition severity presented in the vignettes increased: mild = 2.88, moderate = 2.67 and severe = 2.21. Conversely, elective decision-making preferences (eAPI-DM) increased with increasing condition severity: mild = 2.51, moderate = 2.79 and severe = 3.18 (P < 0.001). Adult patients have universally high information-seeking preferences and moderate to low decision-making preferences regardless of the elective or nonelective nature of their condition. However, as vignette condition severity increases, patients facing nonelective scenarios display progressively less desire for decision-making, whereas patients facing elective scenarios show progressively more decision-making desire.

Einführung in die International Classification of Functioning, Disability and Health (ICF)

The WHO International Classification of Functioning, Disability and Health (ICF) allows a standardized description of functioning and disability based on individual and contextual factors. The ICF adopts a biopsychosocial model of disability and functioning and is complementary to the ICD-10 (International Classification of Diseases). For its implementation in clinical practice ICF-based instruments, such as the ICF core sets were developed in a standardized scientific process. These consist of the ICF categories which are most relevant for patients with specific diseases or in specific health care situations. In trauma care the ICF and ICF core sets can be applied in defined health problems and treatment situations for documentation of functioning, structured planning and implementation of interventions as well as outcome assessment.

The INTERMED Japanese version: Inter-rater reliability and internal consistency

Objective The intent of this study was to establish the inter-rater reliability and the internal consistency of the Japanese version of the INTERMED. Methods The study included a series of patients referred to psychiatric consultation service or palliative care service. The study participants were independently scored using the INTERMED by the raters. Results The INTERMED-Japanese version had high inter-rater reliability (intraclass correlation coefficient=0.98) and high internal consistency (alpha=.89). All four domains (biological, psychological, social, and health care domains) were positively correlated. Based on a cutoff score of 20/21, a κ of 0.79 was found. Conclusions The INTERMED is an easy and useful proactive biopsychosocial screening tool, which could be a reasonable utility under the current Japanese health care situations. Future studies focusing on the INTERMED utility in improving health care delivery for patients with complex biopsychosocial care needs has to be demonstrated in various medical settings in Japan.

Research, forensics, public health, injury prevention and policy development.

This chapter gives an educational overview of: * Management implications of information technology in research, public health and policy development * Modern developments in death investigation, injury prevention and disaster management * The dangers of applying global analysis to individual health care situations and vice versa * Mechanisms that can be used to identify diffuse disaster in global and individual medical practice * The impact of informatics in areas of medical services which rely upon observational studies rather than validated clinical trials to develop knowledge bases * A paradigm shift in health care policy towards client driven services and the implications for medical informatics.

Moral distress in physical therapy practice

ABSTRACTThe purpose of this article is to discuss the theoretical concept of moral distress in the context of current physical therapy practice and ethics knowledge and differentiate it from emotional distress and burnout. Moral distress, largely discussed in nursing, is a theoretical concept that has the potential to elucidate the experiences of physical therapists delivering direct care to patients in complex health care situations and to contribute to physical therapy ethics knowledge and education. It focuses attention on the role of moral agent and the ethical dimensions of practice, offers a basis for dialogue among health professionals, and promotes analysis of the impact of the organizational environment on practice. The article concludes by suggesting how an understanding of the concept of moral distress might inform existing physical therapy ethical decision-making models and future research directions by which the experience of moral distress in physical therapy might be explored.

Enhancing the estimation of blood pressure using pulse arrival time and two confounding factors

A new method of blood pressure (BP) estimation using multiple regression with pulse arrival time (PAT) and two confounding factors was evaluated in clinical and unconstrained monitoring situations. For the first analysis with clinical data, electrocardiogram (ECG), photoplethysmogram (PPG) and invasive BP signals were obtained by a conventional patient monitoring device during surgery. In the second analysis, ECG, PPG and non-invasive BP were measured using systems developed to obtain data under conditions in which the subject was not constrained. To enhance the performance of BP estimation methods, heart rate (HR) and arterial stiffness were considered as confounding factors in regression analysis. The PAT and HR were easily extracted from ECG and PPG signals. For arterial stiffness, the duration from the maximum derivative point to the maximum of the dicrotic notch in the PPG signal, a parameter called TDB, was employed. In two experiments that normally cause BP variation, the correlation between measured BP and the estimated BP was investigated. Multiple-regression analysis with the two confounding factors improved correlation coefficients for diastolic blood pressure and systolic blood pressure to acceptable confidence levels, compared to existing methods that consider PAT only. In addition, reproducibility for the proposed method was determined using constructed test sets. Our results demonstrate that non-invasive, non-intrusive BP estimation can be obtained using methods that can be applied in both clinical and daily healthcare situations.

Dignity not fully upheld when seeking health care: Experiences expressed by individuals suffering from Ehlers–Danlos syndrome

Aim. The principle of human dignity has assumed importance in ethics and constitutional law throughout the 20th century in the Western world. It calls for respect of each individual as unique, and of treating him or her as a subject, never as a mere object. As such, the principle constitutes an ethical cornerstone in health care. Patients suffering from Ehlers–Danlos syndrome (EDS) challenge medical care and knowledge in health-care professionals' as symptoms sometimes are vague. Individuals with this disorder have reported not being respected when seeking health care.Purpose. To describe encounters in health-care situations when individuals suffering from EDS experienced that their dignity was not fully upheld. A further aim was to describe the long-term consequences of these experiences.Method. A study-specific questionnaire was designed, where individuals with EDS described their encounters with health care from a personal perspective.Results. After qualitative content analysis, the following five categories were identified: ‘Being ignored and belittled by health-care professionals,’ ‘Being assigned psychological and/or psychiatric explanations’, ‘Being treated and considered merely as an object’, ‘Being trespassed in one's personal sphere’ and ‘Being suspected of family violence’. Consequences of these encounters were ‘Mistrusting the physician’ and ‘Risking bad health’.Conclusions. The memory of not being respected is substantial for individuals with EDS and can last for years. As a result, lack of trust for the health-care system is created and they may experience difficulties in future encounters with health care. Therefore, health-care professionals should base their actions on norms that protect human dignity and confirm each patient as a unique human being with resources and abilities to master their own life.

Integration of diagnostic and communication technologies

Three key areas in diagnostics will drive the convergence of diagnostic and communication technologies: point-of-care testing, micro-electromechanical systems and biomarker discovery. In addition, the communications revolution means that increasing numbers of people will be able to send data from their home to their doctor using the Internet. Also, the widespread availability of broadband opens up the possibly of realtime videoconferencing with clinicians. It is already possible for patients at home to monitor simple variables, such as heart rate and blood pressure, and send their results using communication technologies to their doctors, who can promptly review the information to diagnose problems. As diagnostic and communication technologies converge, it will be feasible for patients to transmit more complex health-care data periodically to their doctor, who will be able to identify problems early on and thus modify disease management to prevent exacerbations of patients' medical conditions. This will allow improved patient care in a wide range of health-care situations, from acute medical conditions to chronic disease.

Knowledge use in nursing practice: The importance of practical understanding and personal involvement

Understanding knowledge use in everyday nursing practice is important to the improvement of educational preparation and quality in health care. This paper reports registered nurses' experiences in different parts of the Norwegian health care system. The aim of the study was to elucidate nurses' experiences of knowledge use in work situations. Eleven nurses, each with two to three years of experiences after graduation, participated in both in-depth interviews and focus group interviews in 2006. A qualitative hermeneutic approach, inspired by Gadamer's philosophy, guided the research process and the analysis and interpretation of the transcribed interview-texts. Experiences related to coping with frequent changes and complexity in work situations were captured in this study. The participants emphasised that knowledge use is connected to their ability to get involved in and assess particular situations, and so is their skill in integrating situational experiences into their existing knowledge framework. A challenge in nursing education is as follows: for students to understand these interpretive modes of knowledge use and to develop personal abilities, they should have access to and be active participants in certain health care situations, and they should have the opportunity to reflect on acting personally in professional relationships.

JOB SATISFACTION OF HEALTH CARE WORKERS IN THE SACRED PLACES DURING HAJJ SEASON 1429H (2008G).

Background: Health care of pilgrims is a major priority for the government of Kingdom of Saudi Arabia (KSA) and measurement of job satisfaction of health care workers (hcw) is an important step for planning for increasing productivity and quality of care.Aim: This study aimed at assessing the level of job satisfaction and its determinants inhcw involved in health care of pilgrims in the sacred places in Makkah, KSA. Materials and Methods: through a cross sectional study, a sample of 584 hcw were examined according to a structured questionnaire and a modified IDAK group job satisfaction scale. Hcw were classified into satisfied and unsatisfied according to tested cutoff point.Results: The rate of job satisfaction was 83.73 %. Job satisfaction was significantly increased in older hcw, females, Non-Saudis, working in Arafat area, and frequently participating hcw in hajj seasons. Job retention was significantly expected to increaseby 76.03% among satisfied, older age groups, Non-Saudis, preventive teamwork and frequently participating hcw in Hajj seasons. Conclusion: Rate of job satisfaction in hcw in Hajj was high in comparison to other common health care situations. Job retention rate was accordingly expected to be high but lower than satisfaction rate. Recommendations:Younger, males, Saudis, new participants or with lack of previous participations and low paid hcw must be targeted by research, training and education to enhance their job satisfaction and job retention before going to work in Hajj.

Role of Clinical Ethicists in Making Decisions About Levels of Care in the Intensive Care Unit

Role of Clinical Ethicists in Making Decisions About Levels of Care in the Intensive Care Unit

Reframing the Risks and Losses of Teen Mothering

Teen mothers often face a stigmatizing gaze based on the belief that early childbearing jeopardizes their life chances and the health and development of their children. Growing evidence suggests that the poor maternal-child outcomes associated with early childbearing have been overstated and may be explained by teen mothers' childhood disadvantage and adversities. After reviewing what is currently known about the relationships between early childbearing and maternal-child outcomes, as well as teen mothers' perspectives on mothering, clinical practices are suggested that address teen mothers' concerns, strengths, aspirations, and the long-term inequities that contribute to poor outcomes.

Applying Weick's model of organizing to health care and health promotion: Highlighting the central role of health communication

ObjectiveCommunication is a crucial process in the effective delivery of health care services and the promotion of public health. However, there are often tremendous complexities in using communication effectively to provide the best health care, direct the adoption of health promoting behaviors, and implement evidence-based public health policies and practices. This article describes Weick's model of organizing as a powerful theory of social organizing that can help increase understanding of the communication demands of health care and health promotion. The article identifies relevant applications from the model for health communication research and practice. ConclusionWeick's model of organizing is a relevant and heuristic theoretical perspective for guiding health communication research and practice. There are many potential applications of this model illustrating the complexities of effective communication in health care and health promotion. Practice implicationsWeick's model of organizing can be used as a template for guiding both research and practice in health care and health promotion. The model illustrates the important roles that communication performs in enabling health care consumers and providers to make sense of the complexities of modern health care and health promotion, select the best strategies for responding effectively to complex health care and health promotion situations, and retain relevant information (develop organizational intelligence) for guiding future responses to complex health care and health promotion challenges.

Outsourcing in the Healthcare Industry: Information Technology, Intellectual Property, and Allied Aspects

The healthcare industry is being impacted by advances in information technology in four major ways: first, a broad spectrum of tasks that were previously done manually can now be done by computers faster, better, and at lower costs; second, some tasks can be outsourced to other countries using inexpensive communications technology; third, detailed analysis of longitudinal and societal healthcare data can now be analyzed in acceptable periods of time; and fourth, the best medical expertise can be made available to patients without the need to physically transport the patient to the doctor or vice versa. Still, there are many healthcare situations in which face-to-face interaction is the only practical way to render medical assistance. After considering a number of healthcare scenarios in which one or more of the co-authors were involved, this paper concludes that healthcare will increasingly use a portfolio approach comprised of three closely-coordinated components seamlessly interwoven together: healthcare tasks performed by humans on-site; healthcare tasks performed by humans off-site, including tasks performed in other countries; and healthcare tasks performed by computers without direct human involvement. This three-pronged approach will lead to better healthcare services at the most cost-economic rates; further, it will gradually incorporate some of the principles of the 24-Hour Knowledge Factory framework. Organizations that impede or otherwise restrict the use of this multifaceted approach will see higher healthcare costs, and will gradually become less competitive in the global marketplace, as is happening with non-adapting organizations in several other sectors of the economy. Finally, this paper deals with intellectual property and legal aspects related to the proposed three-pronged healthcare services paradigm.

Vaginal birth after cesarean checklist: An evidence‐based approach to improving care during VBAC trials

Several medical organizations and specialty societies, as part of their approach to patient safety, have recommended that checklists be introduced and followed in certain high-risk healthcare situations. There is now evidence that following these kinds of checklists leads to improved outcomes. This article recommends a checklist that can be completed for each patient when she is admitted for a trial of labor after a previous cesarean delivery (VBAC). The elements of the checklist will help confirm the preparedness of the organization, compliance with national standards, and the consent of the patient for the VBAC trial.