Health Care Situations Research Articles

Human Factors in Healthcare: A Field Guide to Continuous Improvement

Abstract Have you ever experienced the burden of an adverse event or a near-miss in healthcare and wished there was a way to mitigate it? This book walks you through a classic adverse event as a case study and shows you how. It is a practical guide to continuously improving your healthcare environment, processes, tools, and ultimate outcomes, through the discipline of human factors. Using this book, you as a healthcare professional can improve patient safety and quality of care. Adverse events are a major concern in healthcare today. As the complexity of healthcare increases-with technological advances and information overload-the field of human factors offers practical approaches to understand the situation, mitigate risk, and improve outcomes. The first part of this book presents a human factors conceptual framework, and the second part offers a systematic, pragmatic approach. Both the framework and the approach are employed to analyze and understand healthcare situations, both proactively-for constant ...

The Adolescent Health Care Broker-Adolescents Interpreting for Family Members and Themselves in Health Care.

Parents with limited English proficiency might rely on their adolescent children to interpret health information. We call this adolescent healthcare brokering. Using a mixed-methods, transformative research approach rooted in grounded theory, we sought to answer these questions: (a) "What is happening? What are people doing?" and (b) "What do these stories indicate? What might they suggest about social justice?" High school students from a community in which 53.4% speak another language at home were invited to participate in a survey and focus groups. Of 238 survey participants, 57.5% (n = 137) indicated they assisted with healthcare tasks. When doing so, 81.7% (n = 112) translated. Common tasks were reading prescriptions and talking to doctors. While some participants cited negative emotions associated with brokering, the net emotion was positive. Focus groups (n = 11) revealed that tasks varied broadly in complexity and type, emotional experiences were dichotomous, and access to interpreting services and other supports was inconsistent. This research adopts an advocacy lens and uses a mixed-methods, transformative research approach rooted in grounded theory to describe and call attention to a social justice phenomenon we call adolescent healthcare brokering. We define adolescent healthcare brokering as young people acting as linguistic interpreters in healthcare situations for themselves and for family members with limited English proficiency (LEP). In such situations, language acts as a barrier to health literacy and access to healthcare [17]. Despite this known barrier, there is a gap in the research regarding how to successfully address this situation (McKee, Paasche-Orlow, Journal of health communication 17(3):7-12, 2012).

Enhanced Decision Support Systems in Intensive Care Unit Based on Intuitionistic Fuzzy Sets

In areas of medical diagnosis and decision-making, several uncertainty and ambiguity shrouded situations are most often imposed. In this regard, one may well assume that intuitionistic fuzzy sets (IFS) should stand as a potent technique useful for demystifying associated with the real healthcare decision-making situations. To this end, we are developing a prototype model helpful for detecting the patients risk degree in Intensive Care Unit (ICU). Based on the intuitionistic fuzzy sets, dubbed Medical Intuitionistic Fuzzy Expert Decision Support System (MIFEDSS), the shown work has its origins in the Modified Early Warning Score (MEWS) standard. It is worth noting that the proposed prototype effectiveness validation is associated through a real case study test at the Polyclinic ESSALEMA cited in Sfax, Tunisia. This paper does actually provide some practical initial results concerning the system as carried out in real life situations. Indeed, the proposed system turns out to prove that the MIFEDSS does actually display an imposing capability for an established handily ICU related uncertainty issues. The performance of the prototypes is compared with the MEWS standard which exposed that the IFS application appears to perform highly better in deferring accuracy than the expert MEWS score with higher degrees of sensitivity and specificity being recorded.

Using forum play to prevent abuse in health care organizations: A qualitative study exploring potentials and limitations for learning.

Abuse in health care organizations is a pressing issue for caregivers. Forum play, a participatory theater model, has been used among health care staff to learn about and work against abuse. This small-scale qualitative study aims to explore how forum play participants experience the potentials and limitations of forum play as an educational model for continued professional learning at a hospital clinic. Fifteen of 41 members of staff of a Swedish nephrology clinic, primarily nurses, voluntarily participated in either one or two forum play workshops, where they shared experiences and together practiced working against abuse in everyday health care situations. Interviews were conducted after the workshops with 14 of the participants, where they were asked to reflect on their own and others' participation or nonparticipation, and changes in their individual and collective understanding of abuse in health care. Before the workshops, the informants were either hesitant or very enthusiastic toward the drama-oriented form of learning. Afterward, they all agreed that forum play was a very effective way of individual as well as collective learning about abuse in health care. However, they saw little effect on their work at the clinic, primarily understood as a consequence of the fact that many of their colleagues did not take part in the workshops. This study, based on the analysis of forum play efforts at a single hospital clinic, suggests that forum play can be an innovative educational model that creates a space for reflection and learning in health care practices. It might be especially fruitful when a sensitive topic, such as abuse in health care, is the target of change. However, for the effects to reach beyond individual insights and a shared understanding among a small group of participants, strategies to include all members of staff need to be explored.

Survey material choices in haematology EQA: a confounding factor in automated counting performance assessment.

The complete blood count (CBC) is one of the most frequently requested tests in laboratory medicine, performed in a range of healthcare situations. The provision of an ideal assay material for external quality assessment is confounded by the fragility of the cellular components of blood, the lack of commutability of stabilised whole blood material and the lack of certified reference materials and methods to which CBC results can be traced. The choice of assay material between fresh blood, extended life assay material and fully stabilised, commercially prepared, whole blood material depends upon the scope and objectives of the EQA scheme. The introduction of new technologies in blood counting and the wider clinical application of parameters from the extended CBC will bring additional challenges for the EQA provider.

Digital technologies as truth-bearers in health care.

In this paper, we explore the idea of digital technologies as truth-bearers in health care and argue that devices like SenseCam, which facilitate reflection and memory recall, have a potentially vital role in healthcare situations when questions of veracity are at stake (e.g., when best interest decisions are being made). We discuss the role of digital technologies as truth-bearers in the context of nursing people with dementia, as this is one area of health care in which the topic of truth-telling has been hotly debated. People with dementia have been excluded from research studies and decisions that affect their lives because they are not regarded as truth-bearers-that is, as being capable of giving truthful accounts of their experiences. Also, considerable research has focused on the ethics of lying to and deceiving people with dementia. Given their increasing prominence in healthcare settings, there has been surprisingly little discussion of what role digital technologies might play in relation to these questions of truth and deception. Drawing on theories from science and technology studies (STS), we explore their possible future role in some of the truth-making processes of health care. In particular, we discuss the potential value of constraints on use of SenseCam to support the accounts of people with dementia as part of their care.

Closure of a local public hospital in Korea: focusing on the organizational life cycle.

Just as living organisms have a creation-maintenance-extinction life cycle, organizations also have a life cycle. Private organizations will not survive if they fail to acquire necessary resources through market competition. Public organizations, however, continue to survive because the government has provided financial support in order to enhance public interest. Only a few public organizations in Korea have closed. With the introduction of new public management since the economic crisis in 1997, however, public organizations have had to compete with private organizations. Public hospitals are not free to open or close their business. They are also controlled by the government in terms of their prices, management, budgets, and operations. As they pursue public interest by fulfilling the government’s order such as providing free or lower-priced care to the vulnerable population, they tend to provide a lower quality of care and suffer a financial burden. Employing a case study analysis, this study attempts to understand the external environment that local public hospitals face. The fundamental problem of local public hospitals in Korea is the value conflict between public interest and profitability. Local public hospitals are required to pursue public interest by assignment of a public mission including building a medical safety net for low-income patients and managing nonprofitable medical facilities and emergent health care situations. At the same time, they are required to pursue profitability by achieving high-quality care through competition and the operation of an independent, self-supporting system according to private business logic. Under such paradoxical situations, a political decision may cause an unexpected result.

RDS affected neonatal conditions and the health care situations in different health care settings

RDS affected neonatal conditions and the health care situations in different health care settings

The application of a feminist poststructural framework in nursing practice for addressing young women's sexual health.

Using a feminist poststructuralist framework, this paper examines the conflicting discourses of young women who experience power struggles with regard to their sexuality and sexual health practices. It aims to provide nurses with a pragmatic framework for exploring, interrogating and potentially transforming health care situations when caring for young women in a sexual health setting. Sexuality and sexual health are important components of health and well-being. Young men and women are continually perpetuated with societal ideals of sexuality and sexual health practices. Young women specifically, receive societal and peer pressure to conform to certain sexual health practices that can lead to both positive and negative health outcomes. Nurses and other health care providers may care for young women in a public or acute care setting that are living with these conflicting sexual health discourses. A review of the literature on young women's sexuality and sexual health was conducted and analysed using a feminist poststructuralist framework. A review of the sexual health literature on young women was conducted. Issues identified from the review, as they relate to sexual discourse were power, language, subjectivity and agency. Nursing strategies to address these issues in practice were identified using a feminist poststructuralist framework. The feminist poststructural framework highlights the conflicting discourses related to young women's sexuality and sexual health practices. This paper provides a pragmatic example of how to incorporate theory to improve nurses' understanding of an individual or group's health. Examples of how a feminist poststructural framework can be used to enhance sexual health nursing practice are discussed, such as helping nurses to challenge the status quo and question the sexual health norms among young women.

Women's autonomy in health care decision-making in developing countries: a synthesis of the literature.

Autonomy is considered essential for decision-making in a range of health care situations, from health care seeking and utilization to choosing among treatment options. Evidence suggests that women in developing or low-income countries often have limited autonomy and control over their health decisions. A review of the published empirical literature to identify definitions and methods used to measure women’s autonomy in developing countries describe the relationship between women’s autonomy and their health care decision-making, and identify sociodemographic factors that influence women’s autonomy and decision-making regarding health care was carried out. An integrated literature review using two databases (PubMed and Scopus) was performed. Inclusion criteria were 1) publication in English; 2) original articles; 3) investigations on women’s decision-making autonomy for health and health care utilization; and 4) developing country context. Seventeen articles met inclusion criteria, including eleven from South Asia, five from Africa, and one from Central Asia. Most studies used a definition of autonomy that included independence for women to make their own choices and decisions. Study methods differed in that many used study-specific measures, while others used a set of standardized questions from their countries’ national health surveys. Most studies examined women’s autonomy in the context of reproductive health, while neglecting other types of health care utilized by women. Several studies found that factors, including age, education, and income, affect women’s health care decision-making autonomy. Gaps in existing literature regarding women’s autonomy and health care utilization include gaps in the areas of health care that have been measured, the influence of sex roles and social support, and the use of qualitative studies to provide context and nuance.

The child’s perspective as a guiding principle: Young children as co-designers in the design of an interactive application meant to facilitate participation in healthcare situations

During the last decade, interactive technology has entered mainstream society. Its many users also include children, even the youngest ones, who use the technology in different situations for both fun and learning. When designing technology for children, it is crucial to involve children in the process in order to arrive at an age-appropriate end product. In this study we describe the specific iterative process by which an interactive application was developed. This application is intended to facilitate young children’s, three-to five years old, participation in healthcare situations. We also describe the specific contributions of the children, who tested the prototypes in a preschool, a primary health care clinic and an outpatient unit at a hospital, during the development process. The iterative phases enabled the children to be involved at different stages of the process and to evaluate modifications and improvements made after each prior iteration. The children contributed their own perspectives (the child’s perspective) on the usability, content and graphic design of the application, substantially improving the software and resulting in an age-appropriate product.

Kids' oral health? It's pure monkey business!

Gaby Bissett looks at how one woman's wish is to make children's experience in the dentist's chair – and other health care situations – a happier one

Feelings of nurses in the reception and risk classification evaluation in the emergency room

Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.

Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Ageing and indigenous health in Aotearoa New Zealand.

Australasian Journal on AgeingVolume 36, Issue 2 p. 134-134 Indigenous Ageing Research FeatureFree Access Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Ageing and indigenous health in Aotearoa New Zealand First published: 07 April 2016 https://doi.org/10.1111/ajag.12217Citations: 1 This Position Statement represents the views of the Australian and New Zealand Society for Geriatric Medicine. The preparation of this paper was coordinated by Dr Oliver Menzies, Professor Ngaire Kerse and Dr Mere Kēpa and was approved by the Federal Council of the ANZSGM on 16 June 2013. Te Ohu Rata O Aotearoa (Te ORA) – The Māori Medical Practitioners Association – has also reviewed this Statement. [Correction added on 21 October 2016, after first online publication: The Position Statement Ageing and indigenous health in Aotearoa New Zealand has been replaced by its summary. The version originally published can be found as the supporting information of this article on Wiley Online Library.] AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Communication between different cultures are common in New Zealand (NZ), and common in healthcare situations. A doctor's culture and belief systems influence his or her interactions with patients and this may impact on the doctor–patient relationship. Older Māori in NZ share a particular health background and understanding this may help to appreciate where current health or ill health may have stemmed. The process of colonisation has had a marked effect on the health of Māori in NZ. The Treaty of Waitangi is NZ's founding nationhood document and has important significance for health. The NZ Government has recognised that there are disparities in health in NZ, and also the governmental responsibility to improve health outcomes for Māori. Socioeconomic disadvantage explains a considerable proportion of the disparity in health between Māori and non-Māori. There have been a number of different models developed for understanding Māori Health; common themes however are spirituality, mental health, physical health, family, language and cultural heritage. The assessment and treatment of Māori can vary compared with non-Māori, and health practitioners should take note of this to allow best care for their patient. Particular examples of this are contained within this Position Statement. It is important, with the patient's consent, to involve family and whānau (wider family) in both assessment and treatment. Management for older Māori should include consideration of Rongoā/Māori Medicine and healing, which may incorporate particular medicinal formulations and massage. The ANZSGM supports further research into Māori Health and government initiatives to improve the deficit in health of Māori populations compared with the NZ European population. Introduction He aha te mea nui o te ao What is the most important thing in the world? He tangata, he tangata, he tangata It is the people, it is the people, it is the people (Māori proverb) Māori is the name given to the Tangata Whenua/people of the land (Indigenous people) of Aotearoa, NZ [1]. This Statement addresses the health of older Māori in NZ. The background and epidemiology of Māori Health in NZ is discussed, followed by practical application in assessment of the older Māori patient. The full document of this Position Statement can be found at http://www.anzsgm.org/posstate.asp Supporting Information Filename Description ajag12217-sup-0001-ArticleS1.pdfPDF document, 163 KB Article S1. Ageing and indigenous health in Aotearoa New Zealand (full document). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Reference Barlow, CB. Tikango Whakaaro, Key Concepts in Māori Culture. Auckland: Oxford University Press, 1991. Google Scholar Citing Literature Volume36, Issue2June 2017Pages 134-134 ReferencesRelatedInformation

Everybody working together

Wireless body area networks (WBANs) are rapidly growing in significance, partly due to their diverse and important applications. Perhaps the most important role they can play is in healthcare: from diagnosis, to monitoring and drug administration. Evidently, monitoring can save lives and a huge amount of research has been devoted to it but problems remain, especially in the context of sleep. The different nodes work cooperatively to improve patient monitoring during sleep As we will see below, sleeping patients are much more difficult to monitor reliably than patients who are awake, especially using WBANs. To address this, researchers from The Australian National University (ANU), and Australia's Information and Communications Technology Research Centre of Excellence (NICTA), have investigated various properties of WBAN channels to show that cooperative communication techniques can achieve a 20% performance improvement. WBANs represent the next generation of wireless personal area networks (WPANs). In this new generation, explained Samiya Shimly, one of the authors of the research, “miniaturised, intelligent, low power, invasive/non-invasive micro and nano technology sensor (and/or actuators) nodes are placed on, inside or around the human body for monitoring physiological signals.” Each WBAN then contains a hub which can connect to the internet or other relevant networks. Shimly told us that, while “WBAN offers a vast range of applications such as ubiquitous health care, military, sports, entertainment and many other areas, it is advanced healthcare that is the main focus of research.” The advantages of WBAN monitoring include patient quality of life – they can engage in their daily lives without being consigned indefinitely to hospital – as well as the ability to monitor several conditions at once. However, sleep still represents a problem, said Shimly, as “the sleeping body channel is a difficult channel to deal with: it is partially quasi-static in nature (not mobile, nor static), and it can be blocked for a long time due to changes in body posture, hence hindering reliability (when many patients can incur life-threatening risks during their sleep).” The work presented in this issue of Electronics Letters is the first to investigate the performance of sleeping body monitoring channels using different cooperative diversity techniques. The authors used cooperatively combined relayed links to improve significantly the reliability of monitoring a sleeping WBAN, which was not possible with single-hop communications. Expanding on this, Shimly explained that “two types of cooperative diversity techniques – 3-branch selection combining, and 3-branch switch-and-examine combining – are performed with two-hop relayed links, and then the results compared with single-hop communications.” This approach led to 7 dB and 20% performance improvement, in the cases of outage probability and outage duration, respectively. Significantly, she said, “the best-case outage probabilities estimated from single link and cooperatively combined links are not more than 10%, which indicates acceptable packet error rate within IEEE 802.15.6 standard requirements.” The improvements offered by the team's research mean that WBANs can be used to monitor patients continuously at home, in hospitals or in healthcare units. (Although, in the longer term, they also believe their prototype could be used for disaster response or emergency healthcare situations.) This will drastically improve the lives of patients in rehabilitation or those with disabilities. The associated devices are small and can activity in a number of situations However, the reliability of the monitoring process is just one part of the problem. The next steps the team are aiming to take are in patient mobility, security and reliability of data transfer, economy of power consumption and scalability. Shimly believes that if all of these aspects can be improved, then “WBAN technology will revolutionise the healthcare sector by enhancing health-care systems with the latest technological advancements leading to major life saving and reduction in healthcare costs.” She also expects that “WBANs wilI be pervasive across the society in many domains apart from healthcare, but it would be great to see WBANs fulfil their promise to save many lives, as well as delivering major improvements in quality of life.”

Mutuality in health care: review, concept analysis and ways forward.

This paper aims to critically investigate the notion of mutuality in nursing, and explore how to resolve the tension between individualised accounts of mutuality and institutional and political factors. The concept of mutuality underlies many theories and models of nursing yet this does not capture the power relations in health care or institutional constraints on mutuality. This is a position paper informed by a narrative literature review. A search of the Scopus, PubMed, Web of Knowledge and CINAHL databases for the terms mutual, mutuality and nursing was conducted, to capture English language literature published from 1990 to mid-2015. There is a large literature discussing the nature and value of mutual exchange and mutuality. There is acknowledgement of institutional and professional constraints which limit the potential of mutuality. Yet there is often a reluctance to engage with critical thinking which emphasises the inequalities of power in health care situations. Accordingly, the notion of social capital is introduced, which emphasises the role of social relationships which individuals and groups can deploy to their advantage. Finally the paper explores how new thinking about mutuality and social capital can make health care more effective. Mutuality and social capital can be enhanced in a variety of ways and may improve client and practitioner outcomes via training, educational and organisational design, and initiatives involving patients and service users, as well as practitioners and service leaders. The sociologically nuanced account of mutuality advanced here sensitises us to questions of power and domination, as well as enabling us to see mutuality in terms of networks of relationships instead of merely an interpersonal phenomenon. This enables practitioners to enhance clients' and their own capacity for mutuality and develop effective resources to increase resilience and recovery.

Bioethics’ Contradiction: Everyday Ethics and the Morality System

Webb Keane’s Ethical Life: Its Natural and Social Histories (2016) asks how people live lives they consider ethical. He calls into question what counts in people’s categorization of a situation as ethical, and he considers the boundaries between the ethical and the moral, noting lack of consistent usage between those terms. This review essay focuses on how Keane’s arguments help articulate a fundamental contradiction between the everyday ethics that people bring to health-care situations and the institutional ethics that frames professionals’ work and discourse. Keane’s work is especially valuable in emphasizing the importance of “minor things” such as dress in how people make ethical evaluations. He emphasizes that ethical work is interactive, taking place in particular forms of talk.

Forum Play as a method for learning ethical practice: A qualitative study among Swedish health-care staff

Background In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care. Method Ten health-care workers participating in a Forum Play course took part in this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison. Results The analysis resulted in the core category “developing response–ability.” It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency. Conclusion The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation.

Characterizing the global context for cross-cultural healthcare work by regions of the world

Healthcare missionaries (n=393) from 18 English-speaking countries, serving in 67 countries, were surveyed. With an average of 11 years of field experience and working primarily in the local language, participants in this study were able to report on healthcare situations and experience for expatriate healthcare missionaries in their countries of service. The healthcare institutions in most countries of the world were reported to be improving. Most countries were reported hospitable to the presence of expatriate missionaries, but there also existed some resistance to expression of Christian faith in the workplace. As mission organizations consider where to place healthcare professionals for medical service, consideration should be given to the trends and opportunities present in different regions of the world, so as to achieve the greatest outcomes and to provide the best match between the missionary and the context in which they work.

Service users' experiences and views of aggressive situations in mental health care: a systematic review and thematic synthesis of qualitative studies.

BackgroundAggressive situations occurring within mental health services can harm service users, staff, and the therapeutic environment. There is a consensus that the aggression phenomenon is multidimensional, but the picture is still unclear concerning the complex interplay of causal variables and their respective impact. To date, only a small number of empirical studies include users’ views of relevant factors. The main objective of this review is to identify and synthesize evidence relating to service users’ experiences and views of aggressive situations in mental health settings.MethodsWe included qualitative studies of any design reporting on service users’ own experiences of conditions contributing to aggressive situations in mental health care and their views on preventative strategies. Eligible articles were identified through an electronic database search (PsycINFO, PubMed, Ovid Nursing Database, Embase, and CINAHL), hand search, and cross-referencing. Extracted data were combined and interpreted using aspects of thematic synthesis.ResultsWe reviewed 5,566 records and included 13 studies (ten qualitative and three mixed methods). Service users recognized that both their own mental state and negative aspects of the treatment environment affected the development of aggressive situations. Themes were derived from experiential knowledge and included calls to be involved in questions regarding how to define aggression and relevant triggers, and how to prevent aggressive encounters effectively. The findings suggest that incidents are triggered when users experience staff behavior as custodial rather than caring and when they feel ignored.ConclusionThe findings highlight the importance of staffs’ knowledge and skills in communication for developing relationships based on sensitivity, respect, and collaboration with service users in order to prevent aggressive situations. An important factor is a treatment environment with opportunities for meaningful activities and a preponderance of trained staff who work continuously on the development of conditions and skills for collaborative interaction with users.