Healthcare Staff Research Articles

Patient safety culture as a mediator between healthcare personnel's psychological empowerment and patient outcome

Preventing healthcare errors and reducing damage are becoming the basic concepts of patient safety development. Healthcare personnel need to be more careful and minimize complications that can occur during patient care. Psychological empowerment is important to support a safety culture and patient outcomes. This study investigates the relationship between psychological empowerment (PE) and patient outcome (PO) mediated by patient safety culture (PSC). A cross-sectional survey study was conducted in private hospitals accredited by Joint Commission International. A total of 150 healthcare personnel as participants who met the requirements were obtained by distributing the questionnaires in March 2023. Significant results in mediating patient safety culture have been analyzed using partial least square-structural equation modeling (SEM). The dimensionality of PE and PSC was assessed by a new method that is a disjoint two-stage approach. The role of PSC was found to fully mediate the positive relationship between psychological empowerment and patient outcome (=0.436, p-value 0.05). This study contributes to growing the value of developing a safety culture and the function of psychological empowerment in healthcare staff to enhance patient outcomes.

"You Don't Realize What a Big Change It Is": A Reflexive Thematic Analysis of Patients' Experiences of Amputation Preparation, Information Provision, and Support.

The objective of this research was to extend current knowledge on the psychological and emotional aspects around patients' preparation for amputation surgery. This research explored amputees' perspectives on their preparation for amputation surgery and how patients can be better supported for this procedure. Data was collected through semi-structured interviews and online qualitative questionnaires with 17 amputees who underwent upper- or lower-limb amputation within the United Kingdom. The interviews were analyzed using reflexive thematic analysis. The analysis generated three themes describing participants' experiences of being prepared for this surgery and their ideas on how this process could be improved: (1) Making sense of amputation surgery, (2) Patients' experiences of information and support from healthcare staff, and (3) Patients' views on approaches to preparation. This research highlighted the importance of information provision and support from healthcare staff, along with the potential benefits of utilizing experiential knowledge through peer support to enhance feelings of preparedness for amputation surgery.

Why are organisational approvals needed for low-risk staff studies in the UK? Procedures, barriers, and burdens.

Health care staff should be given the opportunity to participate in research, but recruiting clinicians via their employing organisation is not always straightforward or quick in the UK. Unlike many countries outside the UK, very low-risk survey, interview or focus group studies can be subject to some of the same governance approval procedures as interventional studies. An exemplar study carried out by the NIHR funded Palliative Care Research Partnership North West Coast is used to highlight the challenges still faced by researchers and health care organisations when setting up a low-risk staff study across multiple NHS and non-NHS sites. A study database was created and information was collected on the first point of contact with the clinical site, Health Research Authority (HRA) and local organisational approval times, time from trust or hospice agreement to the first survey participant recruited and overall site survey recruitment numbers. Descriptive statistics (median, range) were used to analyse these data. Across participating NHS trusts, it took a median of 147.5days (range 99-195) from initial contact with the local collaborator to recruitment of the first survey participant and hospice sites mirrored these lengthy timescales (median 142days, range 110-202). The lengthiest delays in the HRA approval process were the period between asking NHS trusts to assess whether they had capacity and capability to support the research and them granting local agreement. Local approval times varied between trusts and settings which may indicate organisations are applying national complex guidance differently. There is the potential for HRA processes to use more NHS resources than the research study itself when recruiting to a low-risk staff study across multiple organisations. There is a need to reduce unnecessary administrative burden and bureaucracy to give clinicians and research staff more opportunities to participate in research, and to free up NHS R&D departments, research nurses and clinicians to focus on more demanding and patient focused research studies. Hospices need standardised guidance on how to assess the risk of being involved in low-risk research without adopting the unnecessarily complex systems that are currently used within the NHS.

Developing an implementation intervention, and identifying strategies for integrating health innovations in routine practice: A case study of the implementation of an insulin patient decision aid.

Implementation, which is defined as the process of getting evidence-based innovation to be utilised is critical in ensuring innovation is being integrated into real-world practice. The way an implementation intervention (i.e., a bundle of strategies to facilitate implementation) is developed has an impact on the types of strategies chosen, and whether they are relevant to the implementation setting to exert their effects. However, literature pertaining to development of intervention or detailed descriptions of implementation processes are scarce. This study aims to report the development of an implementation intervention to integrate the use of an evidence-based innovation in routine practice, using a Malaysian insulin patient decision aid (PDA) as an exemplar. The development of the insulin PDA implementation intervention was divided into two phases, incorporating step 3 and 4 of the Action Cycle in the Knowledge to Action framework. In Phase 1, barriers to the insulin PDA implementation was explored through qualitative interviews using an interview guide developed based on the Theoretical Domains Framework. In Phase 2, prioritisation of the barriers was conducted using the multivoting technique. Next, potential strategies that can address the barriers were identified based on understanding the clinic context, and evidence from literature. Then, the selected strategies were operationalised by providing full descriptions in terms of its actor, action, action target, temporality, dose, implementation outcome affected, before they were embedded into the patient care pathway in the clinic. The implementation intervention was finalised through a clinic stakeholders meeting. In Phase 1, a total of 15 focus group discussions and 37 in-depth individual interviews were conducted with: healthcare policymakers (n = 11), doctors (n = 22), diabetes educators (n = 8), staff nurses (n = 6), pharmacists (n = 6), and patients (n = 31). A total of 26 barriers and 11 facilitators emerged and they were categorised into HCP, patient, organisational, and innovation factors. The multivoting exercise resulted in the prioritisation of 13 barriers, and subsequently, a total of 11 strategies were identified to address those barriers. The strategies were mandate change, training workshop, involve patients' family members or caretakers, framing/reframing, inform healthcare providers on the advantages of the insulin PDA use, define roles and responsibilities, place the insulin PDA in the consultation room, provide feedback, systematic documentation, to engage patients in treatment discussions, and juxtapose PDA in preferred language with patient's PDA in their preferred language to help with translation. This study highlights main barriers to PDA implementation, and strategies that can be adopted for implementation. The steps for intervention development in this study can be compared with other intervention development methods to advance the field of implementation of evidence-based innovations.

Understanding the Experience of Workplace Violence in Hospitals as Documented by Nursing Staff: Using the READ Approach.

Background: Workplace violence has a significant impact on patients, families, and staff safety. Workplace violence can produce traumatic results for those involved; the importance of preventive measures needs to be paramount in health service policy and process. Health care staff are required to document their experiences of violent incidents after every occasion, usually via an incident reporting system, which allows for a free text description of the event. There is a lack of understanding of how health care staff document reports of violence and how they explain the events. Methods: This study aims to determine the circumstances surrounding workplace violent events as documented by health care staff. The four-step Review, Extract, Analyze, and Document (READ) approach to document analysis was used to examine workplace violence incident reports over 12 months (September 2021-September 2022) in a tertiary referral hospital. Findings: Six categories of workplace violence were found: (a) "Escalation Dynamics"-patterns and progression of how violence incidents intensify; (b) "Warning Behaviors"-verbal or non-verbal signals that may foreshadow physical violence if not addressed; (c) "Authoritative Institutional Interventions"-how aggression correlates to protocols involving security personnel or law enforcement; (d) "Care Delivery Methods"-how certain treatment procedures and approaches might inadvertently elicit violence; (e) "Situational Stressors"-external circumstances or changes that act as triggers for violence; and (f) "Unprovoked triggers"-sudden and seemingly unprovoked violent outbursts. Conclusions and application to practice: Workplace violence in health care is a multifaceted interplay of events with the nurse involved in all aspects of the process. These findings can be used by occupational health nurses in education and policy development. The findings can be used to focus education on how violent incidents may escalate and provide more opportunities for de-escalation by health care staff.

Knowledge, attitude and practice of pediatric healthcare staff towards the therapy for patients with congenital heart disease.

This study aimed to investigate the knowledge, attitude and practice (KAP) of pediatric healthcare staff towards the therapy for patients with congenital heart disease (CHD). CHD is a major global health concern, posing significant risks to health and life despite advancements in early detection and treatment. This web-based cross-sectional study was conducted from May 04, 2023 to August 12, 2023 in the Bengbu area (three counties and one city) for pediatric healthcare staff. Correlations between knowledge, attitude and practice scores were evaluated by Pearson correlation analysis. Factors associated with knowledge, attitude and practice scores were identified by multivariate logistic regression. A total of 332 valid questionnaires were enrolled, including 258 (77.7%) females, and 161 (48.5%) were pediatrician. The median (25% quartile, 75% quintile) of knowledge, attitude, and practice scores were 38 (36, 40) (possible range: 10-49), 28 (27, 31) (possible range: 7-35), and 35 (32, 39) (possible range: 9-45), respectively. Correlation analysis showed that significant positive correlations were found between knowledge and attitude (r = 0.528, P < 0.001), as well as practice (r = 0.399, P < 0.001). Meanwhile, there were also correlations between attitudes and practice (r = 0.528, P < 0.001). Univariate logistic regression showed that treated more than 100 children with congenital heart disease annually (OR = 2.976, 95% CI: 1.405, 6.303, P = 0.004) was independently associated with knowledge. Female (OR = 0.470, 95% CI: 0.277, 0.797, P = 0.005) and with more than 5years of work experience (OR = 0.507, 95% CI: 0.262, 0.982, P = 0.044) were independently associated with attitude. Female (OR = 0.584, 95% CI: 0.343, 0.994, P = 0.048) and treated more than 100 children with congenital heart disease annually (OR = 3.743, 95% CI: 1.702, 8.232, P = 0.001) were independently associated with practice. Pediatric healthcare staff had sufficient knowledge, positive attitude and proactive practice towards the therapy for patients with congenital heart disease. To improve clinical practice, prioritize training programs to build knowledge and positive attitudes among healthcare staff, encourage hands-on experience with CHD cases, and promote mentorship by experienced professionals for a collaborative work environment and better care.

Assessment of the Psychometric Properties of the Mask Usability Scale: A Measure of the Perceived Usability of N95 Respirators Among Healthcare Students and Staff.

To test the reliability and construct validity of the Mask Usability Scale in healthcare students and staff. A methodological study involving repeated measures. The study included two batches of participants: (1) 283 university nursing students and (2) 1753 participants composed of students (61%) and clinical staff (39%). All participants underwent N95 respirator fit tests and user seal checks. They also responded to the Mask Usability Scale, which comprises 11 items evaluated using Likert scales. The internal consistency was assessed using Cronbach's alpha and item-total correlation test. Test-retest reliability was evaluated by the intraclass correlation coefficient (ICC). The factor structure was initially identified through exploratory factor analysis (EFA), laying the groundwork for the model. This approach was followed by confirmatory factor analysis (CFA) to ensure the model fits with the standardised solution. Excluding items 9, 10 and 11, the study showed satisfactory internal consistency, evidenced by a Cronbach's alpha of 0.842 for the eight-item scale from the combined samples. Factors, such as 'Heat', 'Breathability', 'Tightness' and 'Ease in talking' showed moderate to strong correlations. The test-retest reliability in the batch one sample was acceptable with ICCs ranging between 0.69 and 0.71 for different models. The EFA and fit indices supported a two-factor structure. The first factor 'Comfort and Usage' included 'Heat', 'Breathability', 'Tightness', 'Ease in talking' and 'Prolonged use', which were keys for the usability of N95 respirators. The second factor 'Suitability' encompassed 'Itchy', 'Easily displaced' and 'Ear soreness'. The variance explained by the first and second factors was 49% and 12%, respectively, with a strong inter-factor correlation. The CFA results were satisfactory with fit metrics (NFI = 0.967, IFI = 0.969, TLI = 0.952, CFI = 0.969, RMSEA = 0.078 with 90% CI [0.069, 0.086] and p < 0.001) and a chi-squared to df ratio of 13.58. The eight-item mask usability scale exhibited satisfactory internal consistency and construct validity in both healthcare student and staff samples. The primary concern in the purchase policy of N95 respirators for clinical use is to strike the right balance between usability and fit rate (passing % of fit testing). Our study solidified the concept of quantifying the usability of respirators. With that mask usabilityscale measurement, a provision of benchmark and reference for the design and selection of respirators would be possible. This validated scale has significant implications for senior management in clinical settings and respirator manufacturers regarding the N95 respirator purchase policy and design. The results indicatedthe psychometric propertiesof mask usability scale in measuring the usability of N95 respirators. This scale is particularly valuable for assessing the perceptions of healthcare students and staff of factors, namely, 'Heat', 'Breathability', 'Tightness', 'Ease in talking', 'Prolonged use', 'Itchy', 'Easily displaced' and 'Ear soreness' concerning the use of N95 respirators. We adhered to EQUATOR guidelines following the STROBE statement. No patient or public contribution. ISRCTN registry: ISRCTN40115047.

The Implementation Process Assessment Tool: translation, contextualization, and psychometric evaluation of a Swedish version in a municipal elderly care context.

The number of older adults with complex healthcare needs is growing alongside limited resources available in health services. To meet this challenge, it is urgent that healthcare staff are motivated and able to continuously translate new knowledge and working methods into daily practice. To facilitate such implementation, supportive measures responding to the healthcare personnel's needs seem essential. The present study aims to translate, contextualize and test a Swedish version of the Implementation Process Assessment Tool (IPAT) for measuring the facilitation needs among staff implementing a new working process in municipal elderly care. A mixed-method design was used. First, the existing instrument was translated into Swedish. Thereafter, twelve staff members with different professions working in healthcare and at the municipal elderly care were interviewed using Think-aloud interviews to contextualize and test the face validity of the translated instrument. Lastly, the adjusted instrument (Swe-IPAT) was psychometrically evaluated through a cross-sectional survey among 305 staff members working in municipal elderly care. The psychometric evaluation of the Swe-IPAT revealed satisfying properties. Three factors, largely in line with the original IPAT, are suggested. Internal consistency assessed using Cronbach's alpha was 0.93 for the factor individual phases for behavioral change and perception of the intervention, 0.84 for the factor individual activities, and 0.95 for the factor collective readiness and support. The 27-item Swe-IPAT, translated into Swedish and contextualized, demonstrated satisfactory psychometric properties when tested in an elderly care context. The instrument is suggested to be useful in providing feedback to managers in tailoring support and assessing implementation efforts among healthcare staff in elderly care. However, more research is needed to evaluate its properties throughout the entire implementation process and to test the usability of Swe-IPAT in other settings.

Comparison of Mindfulness Practices for Effectiveness of Stress and Burnout Reduction in Healthcare Staff.

Comparison of Mindfulness Practices for Effectiveness of Stress and Burnout Reduction in Healthcare Staff.

Healthcare and Pharmacy Staffs' Experiences on Medication Management for Migrants-A Qualitative Exploratory Case Study in Primary Health Care.

To explore what healthcare staff and staff in pharmacies experiences, as challenges, and possibilities in handling and use medications by foreign-born persons or their relatives, and how necessary information is exchanged between different units in the healthcare chain to prevent medication errors. A qualitative explorative single-unit case study in a primary healthcare centre, with connected home care and pharmacies in an immigrant-dense area. Individual semi-structured interviews with 17 respondents, including pharmacists, physicians and registered nurses, were conducted between May and December 2022, in Sweden. Inductive qualitative content analysis was applied. Six categories were identified: limited knowledge about medications, lack of knowledge about the Swedish system for medication prescriptions and pharmacy regulations, insufficient time to develop trusting relations, communication to support medication management, tools for facilitating safe use of medications and problems in exchange of information in the healthcare chain. Good communication is both a challenge and a prerequisite for safe medication management by well-informed patients. To ensure patient safety, it is crucial to establish ways to communicate with patients about their medications, regardless of their language skills. Improving communication within the healthcare chain is essential to prevent medication errors. Understanding the complexity of medication management and preventing medication errors requires staff to communicate effectively with patients at all steps in the healthcare chain to identify their informational and educational needs. This study provides a comprehensive understanding of the importance of communication within the healthcare chain, including prescribing physicians, nurses, pharmacists and patients, to prevent medication errors. COREQ checklist. This study focused on staff at a healthcare centre and two pharmacies.

Exploring Clinical Documentation Practices among Healthcare Staff: A Clinical Audit of National Hospital Galle, Sri Lanka

Introduction: Valid and trustworthy clinical documentation improves patient outcomes, boosts hospital data accuracy, and enhances reflective action to improve healthcare service quality and safety. In Sri Lanka, the bedhead ticket (BHT) is the legal documentation record for inpatients. In 2022, the Ministry of Health (MoH) issued new rules for the correct maintenance of BHTs.Objective: This clinical audit's objective was to assess the in-patient clinical documenting practices at National Hospital Galle (NHG), Sri Lanka.Methodology: A total of 384 randomly selected BHTs from the record room, which belonged to patients who received inward care from April 2023 to September 2023, were included in this clinical audit. A checklist and a marking scheme were prepared according to MoH guidelines and filled out after going through each BHT.Results: The level of completeness of the first page was good in 96% of BHTs. Maintenance of continuation sheets was average in 82%of BHTs and good in only 2%. Around 67% of BHTs obtained good marks for the level of completeness of entries. Only 1% of BHTs had entries with a signature placed at the end. The date and time of the entry were recorded in 73.5% and 64.3% consecutively.Conclusion: Adherence to the MoH guidelines for clinical documentation practices was satisfactory at NHG, and regular audits and staff awareness and training are required to maintain the standards.

Effective Communication of System-Level Events for Hospital System Health and Nurse Well-Being: A Qualitative Study

Many injuries and deaths occur yearly in the United States due to preventable errors; however, documented harm is lower in hospitals with Magnet® designation from the American Nurses Credentialing Center (Silver Spring, MD, USA). This manuscript illustrates insights from Magnet® and non-Magnet® nurses and nursing leaders regarding what impacts hospital system health, how those factors are communicated, and how hospital system health impacts patient safety. A qualitative descriptive approach was used with semi-structured interview questions. Within-methods data triangulation was applied to transcribed interviews using thematic analysis, application of the Goodwin statistic, and natural language processing (NLP). Thematic analysis revealed the four main themes of Healthy Systems, Unhealthy Systems, Patient Safety, and Nurse Well-Being. NLP revealed non-Magnet® leaders and nurses scored highest for anxiety, anger, and sadness, in contrast to Magnet® participants who had the highest levels of positive emotion. Key findings from the Magnet® participants revealed that poaching employees and placing people in the wrong positions harm hospital system health and patient safety. The use of within-methods data triangulation illuminated the contextual depth of the participants’ speech, revealing the alarming emotional state that non-Magnet® nurses and leaders are facing. Healthcare staff’s wellness must be prioritized to cultivate environments that provide safe care.

Feasibility and challenges in sustaining a community based surveillance system in post-Ebola Sierra Leone

BackgroundIn outbreak-prone settings, community-based surveillance (CBS) systems can alert health authorities to respond in a timely manner where suspected cases of disease are being reported. After the 2014–2016 Ebola outbreak, the WHO and other stakeholders supported the establishment of CBS in Sierra Leone, for which community health workers (CHW) were trained to collect and report symptoms data of 11 priority health conditions in their communities. Our study objective was to assess feasibility and challenges to sustain CBS in a low resource setting as part of a World Bank evaluation of Sierra Leone’s Ministry of Health and Sanitation’s (MoHS) CBS and electronic Integrated Disease Surveillance & Response (eIDSR) systems.MethodsIn 2019 we conducted a mixed methods assessment consisting of a household incidence survey, health facility survey, household case verification survey, a costing analysis, and in-depth interviews and focus group discussions with key stakeholders of the CBS system in eight chiefdoms of 4 purposefully selected districts in Sierra Leone. The study period for primary data collection was February through April 2019. We also conducted secondary data analysis of surveillance data in DHIS2 of all 32 chiefdoms.ResultsIn districts where CBS was ‘fully functional’, the number and type of CBS alerts corresponded to the number and type of diseases reported through facility based eIDSR system in the same period. However under-reporting of diarrhea and measles suspects from the community still appeared to occur, and reporting deteriorated when primary health care staff including CHWs reported the stoppage of stipends. The annual budget impact for CBS was estimated at 4.4 million USD in 2018. The majority of costs were made at community level (73%) compared to regional (0.3%), primary health unit (21%), district (4%) and national (2%) level. The most important costs drivers were training of CHWs (59% of total costs) and salaries (including stipends of the CHWs) of human resources (15%). Barriers included sustainable financing of human resources, internet connectivity, as well as limited trainings and supportive supervision, and unsupported transportation costs for CHWs and peer supervisors (PS). CHWs and community members reported that communities are more willing to share information about health issues compared to the pre-CBS implementation period.ConclusionsThe similarity between CBS and IDSR reports support the possibility that CBS increases the sensitivity of disease surveillance to the level of the community, which would enable local authorities to take early prevention measures when and where impact will be the greatest. Qualitative interviews suggest that CBS has improved the interface between the community and primary level of the health system. However if the barriers to sustainability are left unaddressed, opportunities for CBS to prevent disease outbreaks will go unrealized.

Investigating the organizational commitment and its associated factors among the staff of the health sector: a cross-sectional research

IntroductionOrganizational commitment (OC) significantly impacts the quality of care provided by healthcare staff. It reflects employees’ connection to and engagement with their organization, affecting job satisfaction, employee turnover, and the overall success of the healthcare organization. This research seeks to assess OC levels and identify its influencing factors among health sector staff in Shiraz, southwestern Iran.MethodsIn this cross-sectional study, the staff of the health sector including physicians/family physician (FP), midwives, healthcare workers, psychologists, dentists, and nutritionists were selected through a multi-stage sampling; they filled out an online 36-item questionnaire (12 demographic items and 24-item Allen and Mayer OC questionnaire). The data were analyzed using SPSS software (version 25). Descriptive statistics of OC scores were provided. Also, independent samples t-test and analysis of variance were used as statistical tests, and P-value < 0.05 was considered the significant level.ResultsOverall, 289 staff with a mean age of 32 ± 7.6 years participated in this study. The OC total mean score was higher in the public sector compared with the private sector and higher in the non-FP team compared with the FP team. The mean score of all types of OC among all job positions was low. Moreover, education level, workplace, job experience in current job, engagement in other jobs for making money, and FP staff showed a significant association with the total mean score of OC.ConclusionAccording to the results, OC among health sector staff is low. Therefore, policymakers in the health sector are strongly recommended to implement immediate measures to enhance this critical factor among their workforce.

The allocation and fairness of hospital pharmacist human resources in China: a time-series study

BackgroundTo address the rational use of medicines in healthcare institutions, the Chinese government enacted legislation for pharmacists in 2021, emphasizing the importance of pharmacists in medical services. The allocation and equity of pharmacist human resources in healthcare institutions directly affect people’s accessibility to pharmaceutical services. The study aims to analyze the supply and demand of pharmacist human resources in Chinese healthcare institutions and evaluate the equity of their distribution to provide a reference for the rational management of pharmacist resources.MethodsThis was a time-series study that was conducted using data obtained from Health and Health Statistical Yearbook that is performed every year by the National Health Commission of the People’s Republic of China. The study included 31 provinces, municipalities, and autonomous regions and 34,354 medical institutions in mainland China, which were classified into different economic regions based on their level of economic development. The study collected healthcare technicians and pharmacist data from national healthcare institutions between 2016 and 2020. The study evaluated the level of pharmacist human resource allocation using the health resource density index. The study explored the equity of pharmacist human resource allocation from two aspects: population and geographic area, using the Gini coefficient and Theil index.ResultsThe average annual growth rates of healthcare technical staff and pharmacists in Chinese medical institutions from 2016 to 2020 were 5.67% and 3.03%, respectively. The Gini coefficients of healthcare personnel resources based on population distribution were all below 0.119, while those based on geographical area were all above 0.655. The total Theil indexes of pharmacist human resources based on population distribution were all below 0.010, while those based on geographical area were all above 0.511. In addition, the contribution rates of the within-group Theil indexes of pharmacist human resources based on population and geographical area distributions to the total Theil index were all greater than or equal to 50%.ConclusionsThe allocation level of pharmacist human resources in China continues to improve, but there are differences in different economic development areas. Currently, allocation based on population shows equity, but allocation based on geographic area shows inequity. In the future, more attention should be paid to the geographic accessibility of pharmacist human resources, and resource allocation should consider both the population served and geographic area.

Knowledge, attitudes and practices of the healthcare staff and students about disposal of unwanted medications: a systematic review

Abstract Introduction Improper disposal of medications poses a significant environmental risk on the ecosystems and human beings1. When medicines are discarded by flushing them down the toilet or throwing them in the household trash, their active components may leak into the water supply2. Aim This systematic review seeks to compile studies that examine healthcare professionals' and students' knowledge, attitudes, and practices (KAP) regarding medication disposal. It also aims to explore recommendations and barriers related to appropriate medication disposal. Methods A systematic review was conducted by adhering to guidelines outlined in Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and the Joanna Briggs Institute. The primary outcome is to measure the levels of the healthcare staff and students' knowledge, as well as their attitudes, and practices about disposal of unwanted medications. Authors included qualitative, quantitative, and mixed-method primary research studies. Participants included pharmacists, doctors, nurses, and both undergraduate and postgraduate medical, pharmacy, and nursing students due to their significant involvement with medication and its disposal in healthcare settings. Data extraction was conducted by four of the researchers independently. The study details were categorised into three main domains i.e., knowledge, attitude, and practice using the KAP model. Other relevant information was also extracted, thematically, such as challenges and recommendations. Ethical approval was not required as this systematic review used previously published data. Results 37 studies from 18 countries (21 from Asia, 7 from the US, 5 from Africa, and 2 each from the EU and South America) met the inclusion criteria. 86.5% (n=32) investigated participants' knowledge of medication disposal. Although there is a good level of awareness about the environmental impacts, there are significant gaps in knowledge regarding correct disposal methods, available services, guidelines, and training. 30 studies explored participants' attitudes toward medication disposal. The results indicate a generally positive attitude towards the need for environmentally safe disposal practices. 35 studies evaluated participants' practices in relation to medication disposal. Although there was generally a positive attitude and some understanding of appropriate disposal methods, majority of the participants do not follow the practice guidelines, especially outside healthcare settings. This inconsistency may be due to numerous factors such as inadequate practical training, limited resources, or unclear guidelines. Discussion/ Conclusion Overall, it was found that while healthcare staff and students have fair knowledge and positive attitudes toward medicine disposal, their actual practices are lacking. One significant challenge identified is the limited awareness about proper disposal methods coupled with a lack of established services or guidelines in many regions. Even in cases where take-back programs are available, they often face issues with accessibility. To tackle these challenges, it is suggested by the studies that governmental bodies should establish and enforce clear policies on medication disposal while also expanding educational initiatives to increase understanding among healthcare professionals and students about appropriate disposal methods. Furthermore, improving access to take-back programs is crucial for ensuring safe medication disposal and minimising potential environmental and health hazards.

LBTQ parents’ bonding experiences after complicated births: managing minority stress and traumatic experiences

ABSTRACT Background Birth complications increase the risk of birth injuries and neonatal complications, as well as the risk of experiencing childbirth as a trauma. This, in turn, increases the risk of postpartum mental ill-health and may affect early bonding with the baby. Birth complications add additional stress on lesbian, bisexual, transgender and queer (LBTQ) parents, as they also must navigate hetero- and cisnormative assumptions, being subject to othering, and negative attitudes from healthcare staff. Aim To explore LBTQ parents’ experiences of bonding with their child following a complicated birth. Methods Semi-structured interviews with 22 birthing and non-birthing parents. Interviews were recorded, transcribed, and analysed using thematic analysis. Results The results describe obstructive and facilitating factors. Being traumatised was the main obstacle for mentally engaging with the baby. A focus on physical injuries and healing hindered caretaking and bonding for birthing parents. Stress related to their parental role was obstructive for some non-birthing parents, who struggled to find space to process their own experiences when the partner and/or child was not well. Other non-birthing parents experienced a head start in the bonding process when their partner was injured. Some birthing parents had positive bonding experiences despite the birth complications, as they felt an alliance with their child in the harsh situation. Conclusion Complicated births and minority stressors can increase the risk of bonding difficulties and mental ill-health. Tailored, LBTQ-competent care is essential to support both birthing and non-birthing parents in overcoming these challenges.

Australian private healthcare staff perspectives on patient reported experience measures (PREMs): a qualitative interview study

ObjectivePatient reported experience measures (PREMs) are common tools utilised in hospitals to support quality improvements, allow consumers to provide feedback on care experiences and can be used to support consumers’ hospital selections. This study aimed to understand the views and opinions of private hospital staff on PREM use and the utility of PREMs as a consumer decision-making tool.MethodQualitative, semi-structured interview study conducted via telephone between March-June 2023. Participants (n = 10) were recruited from major private healthcare providers in Australia with half representing hospital-based staff and the other half corporate head office staff who work in patient experience and quality. Interviews were audio-recorded, transcribed, and analysed thematically.ResultsPREM benefits included an understanding of patient experience that improved provision of patient centred care with feedback acting as catalyst for change, to corporate-level strategic initiatives that address specific issues. Drawbacks of PREM reporting included concerns around skewed results by biased respondents, and completion based on hard to alter items (e.g., infrastructure) or on matters outside of hospital control (e.g., insurance). Staff had mixed reactions to consumers using PREMs results when selecting a hospital, some advocated for transparency while others feared consumers would misinterpret the data.ConclusionsImproved real-time reporting of PREMs, learning from other industries about recording customer experience, and mandatory reporting by private hospitals could further the benefits of PREM measurement in private healthcare. Recognised was the need for PREMs to be displayed in a readily understood way so those with limited health literacy can correctly interpret.

Pre and post diagnostic dementia care in four Scottish prisons

Background and purposeThe number of older people in prisons is increasing across the globe. Many have poor physical and mental health, higher prevalence of head injury, cognitive impairment and dementia than found in community populations. Meeting the complex needs of this vulnerable group has become an increasing concern for prison and prison healthcare services. The aim of this multi method qualitative study was to investigate how men with diagnosed or suspected dementia were identified, assessed, and cared for in Scottish prisons. It also explored the lived experience of individuals being assessed for or diagnosed with dementia within four prisons. The data from twenty nine interviews was thematically analysed and used to collaboratively propose principles for dementia care in prison and present the resultant co-designed care pathway.ResultsAt the time of data collection almost all the men known to have a dementia diagnosis or suspected dementia had complex health and social care needs, and some were living with advanced dementia. Prison healthcare staff reported taking a ‘case by case’ approach to their pre- and post-diagnostic care. Meeting these prisoner’s needs was complicated by the absence of organisational leads for care of older adults or people with dementia and there was no pathway or model in place to guide staff. Prison healthcare teams often had difficulty accessing specialist community services to support diagnosis. There was a lack of dementia education and knowledge about how to provide pre and post diagnostic dementia care in this setting amongst staff. The findings arising from this research have informed the co-production of two important evidence informed innovations namely a Model of Care and a pre- and post-diagnostic Care Pathway.ConclusionThis research adds insights critical to understanding the adequacy of current approaches to meeting dementia related needs within the prison setting. To our knowledge this paper offers the first co-produced evidence informed pre- and post- diagnostic dementia care pathway and model of care for use in prisons. These could serve as tools for change that could enable prison healthcare staff to deliver the right care, at the right time, by the right people, and provide an opportunity to assess risk and plan care for the future.

Do we need a guideline for all: a qualitative study on the experiences of male athletes following anterior cruciate ligament reconstruction

BackgroundConsidering the low rate of qualitative studies on athletes with anterior cruciate ligament reconstruction (ACLR), aiming to access in-depth data, we thought that the utilization of the qualitative method would allow us to collect the appropriate and sufficient data to yield novel findings and achieve sound conclusions. The study’s aim was to investigate anterior cruciate ligament (ACL) injury experience processes in athletes who had undergone isolated ACLR, reveal the clinically related milestones, and highlight the necessary gaps.MethodsSemi-structured interview techniques, in-depth follow-up questions, and thematic analysis were used to explore the experiences of participants with isolated ACL injuries 1–3 years after surgical treatment. The study was conducted in the Orthopaedics and Traumatology outpatient clinic of the Adana City Training and Research Hospital and included 14 male athletes who had undergone isolated primary ACLR. The study group’s demographic and qualitative data were collected in the first week of September 2023. The member checking process was completed in the third following week. A thematic analysis checklist was used to ensure the reliability of the thematic analysis. The Consolidated Criteria for Reporting of Qualitative Research (COREQ) guidelines were followed.ResultsThe experiences of 14 patients (22.78 ± 3.76 years, all males) were summarized into four themes that emerged from the data analysis process: ‘The Distinctions in the Participants’ Experiences Regarding the Moment of Injury,’ ‘Gathering Information about the ACL Injury,’ ‘Factors That Facilitate The Treatment Process and Reinforce Positive Experiences,’ and ‘Desperate Plight: Main Points of Patients’ Negative Experiences.’ Based on the main themes, there were 14 subthemes.ConclusionsOur study revealed that varying perceptions of ACL injury presented by the participants, which were caused by all stakeholders, including themselves, the professional environment, family members, social network, and the healthcare staff, showed that the physical and psychological impacts of the injury were observed in different severity levels at each stage of the process. We believe that an extensive guide for athletes with ACL injuries that includes all components of well-being and displays the required details for the sports club/coach, family/companion, and physician.