Health Care Administrators Research Articles

Workplace violence and nurses' psychological well-being: The mediating role of burnout and the moderating role of psychological resilience

Workplace violence can harm healthcare professionals. It can cause bodily harm, psychological distress, and even death. Moreover, it creates an unpleasant workplace that lowers morale and productivity. To provide quality patient care without fear of danger or intimidation, healthcare organizations must keep their personnel safe from violence. This article examines workplace violence and nurses' psychological relationship with nurses' burnout as the mediator. Psychological resilience's moderating role between workplace violence and nurses' psychological well-being is also examined. The data of this study includes 945 nurses from 15 university hospitals in Turkey. The proposed model was tested by using hierarchical multiple regression analysis. This study showed that workplace violence and burnout negatively affect nurses' mental health. Psychological resilience also weakens the relationship between workplace violence and nurses' psychological well-being. The study suggests that healthcare administrators may build a secure and supportive workplace by enacting workplace violence prevention and response policies. They can also be trained in recognizing and responding to warning signals of violence. Nurses should feel safe reporting violence concerns. Moreover, nurses with high workplace violence and low psychological well-being must emphasize psychological resilience's buffering effect.

Healthcare Needs of Provincially Uninsured Migrant Families with Newborn Infants: A Qualitative Descriptive Study

Aim: This project aimed to explore the healthcare needs of provincially uninsured migrant families with newborns receiving care at a nurse practitioner (NP)-led clinic in Montreal, Quebec, Canada. The findings of this study are intended to guide primary healthcare professionals and administrators in understanding and addressing the specific needs of these families, enabling them to tailor their services appropriately. Background: Newborns of provincially uninsured migrant families in Quebec can experience delays in accessing provincial health insurance, preventing timely access to primary care services. In Montreal, a publicly funded NP-led clinic was created to enable newborns without provincial health insurance to access recommended well-baby visits in the first 4 months of life. There exists a paucity of literature on the specific healthcare needs of uninsured families with newborn infants, making tailored care difficult. Methods: A qualitative descriptive study was undertaken. Semi-structured interviews were conducted with the parents of provincially uninsured Quebec-born newborns being treated at a NP-led clinic. Ten interviews were conducted with a total of 13 participants between October 2023 and January 2024. Socio-demographic data were collected. Content analysis was undertaken to identify important themes. Findings: Two overarching themes were identified including (a) healthcare service needs related to newborn care, maternal postpartum care, and family healthcare; (b) healthcare access needs related to navigating the local healthcare system, transportation, and provincial health insurance. Conclusion: Provincially uninsured migrant families with newborns in Quebec face barriers to accessing healthcare. This study provides information on the healthcare services and access-related needs of these families and provides recommendations including how NP-led clinics can facilitate access to the healthcare services needed by these families.

Efficiency of night shifts in Primary Healthcare Centers, Aseer Region, Saudi Arabia: Data envelopment analysis

BACKGROUND: Efficient allocation of healthcare resources is essential for meeting the increasing demand for healthcare services. This study aimed at exploring the performance of both one- and two-shift Primary Healthcare Centers (PHCCs) and examining the efficiency of healthcare centers to discover how efficiency is affected by the levels of resource allocation and staffing. MATERIALS AND METHODS: The study was conducted at 31 PHCCs assigned to cover extended hours, from 4:00 PM to 8:00 AM during May-October 2023. Study employed a quantitative approach and the data envelopment analysis technique to assess the efficiency of PHCCs, specifically focusing on night shift performance. Data were collected through interviews and surveys with primary healthcare staff including 99 doctors, 119 nurses, and 139 support staff using structured questionnaire. The DEA technique was utilized to measure the relative efficiency of the PHCCs by comparing the inputs and outputs. RESULTS: Out of 31 PHCCs, 45.2% run two shifts. Over the reported period, a total of 126,619 patient visits were recorded; 81.7% came to the two-shift PHCCs and 18.3% to the one-shift PHCCs. On average, each two-shift PHCC received approximately 161 visits/ shift, and the one-shift received 123 visits. Upper respiratory tract infections accounted for 30% of morbidities and chronic diseases for more than 20%. The performance of the two-shifts PHCCs revealed varying levels of efficiency with a score of 1.00 for the most efficient PHCC and 0.31 for the least efficient PHCC. CONCLUSION: This study underscores the importance of data-driven decision-making for healthcare administrators. Ongoing assessments and benchmarking are essential for continuously improving the quality of healthcare service and optimizing utilization of resources. Future research in this field can further explore the factors that contribute to healthcare efficiency and provide deeper insights into healthcare resource management and optimization of service delivery.

HYBRID ARCHITECTURE WITH IMPROVED SCORE LEVEL FUSION FOR PATIENT WAITING TIME PREDICTION

Hospitals are overcrowded in proportion to the massive increase in population, making it difficult for hospitals to manage or arrange or shorten patient wait time during medical care. However, it is difficult to overstate the significance of patient waiting time management and predictability. In most of the hospitals, the clinical workflow is defined and driven by the patient queues. Predicting the incoming patients and waiting times has thus emerged as one of the most crucial clinical management techniques. Our proposed work aims to address the limitations of current waiting time prediction models by providing a more sophisticated, data-driven approach that can adapt to the complexities of healthcare environments. This work focuses on developing a new model for predicting the patient’s waiting time. The primary aim of this research is to create a reliable predictive model capable of accurately anticipating patient waiting times. This innovation aims to enhance both patient satisfaction and operational efficiency within healthcare settings. By offering healthcare administrators a tool to better manage patient flow, allocate resources efficiently, and minimize waiting times, this model seeks to optimize overall healthcare service delivery. The initial process carried out is pre-processing which includes data acquisition and improved [Formula: see text]-score normalization. Subsequently, entropy features, correlation features, and improved mutual information (MI) features are extracted. Then, prediction is carried out using hybrid classifier (HC) that involves a convolutional neural network (CNN) and bidirectional gated recurrent unit (Bi-GRU). Finally, improved score level fusion (ISLF) is introduced to get absolute outcomes on WTP. The analysis outcomes on varied error metrics show the efficacy of the proposed WTP model.

Average Daily Dose Trajectories for Episodes of Buprenorphine Treatment for Opioid Use Disorder.

High-dose (≥24 mg) buprenorphine daily doses (BDD) may be important in treating patients with opioid use disorder (OUD) to improve retention and prevent overdose, particularly in the context of increased illicit fentanyl use. This study sought to: (1) identify trajectories for average BDD among patients initiating buprenorphine treatment for OUD and (2) assess patient characteristics associated with these identified trajectories. Buprenorphine treatment episodes among patients in the US Veterans Healthcare Administration (VHA) from federal fiscal years 2006 to 2020 were identified. Group-based trajectory modeling (GBTM) was used to identify BDD trajectories based on weekly averages of BDD over the 180 days after buprenorphine episode initiation. A total of 79 303 buprenorphine treatment episodes among 44 583 patients were included in the analytic sample. GBTM identified 9 latent trajectories for BDD: (1) moderate dose, early discontinuation (10.1%), (2) moderate dose, delayed discontinuation (4.5%), (3) moderate dose, moderate-paced discontinuation (5.2%), (4) low-moderate dose, delayed discontinuation (7.0%), and (5) low-moderate dose, early discontinuation (21.1%), (6) low dose retention (9.6%), (7) low-moderate dose retention (16.7%), (8) moderate dose retention (18.6%), and (9) high dose retention (7.4%). Patient BDD can broadly be characterized as low [2-4 mg/day], low-moderate (6-8 mg/day), moderate (12-18 mg/day), and high dose (≥ 24 mg/day). Patients with episodes in the high BDD trajectory have the lowest social risk (eg, lowest rate of past-year history of homelessness) and the lowest diagnosed rate of physical and mental health-related comorbidities compared to those following other trajectories. BDD ranges widely and patient characteristics are significantly different between those episodes following differing BDD trajectories. Future research on the association between BDD and subsequent patient outcomes (eg, overdose) needs to carefully consider these differences in baseline characteristics.

Impact of Complementary Health Approaches on Opioid Prescriptions Among Veterans with Musculoskeletal Disorders—A Retrospective Cohort Study

To examine whether complementary and integrative health approaches mitigate opioid prescriptions for pain and whether the relationship differs by post-dramatic stress disorder (PTSD) diagnosis, we followed 1,993,455 Veterans with musculoskeletal disorders during 2005-2017 using Veterans Healthcare Administration electronic health records. Complementary and integrative health (CIH) approaches were defined as ≥1 primary care visits for meditation, Yoga, and acupuncture etc using natural language processing. Opioid prescriptions were ascertained from pharmacy dispensing records. A propensity score was estimated and used to match one control Veteran to each CIH recipient. Over the 2-year follow-up period after the index diagnosis, 140,902 (7.1%) Veterans received ≥ 1 modalities. Among the matched analytic sample (272,296 Veterans), the likelihood of dispensing opioid prescriptions was significantly lower for Veterans in the CIH group than their controls [adjusted hazard ratio (aHR), 0.45 (95% Confidence Intervals (CI): 0.44-0.46)]. The association did not differ between Veterans with [aHR: 0.46 (95% CI: 0.45-0.47)] and without [aHR: 0.44 (95% CI: 0.43-0.45)] PTSD. In sensitivity analyses, the exposure group had 3.82 (95% CI: 3.76-3.87) months longer restricted mean survival time to opioid initiation, 2% (95% CI: 4%-1%) lower morphine equivalent and 17% lower total days’ supply (95% CI: 18%-16%). The relationship remains significant but was attenuated after eliminating waiting time for the exposure group (aHR, 0.63 (95% CI: 0.62-0.64)). These observations suggest that CIH approaches may help reduce opioid prescriptions for Veterans with musculoskeletal disorders and related pain. The impact of the timing of receiving such approaches warrants further investigation. PerspectiveThis article presents a quasi-experimental investigation into potential benefit of complementary and integrative health approaches (CIH) on de-prescribing opioids. The findings may potentially help clinicians who are seeking non-pharmacological alternative options to manage patient pain and opioid dependence”.

The Role of Healthcare Administration and Policy in Improving Access to Dialysis for ESRD Patients in CKD: Challenges and Solutions

End-Stage Renal Disease (ESRD) presents a critical challenge within the spectrum of Chronic Kidney Disease (CKD) and represents the final stage of CKD, necessitating timely and consistent access to dialysis for patient survival. However, access to dialysis remains significantly constrained in many regions due to a combination of systemic, financial, and infrastructural barriers. This article explores the pivotal role that healthcare administration and policy play in overcoming these challenges to enhance dialysis accessibility for ESRD patients. Multifaceted barriers are there regarding access to dialysis, including the economic burden of treatment, limited availability of dialysis centers, and disparities in healthcare delivery. The analysis then shifts to the policy landscape, discussing existing healthcare policies aimed at expanding dialysis services, as well as gaps that persist in current frameworks. The role of healthcare administration is also scrutinized, particularly in terms of resource allocation, service delivery optimization, and patient education. Through case studies and comparative analysis, it was identified that successful strategies from various regions that have effectively improved access to dialysis. These include public-private partnerships, subsidies, and advancements in telemedicine. The article concludes by offering policy recommendations and administrative strategies tailored to address the unique challenges faced by ESRD patients, emphasizing the need for a collaborative, patient-centered approach in healthcare planning and implementation. By highlighting these key areas, this article aims to provide actionable insights for policymakers, healthcare administrators, and other stakeholders committed to improving dialysis access and, ultimately, patient outcomes for those suffering from ESRD.

Experiences and perceptions of patients with cancer receiving home-based chemotherapy: a qualitative systematic review protocol

BackgroundHome-based chemotherapy (HBC) has emerged as a standard option for treating various types of cancer, primarily to decrease the waiting time for treatment. As HBC gains more recognition, ongoing research is delving into the experiences of patients with cancer who receive chemotherapy in a home setting or chemotherapy closer to home. Understanding these experiences is vital for the use of chemotherapy delivery outside the traditional hospital environments. This review aims to synthesize and critically appraise qualitative studies that investigate the experience and perspectives of patients with cancer who received parenteral chemotherapy administration in home settings. Findings will be used to develop evidence-based policies to support home-based care models.MethodsThis review will follow JBI methods for systematic reviews of qualitative evidence. The databases for searching will include MEDLINE (PubMed), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), ProQuest Health and Medical Collection, two Chinese databases, CNKI and Wanfang, and one Thai database, ThaiJO. Studies published in English, Chinese, and Thai will be considered for inclusion. Two reviewers will independently undertake study selection, data extraction, and critical appraisal of the methodological quality of studies. The synthesized findings will be assessed using the ConQual approach.DiscussionThe synthesis of qualitative studies on this topic will provide insights into the nuanced and varied experiences of patients receiving chemotherapy within the comfort of their homes. The review will also provide evidence-based recommendations to policymakers and healthcare administrators, to support the implementation of HBC for patients.Systematic review registrationSystematic review registration: PROSPERO CRD42024500476.

The role of family doctors in developing primary care systems in Asia: a systematic review of qualitative research conducted in middle-income countries 2010-2020.

The Asia Pacific Region's middle-income countries (MICs) face unique challenges in the ongoing development of primary care (PC) systems. This development is complicated by systemic factors, including rapid policy changes and the introduction of private healthcare services, as well as the mounting challenges associated with ageing populations and increasing rates of chronic diseases. Despite the widespread acknowledgement of the importance of family doctors in the development of PC services, relatively little is known about how these roles have developed in Asian MICs. To address this gap, this systematic review presents a synthesis of recent research focused on the role of family doctors within the PC systems of MICs in the Asia Pacific Region. We searched six electronic databases (CINAHL Complete, Embase, PsycINFO, PubMed, Web of Science, and Index Medicus for the South-East Asia Region and Western Pacific) for peer-reviewed qualitative literature published between January 2010 and December 2020. The quality of the studies was evaluated using the Critical Appraisal Skills Programme tool. Eighteen articles were included in the analysis. Findings from these articles were extracted and synthesised using qualitative thematic synthesis. We used the Rainbow Framework to analyse the interconnections within health systems at the macro, meso and micro levels. Our analysis of the included articles showed that family doctors play a crucial role in bridging the gap between hospitals and communities. They are essential in adopting holistic approaches to health and wellbeing and are in a unique position to try and address social, psychological, and biological aspects of health. Our findings also highlight the influence of policy changes at the macro level on the role and responsibilities of family doctors at the meso (organisational) and micro (interpersonal) levels. Limited research has explored the role of family doctors in the ongoing development of primary care systems in MICs in the Asia Pacific Region. The findings of this review have significant implications for policymakers and healthcare administrators involved in ongoing improvements to and strengthening of PC systems. Areas of particular concern relate to policy linked with training and workforce development, insurance systems and public awareness of what primary care services are.

The impact of moral resilience on nurse turnover intentions: the mediating role of job burnout in a cross-sectional study

BackgroundHigh nursing staff turnover is a critical issue that negatively impacts the quality of care and patient safety. Turnover intentions, a key predictor of actual turnover, reflect an individual’s likelihood of leaving their current position. Understanding the underlying mechanisms driving nurse turnover intentions is crucial for developing targeted interventions to stabilize the nursing workforce globally.ObjectivesThis study aims to explore the relationship between moral resilience, job burnout, and turnover intentions among nurses, focusing on the mediating role of job burnout in this relationship.DesignThis study employed a quantitative, cross-sectional design.MethodsA convenience sample of 322 registered nurses was recruited from two tertiary hospitals in China between August and October 2023. Data were collected using the Chinese version of the Rushton Moral Resilience Scale (Chi-RMRS), the Maslach Burnout Inventory (MBI), and the Turnover Intention Scale. Data analyses were conducted using SPSS 26.0 and Amos 21.0. The study followed the STROBE guidelines for observational research.Ethical considerationBefore the commencement of data collection, the Institutional Review Board of Hunan Traditional Chinese Medical College (YXLL202401004) granted ethical approval.ResultsThe proposed model exhibited an excellent fit to the data, with fit indices as follows: χ2/df = 1.819, CFI = 0.977, TLI = 0.961, RMSEA = 0.072 (90% confidence interval [CI]: 0.033 to 0.107). The structural equation model revealed that moral resilience was inversely associated with job burnout and turnover intentions. Furthermore, job burnout fully mediated the relationship between moral resilience and turnover intentions (β = −0.473, p = 0.007). Further analysis indicated that the depersonalization component of job burnout was the sole mediator in the relationship between moral resilience and turnover intention (β = -3.934, 95% CI [-5.837, -1.932]).ConclusionThe findings indicate that moral resilience among nurses is negatively associated with turnover intentions, with this effect fully mediated by the depersonalization dimension of job burnout. Enhancing moral resilience in nurses may be valuable strategy for healthcare administrators to mitigate job burnout and subsequently reduce turnover intentions.

Nursing perception towards the impact of JCI accreditation on the quality of care in a university hospital in Palestine: a cross-sectional study

BackgroundThis study investigates nursing staff perceptions regarding the impact of Joint Commission International (JCI) accreditation on the quality of care within a university hospital in Palestine. The research specifically examines how the accreditation process influences nursing practices, patient results, and overall healthcare quality in a challenging environment marked by unique operational and external pressures.MethodsThe study was conducted at An-Najah National University Hospital (NNUH), a university hospital in Palestine, using a cross-sectional survey design. The structured questionnaire employed in the study was based on the Donabedian model, which evaluates the process and outcome dimensions of healthcare quality influenced by JCI accreditation. The questionnaire consisted of 47 items, divided into ten main subsections. These subsections included participants’ demographical information (6 items), quality measurement and analysis (4 items), leadership, commitment and support (4 items), use of data (4 items), strategic quality planning (4 items), human resources education and training (4 items), quality management (4 items), quality results (4 items), staff involvement (5 items), and benefits of accreditation (8 items). The questionnaire was rigorously designed to assess both the quality processes and quality results. The eight subscales evaluated various aspects, such as leadership commitment, strategic planning, and staff involvement. To ensure reliability, the internal consistency of the survey was confirmed with a high Cronbach’s alpha score, demonstrating the tool’s robustness and reliability in capturing the intended data.ResultsThe study of 180 nurses overwhelmingly supported the positive impact of JCI accreditation on hospital quality improvement processes. More than 90% of respondents acknowledged the role of accreditation in improving resource utilization, meeting population needs, and promoting professional standards and values ​​among staff. Statistical analyses, including Pearson correlation and stepwise regression, highlighted strong positive associations between quality process variables and quality results. In particular, leadership commitment, strategic planning, and staff engagement were found to be significant predictors of improved quality results.ConclusionsThis study’s findings demonstrate that JCI accreditation significantly positively impacts nurses’ perceptions of care quality at NNUH. The study underscores the importance of international accreditation in driving quality improvements in healthcare, particularly in settings with unique challenges such as those faced in Palestine. These insights are crucial for policymakers and healthcare administrators aiming to enhance care standards through accreditation in similar environments.

Comparative Clinical Characteristics of Frail Older Adults in the Emergency Department: Long-Term Care Hospital versus Community Residence.

Older patients from long-term care hospitals (LTCHs) presenting to emergency departments (EDs) exhibit a higher prevalence of frailty than those from the community. However, no study has examined frailty in patients from LTCHs in the ED. This study compared frailty in older patients from LTCHs and the community. We retrospectively analyzed data from the EDs of three university hospitals between 1 August and 31 October 2023, involving 5908 patients (515 from LTCHs and 5393 from the community). The Korean version of the Clinical Frailty Scale (CFS-K) was used to assess individuals aged 65 and older. We compared clinical characteristics, frailty, length of stay (LOS), and diagnosis between patients from LTCHs (LTCH group) and the community (community group). Among ED patients, 55.0% and 35.2% in the LTCH and the community groups, respectively, were frail (p < 0.001). Of these, 71.7% in the LTCH group were hospitalized compared with 53.1% in the community group (p = 0.001). The odds ratio for in-hospital mortality was 4.910 (95% CI 1.458-16.534, p = 0.010) for frail LTCH patients and 3.748 (95% CI 2.599-5.405, p < 0.001) for frail community patients, compared to non-frail patients. Patients from LTCHs with frailty had higher hospital admission rates and increased in-hospital mortality compared to those in the community at the same frailty level. This study offers essential insights into the characteristics of older patients in LTCHs for healthcare administrators and medical staff worldwide.

Efforts to Introduce an Indigenous Identifier in a Canadian Provincial Health Authority

Across Canada, Indigenous identity data is not routinely collected in healthcare settings. This paper focuses on [province] and whether the largest and only province-wide healthcare services organization in Canada, [healthcare organization name] should implement an Indigenous identifier in their new electronic medical record system. Due to the current absence of an Indigenous identifier, it is difficult to identify Indigenous peoples in administrative healthcare data to guide healthcare decision-making specifically for Indigenous peoples and to assist with population-specific disease surveillance and prevention programs. Moreover, it is often challenging for Indigenous nations, communities, and organizations to access this data. The data that does exist in [province] frequently excludes large segments of the Indigenous population. Indigenous researchers globally have called for improved health data in alignment with Indigenous research principles, data governance and sovereignty. This paper reports on an exploratory study of potential avenues to enhance availability of Indigenous specific health data in [province]. Of interest are possible supports, concerns, and potential barriers for the introduction of a policy to collect self-disclosed Indigenous identity data in the [org] new electronic medical record system. This research included interviews and focus group sessions with diverse subject matter experts including academics, Indigenous health practitioners and healthcare administrators. The project was embedded in the [removed] which is an [province] based research network for improving primary health with and for Indigenous peoples

Strengthen the doctor-patient relationship and avoid administrative stifling.

The acquisition of private medical practices by large health-care corporations is transforming clinical practice in many Western countries. The growing influence of health administration on medical practice is increasingly perceived as a danger by the public and health professionals. Health-care administrators should not replace doctors or invade their competencies. Back to principles, the patient-doctor relationship must be funded in trust. Representing society, governments must try to ensure health care to all citizens, serving one of the fundamental human rights. Using the principle of subsidiarity, administrators should fill gaps in the provision of health care to all patients by doctors.

Negotiating Meaning with Machines: AI's Role in Doctoral Writing Pedagogy

AbstractThis paper examines the integration of generative artificial intelligence (AI) in doctoral writing pedagogy. It explores how AI augments traditional teaching and composition processes, fosters a new paradigm of cognitive engagement and collaborative academic writing, and the broader ethical and social implications of human-AI writing in doctoral writing pedagogy. A community-engaged participatory research methodology was employed within a Doctor of Healthcare Administration program. Data were collected through discussion board messages, self-assessment papers, student reflections, and a focus group interview, and analyzed using thematic analysis. The research unearthed a hybrid human-AI writing process characterized by dynamic brainstorming, continuous negotiation of meaning, and comparative evaluation. These practices enhanced students' cognitive and metacognitive engagement, confidence, and learner agency, signifying a shift toward a collaborative approach to academic writing. The findings highlight the need for academic institutions to adapt policies and curricula to incorporate AI technologies ethically and responsibly. Emphasis on AI literacy and academic integrity is crucial for preparing graduates for an AI-integrated workforce. This study contributes to the understanding of AI's role in doctoral education, specifically doctoral writing development, presenting a novel perspective on the synergistic collaboration between students and AI in academic writing and its implications for institutional policies and writing pedagogy.

Factors Associated With Turnover Intention Among Healthcare Providers in Saudi Arabia: A Comprehensive Review.

Turnover has a negative impact and can harm businesses, specifically the organizational structure and service delivery. The purpose of this review is to provide policymakers, healthcare administrators, and stakeholders in Saudi Arabia with approaches and strategies for reducing turnover and improving provider retention by synthesizing existing literature and identifying the key variables influencing turnover intention. This study conducted a comprehensive literature review to explore numerous variables associated with medical professional turnover intentions in Saudi Arabia from 2016 to 2024. The librarian assisted with the creation of the query string. The literature search was carried out using PubMed, Web of Science, and Google Scholar. By utilizing the key terms turnover AND healthcare providers ANDhealthcare facilities AND Saudi*. The authors separately examined and evaluated the risk of bias in each study using Joanna Briggs Institute (JBI) tools. The findings of this review show that all studies were executed using a cross-sectional design, and five studies were published in 2022. According to this review, ten studies were carried out in hospital settings. Ten studies examined elements associated with work. Moreover, five studies were associated with external variables, followed by five studies linked to personal factors. The most common factors for turnoverwere satisfaction, stress, and work. Turnover-related factors can have an impact on the long-term sustainability of the healthcare system. This review provides crucial information on the factors related toturnover, using the growing body of research in the Saudi context.

A Cross-Sectional Study Exploring the Impact of Violence on Healthcare Employees' Work Engagement and Meaningful Work.

This study aims to determine the prevalence of workplace violence against healthcare professionals and its effects on work engagement and meaningful work in healthcare settings. This study is designed as an analytical cross-sectional study. This study surveyed 676 healthcare professionals in Turkiye between June and December 2022, using face-to-face and online methods. Scales measured exposure to and witnessing violence, work engagement, and meaningful work. The study has adhered to STROBE guidelines. Statistical analyses included descriptive, correlation, and linear regression. According to the results, shouting and cursing by patients and their companions were determined as the most common type of violence encountered by healthcare professionals. The effect of healthcare professionals' exposure to violence from patients' companion on work engagement and witnessing to violence from colleagues on meaningful work were found to be negative and significant. The findings emphasise the urgent need for interventions addressing workplace violence against healthcare professionals. Since workplace violence significantly reduces work engagement and the sense of meaningful work in healthcare setting. By highlighting the prevalence of workplace violence and its negative impact on both work engagement and meaningful work in healthcare setting, this study provides critical evidence for policymakers and healthcare administrators. The participants in this study were healthcare professionals who had direct contact with patients and their relatives.

Perceived structural empowerment, resilience, and intent to stay among midwives and registered nurses in Saudi Arabia: a convergent parallel mixed methods study

BackgroundRetaining midwives and registered nurses in the Obstetrics and Gynecology department/unit (OB/GYN) is not just a matter of organizational effectiveness and financial wellness. It’s a crucial aspect of ensuring quality healthcare delivery. This study aimed to discuss the degree to which midwives and nurses in OB/GYN departments are structurally empowered, resilient, and committed to remaining at the organizations and to examine whether nurses’ and midwives’sense of structural empowerment and resilience is a good predictor of their decision to stay with the organization.MethodsThis study employed a unique convergent parallel mixed methods approach. The research was conducted in two distinct phases. The first phase involved a cross-sectional quantitative survey with a convenience sample of 200 midwives and nurses in OB/GYN departments. The second phase was a qualitative study utilizing semi-structured, open-ended interviews. Eighteen nurses and midwives, specifically chosen as the target population, were invited to participate in individual interviews. The data collection took place at three major hospitals in Saudi Arabia, starting in January 2023 and concluding in February 2023.ResultsThe study results revealed that structural empowerment and resilience were statistically significant predictors of the intent to stay in the organization (F = 35.216, p < 0.001), with 26.3% variation, the structural empowerment is higher predictor (β = 0.486, p < 0.000) to intent to stay if compared to resilience (β = 0.215, p < 0.008). Five major themes emerged from the narratives of the nurses and midwives: the nurturing of the physical and physiological, the development of the psychological, the managing finances, the restructuring of the organization, and the enrichment of the professional and occupational.ConclusionThe study’s findings have significant implications for healthcare organizations. They highlight the importance of cultivating a culture of empowerment and resilience, which can serve as a powerful tool to encourage registered nurses and midwives to remain in their organizations. This insight empowers healthcare administrators, human resource managers, and obstetrics and gynecology professionals to take proactive steps toward improving retention rates.

Exploring gaps, opportunities, barriers and enablers in malnutrition policy through key informant interviews: a qualitative inquiry from the CANDReaM initiative

ObjectivesDisease-related malnutrition (DRM) presents in up to half of adults and one-third of children admitted to Canadian hospitals and significantly impacts health outcomes. Strategies to screen, diagnose and treat DRM...

CABG Case Volume and Patient Outcomes at the Veterans Healthcare Administration: On-Pump versus Off-Pump

Objective: To evaluate use trends and perioperative outcomes of on- and off-pump coronary artery bypass graft (CABG) in US Veterans. Methods: We retrospectively reviewed 44,960 Veteran Health Administration (VHA) patients who underwent isolated CABG between 2008–2021. Multivariable logistic regression was used to analyze associations between surgical technique and outcomes. Adjusted hazard ratios (aHR) are reported. p &lt; 0.05 using two sided tests was considered significant. Results: 6169/44,960 (13.7%) patients underwent isolated off-pump CABG and 38,791/44,960 (86.3%) patients underwent on-pump CABG. Between 2008 and 2021, the proportion of off-pump procedures decreased: 18.8% between 2008–2012, 11.6% between 2013–2017, and 8.6% between 2018–2021 (χ2 = 712.78, df = 2, p &lt; 0.001). Groups were found to be well balanced with respect to age, history of chronic obstructive pulmonary disease (COPD), history of diabetes, history of prior cardiac surgery, as well as left ventricular ejection fraction and history of smoking, and thus an analysis was conducted using the entire cohort. After covariate adjustment, group status was found to not be a predictor of death (aHR = 0.92, 95% confidence interval (95% CI) = 0.66–1.28, p = 0.62), stroke (aHR = 1.33, 95% CI = 0.83–2.12, p = 0.23), myocardial infarction (MI) (aHR = 0.86, 95% CI = 0.51–1.46, p = 0.58). However, given the large imbalance between group size, the groups were then propensity matched on age, history of chronic obstructive pulmonary disease (COPD), diabetes hypertension, smoking, prior cardiac surgery, and left ventricular ejection fraction, resulting in a smaller cohort of 12,130 patients: 5961 (49.1%) on pump and 6169 (50.9%) off pump. After covariate adjustment, the on-pump group in the matched cohort had increased risk of the following within 30 days: death (aHR = 2.60, 95% CI = 1.50–4.51, p &lt; 0.001), stroke (aHR = 1.61, 95% CI = 1.09–2.38, p = 0.016), acute renal failure (aHR = 2.31, 95% CI = 1.46–3.66, p &lt; 0.001), atrial fibrillation (aHR = 1.39, 95% CI = 1.23–1.57, p &lt; 0.001), intraoperative death (aHR = 1.67, 95% CI = 1.07–2.59, p = 0.023), and prolonged intubation (aHR = 1.53, 95% CI = 1.27–1.85, p &lt; 0.001). They also experienced increased length of stay (Beta = 0.05, p &lt; 0.001). Group did not predict risk of reintubation, perioperative myocardial infarction, or postoperative cardiac arrest requiring cardiopulmonary resuscitation (CPR). Conclusions: In a propensity matched cohort of veterans undergoing isolated CABG, off-pump technique was associated with decreased risk of multiple perioperative outcomes measures. However, the proportion of off-pump procedures within the VHA decreased between 2008–2021. This may be secondary to more selective use as overall volume has decreased, though additional study is needed to evaluate these trends.