Experiences Of Healthcare Professionals Research Articles

Experiences of antenatal care practices to reduce stillbirth: surveys of women and healthcare professionals pre-post implementation of the Safer Baby Bundle

BackgroundThe Safer Baby Bundle (SBB) aimed to reduce stillbirth rates in Australia through improving pregnancy care across five elements; smoking cessation, fetal growth restriction (FGR), decreased fetal movements (DFM), side sleeping in late pregnancy and decision making around timing of birth. We assessed experiences of women and healthcare professionals (HCPs) with antenatal care practices around the five elements.MethodsA pre-post study design using online surveys was employed to assess change in HCPs awareness, knowledge, and frequency of performing recommended practices (22 in total) and women’s experiences of care received related to reducing their chance of stillbirth. Women who had received antenatal care and HCPs (midwives and doctors) at services participating in the SBB implementation program in two Australian states were invited to participate. Surveys were distributed over January to July 2020 (pre) and August to December 2022 (post). Comparison of pre-post responses was undertaken using Fisher’s exact, Pearson’s chi-squared or Wilcoxon rank-sum tests.Results1,225 women (pre-1096/post-129) and 1,415 HCPs (pre-1148/post-267, ≥ 83% midwives) completed the surveys. The frequency of HCPs performing best practice ‘all the time’ significantly improved post-SBB implementation across all elements including providing advice to women on side sleeping (20.4–79.4%, p < 0.001) and benefits of smoking cessation (54.5–74.5%, p < 0.001), provision of DFM brochure (43.2–85.1%, p < 0.001), risk assessments for FGR (59.2–84.1%, p < 0.001) and stillbirth (44.5–73.2%, p < 0.001). Practices around smoking cessation in general showed less improvement e.g. using the ‘Ask, Advise and Help’ brief advice model at each visit (15.6–20.3%, p = 0.088). Post-implementation more women recalled conversations about stillbirth and risk reduction (32.2–50.4%, p < 0.001) and most HCPs reported including these conversations in their routine care (35.1–83.0%, p < 0.001). Most HCPs agreed that the SBB had become part of their routine practice (85.0%).ConclusionsImplementation of the SBB was associated with improvements in practice across all targeted elements of care in stillbirth prevention including conversations with women around stillbirth risk reduction. Further consideration is needed around strategies to increase uptake of practices that were more resistant to change such as smoking cessation support.Trial registrationThe Safer Baby Bundle Study was retrospectively registered on the Australian New Zealand Clinical Trials Registry database, ACTRN12619001777189, date assigned 16/12/2019.

Microaggression Interactions Among Healthcare Professionals, Trainees and Students in the Clinical Environment: A Mixed-Studies Review.

This review aims to comprehensively consolidate and synthesize the existing body of empirical research on the perceptions and experiences of healthcare professionals, trainees, and students concerning microaggression interactions within diverse clinical settings. The review protocol was registered with the international prospective register of systematic reviews (PROSPERO CRD42024546443). We employed the Joanna Briggs Institute's mixed-methods systematic review approach. Comprehensive electronic database searches were conducted across eight databases (Medline, Embase, CINAHL, PsycINFO, Scopus, Web of Science, Social Science Database, and ProQuest Dissertation and Theses) from their respective inception dates up to October 1, 2023. The selection criteria included studies reporting instances of interprofessional or intra-professional microaggressions occurring in clinical environments among healthcare professionals, trainees, and students identifying as heterosexual and without disabilities. In total, 37 studies met the eligibility criteria and were included in our review. Our analysis revealed three primary themes: Racial Microaggressions in the Clinical Environment, Gender Microaggressions in the Clinical Environment, and Religious Microaggressions in the Clinical Environment. Research must delve deeply into these experiences to better understand their long-term consequences, while policy initiatives should be designed to establish equitable, inclusive, and respectful healthcare environments. Collaborative endeavors bridging research and policy are paramount to dismantling barriers and nurturing an inclusive healthcare landscape.

Experience of healthcare professionals at the Makiso General Reference Hospital on nursing-related accidents

Introduction: In our hospitals, nursing-related accidents are frequent. It is not uncommon for minor incidents and near misses to occur before a serious accident occurs. The main aims of this study are to explore the experience of healthcare professionals of nursing-related accidents; to determine what to do about nursing-related accidents; and to analyze the attitudes of healthcare professionals to nursing-related accidents. Methods: We conducted a qualitative, phenomenological study based on free, face-to-face interviews. It involved 3 care providers working at the Makiso General Referral Hospital from March 2 to 31, 2024. Results: In terms of experience, respondents identified risk factors, managing emotions during the accident and the consequences of a nursing-related accident. In terms of what to do in the event of a care-related accident, the subjects identified teamwork to prevent care-related accidents, taking precautions before administering care and ensuring patient safety. Finally, with regard to the attitude of nursing staff to accidents attributable to care, respondents expressed their views on reassuring patients that their health would be restored in the event of an accident attributable to nursing care, identifying problems linked to the accident and ways of preventing accidents attributable to care. Conclusion: To prevent nursing-related accidents, it is necessary to put into practice preventive measures that should be taken to reduce the frequency and severity of accidents attributable to nursing care. Nurses should regularly undergo medical training to prevent nursing-related accidents

Measuring Documentation Burden in Healthcare.

The enactment of the Health Information Technology for Economic and Clinical Health Act and the wide adoption of electronic health record (EHR) systems have ushered in increasing documentation burden, frequently cited as a key factor affecting the work experience of healthcare professionals and a contributor to burnout. This systematic review aims to identify and characterize measures of documentation burden. We integrated discussions with Key Informants and a comprehensive search of the literature, including MEDLINE, Embase, Scopus, and gray literature published between 2010 and 2023. Data were narratively and thematically synthesized. We identified 135 articles about measuring documentation burden. We classified measures into 11 categories: overall time spent in EHR, activities related to clinical documentation, inbox management, time spent in clinical review, time spent in orders, work outside work/after hours, administrative tasks (billing and insurance related), fragmentation of workflow, measures of efficiency, EHR activity rate, and usability. The most common source of data for most measures was EHR usage logs. Direct tracking such as through time-motion analysis was fairly uncommon. Measures were developed and applied across various settings and populations, with physicians and nurses in the USA being the most frequently represented healthcare professionals. Evidence of validity of these measures was limited and incomplete. Data on the appropriateness of measures in terms of scalability, feasibility, or equity across various contexts were limited. The physician perspective was the most robustly captured and prominently focused on increased stress and burnout. Numerous measures for documentation burden are available and have been tested in a variety of settings and contexts. However, most are one-dimensional, do not capture various domains of this construct, and lack robust validity evidence. This report serves as a call to action highlighting an urgent need for measure development that represents diverse clinical contexts and support future interventions.

Peripherally administered vasopressors in critically ill adult patients: A survey of UK healthcare professional practices, attitudes and experiences

Peripherally administered vasopressors in critically ill adult patients: A survey of UK healthcare professional practices, attitudes and experiences

Healthcare professionals' perceptions of digital care in clinical practice for patients with non-cardiac chest pain

Abstract Background Healthcare professionals’ attitudes and perceptions of digital care are crucial for successful introduction of a new digital form of treatment in the workplace. Purpose This study aimed to describe healthcare professionals’ perceptions of digital care in clinical practice for patients with non-cardiac chest pain. Methods A qualitative descriptive study design with individual semi-structured interviews, analyzed using inductive thematic analysis based on Braun and Clarke (2006). Study data were collected by individual digital (15) and face-to-face (2) interviews with licensed healthcare professionals (doctors and nurses) working in emergency care or cardiology. Results The results illustrate healthcare professionals’ perceptions of digital care within clinical settings in emergency and cardiology care for patients with non-cardiac chest pain. Four themes and eleven subthemes were identified. The first theme "New ground to walk on" describes healthcare professionals' experiences of digital care. The second theme: "A challenge to current healthcare system" depicts how digital care was seen as a challenge for the current healthcare system. The third theme: "Digital care has its potential" shows that a majority believed healthcare can gain valuable insights from embracing digital care. The last theme: "Prerequisites for use in clinical practice" describes factors that can facilitate the adoption of digital care in clinical practice. Conclusions The findings delineate the diverse knowledge and experiences of healthcare professionals in digital care. The perception of digital care ranged from skepticism to trust, illustrating challenges in implementing digital solutions in clinical care. Healthcare professionals expressed concerns about potential errors, the reliability of digital solutions, and concerns regarding resistance to change among colleagues. Nevertheless, they also recognized benefits and identified several factors that can facilitate the implementation of digital care into clinical practice and expressed cautious trust in digital care.

The Paradoxes of Digital Tools in Hospitals: Qualitative Interview Study.

Digital tools are progressively reshaping the daily work of health care professionals (HCPs) in hospitals. While this transformation holds substantial promise, it leads to frustrating experiences, raising concerns about negative impacts on clinicians' well-being. The goal of this study was to comprehensively explore the lived experiences of HCPs navigating digital tools throughout their daily routines. Qualitative in-depth interviews with 52 HCPs representing 24 medical specialties across 14 hospitals in Switzerland were performed. Inductive thematic analysis revealed 4 main themes: digital tool use, workflow and processes, HCPs' experience of care delivery, and digital transformation and management of change. Within these themes, 6 intriguing paradoxes emerged, and we hypothesized that these paradoxes might partly explain the persistence of the challenges facing hospital digitalization: the promise of efficiency and the reality of inefficiency, the shift from face to face to interface, juggling frustration and dedication, the illusion of information access and trust, the complexity and intersection of workflows and care paths, and the opportunities and challenges of shadow IT. Our study highlights the central importance of acknowledging and considering the experiences of HCPs to support the transformation of health care technology and to avoid or mitigate any potential negative experiences that might arise from digitalization. The viewpoints of HCPs add relevant insights into long-standing informatics problems in health care and may suggest new strategies to follow when tackling future challenges.

Research on Artificial-Intelligence-Assisted Medicine: A Survey on Medical Artificial Intelligence.

With the improvement of economic conditions and the increase in living standards, people's attention in regard to health is also continuously increasing. They are beginning to place their hopes on machines, expecting artificial intelligence (AI) to provide a more humanized medical environment and personalized services, thus greatly expanding the supply and bridging the gap between resource supply and demand. With the development of IoT technology, the arrival of the 5G and 6G communication era, and the enhancement of computing capabilities in particular, the development and application of AI-assisted healthcare have been further promoted. Currently, research on and the application of artificial intelligence in the field of medical assistance are continuously deepening and expanding. AI holds immense economic value and has many potential applications in regard to medical institutions, patients, and healthcare professionals. It has the ability to enhance medical efficiency, reduce healthcare costs, improve the quality of healthcare services, and provide a more intelligent and humanized service experience for healthcare professionals and patients. This study elaborates on AI development history and development timelines in the medical field, types of AI technologies in healthcare informatics, the application of AI in the medical field, and opportunities and challenges of AI in the field of medicine. The combination of healthcare and artificial intelligence has a profound impact on human life, improving human health levels and quality of life and changing human lifestyles.

Healthcare professionals as change agents: Factors influencing bottom-up, personal initiatives on appropriate care, a qualitative study in the Netherlands

IntroductionHealthcare organisations face multiple challenges, often conceptualised as appropriate care. It requires change on different levels: healthcare systems (macro), healthcare organisations (meso), and healthcare professionals (micro). This study focuses on bottom-up changes initiated by healthcare professionals. The aim is to investigate hindering and stimulating factors healthcare professionals experience. Materials and methodsThe study used a qualitative design with purposive sampling of eight Dutch healthcare professionals who initiated changes. We conducted online interviews and used Atlas TI with a combination of open, axial, and selective coding for data analysis. ResultsThe results indicate that professionals are often mission-driven when they initiate change, support from clients and peers may help them overcome barriers. Conversely, peers who feel threatened in their autonomy hinder initiatives of professionals, especially when their changes have financial consequences for their organization. ConclusionAligning and integrating macro- and micro-level initiatives is crucial to advancing the movement towards appropriate care and stimulating bottom-up initiatives of healthcare professionals. More research remained needed, in particular studies on the hindering or stimulating role of employers and healthcare professionals' representatives, and the adoption of the concept of appropriate care by patients.

Healthcare experiences of pregnant and postnatal women and healthcare professionals when facing child protection in the perinatal period: A systematic review and Critical Interpretative Synthesis.

The perinatal period is known as time of transition and anticipation. For women with social risk factors, child protection services may become involved during the perinatal period and this might complicate their interactions with healthcare providers. To systematically review and synthesise the existing qualitative evidence of healthcare experiences of women and healthcare professionals during the perinatal period while facing child protection involvement. A systematic search of databases (Web of Science, MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, MIDIRS, Social Policy and Practice and Global Health) was carried out in January 2023, and updated in February 2024. Quality of studies was assessed using the Critical Appraisal Skills Programme. A Critical Interpretative Synthesis was used alongside the PRISMA reporting guideline. A total of 41 studies were included in this qualitative evidence synthesis. We identified three types of healthcare interactions: Relational care, Surveillance and Avoidance. Healthcare interactions can fluctuate between these types, and elements of different types can coexist simultaneously, indicating the complexity and reciprocal nature of healthcare interactions during the perinatal period when child protection processes are at play. Our findings provide a novel interpretation of the reciprocal interactions in healthcare encounters when child protection agencies are involved. Trust and transparency are key to facilitate relational care. Secure and appropriate information-sharing between agencies and professionals is required to strengthen healthcare systems. Healthcare professionals should have access to relevant training and supervision in order to confidently yet sensitively safeguard women and babies, while upholding principles of trauma-informed care. In addition, systemic racism in child protection processes exacerbate healthcare inequalities and has to be urgently addressed. Providing a clear framework of mutual expectations between families and healthcare professionals can increase engagement, trust and accountability and advance equity.

O-317 Recurrent miscarriage and infertility : a qualitative study of views and experiences of services in the republic of Ireland

Abstract Study question How do women with recurrent miscarriage (RM) and infertility and healthcare professionals view and experience services and supports? Summary answer RM and infertility is a complex experience, intensified by divisions within the Irish healthcare system and a lack of knowledge and awareness around reproductive health What is known already While services for recurrent miscarriage (RM) are gradually improving with increasing awareness, women with RM and infertility have received limited attention in research and clinical guidance internationally. RM and infertility are separately associated with psychological distress and adverse pregnancy outcomes. Moreover, the dual experience is devastating for women and couples, and the optimal supports remain unidentified. Identifying the needs of this cohort is especially pertinent in the Republic of Ireland as public fertility care expands to include assisted reproductive technologies, previously only available through private or not-for-profit fertility clinics. Study design, size, duration We undertook a qualitative semi-structured interview study using a Reflexive Thematic Analysis approach. Thirty-three interviews were conducted, virtually on MIcrosoft Teams and in-person, between Dec 2022 and May 2023. These were audio-recorded, and data transcribed to NVivo12 for subsequent analysis. Participants/materials, setting, methods We recruited healthcare professionals delivering RM and/or fertility services, and women who experienced two or more consecutive miscarriages in the last four years and had undergone fertility care, through our professional networks and social media. Purposive sampling was used to include diverse perspectives across disciplines, public and private sectors, lived experiences and geographical locations. Interviews were audio-recorded, and data transcribed for subsequent reflexive thematic analysis. Main results and the role of chance We interviewed 16 healthcare professionals and 17 women with lived experience. Women were aged 35-47 and had experienced two to nine miscarriages. All received fertility care in ROI, with some additional care abroad. Healthcare professionals included four Clinical Midwifery Specialists in Bereavement eight Consultants and four Clinical Nurse Specialists in Fertility. We actively generated four themes during data analysis. (1) “Exploring all avenues”- women sought the best care and information, but their search was hindered by stigmatisation, definitions of RM and misinformation. (2) “Exhausting all resources” - women wanted to ensure they had tried everything to have a baby, investing all physical, emotional and financial reserves (3) “Separateness” - women feel remote from others who have not experienced RM or infertility and removed from both maternity and fertility services, as well as caught between public and private systems. (4) “No woman is an island” - supports come from multiple sources in their lives and in various guises but are limited, especially psychological supports. Limitations, reasons for caution This was a sample of white, educated, professional women with access to private fertility services. While a diverse group of HCPs were interviewed with current and past clinical experiences of private fertility services, there was limited engagement from fertility care providers. Wider implications of the findings This study identifies areas for improvement, such as access to investigations and supports, as well as the experiences and specific care and support needs of women/couples experiencing RM and infertility. Issues such as women’s awareness of their reproductive health, and equity in services, are applicable to all maternity service users. Trial registration number N/A

O-177 Emotional experiences of staff caring for parents suffering a pregnancy loss

Abstract Experiencing pregnancy loss can have devastating emotional impacts on expectant parents, leading them to experience depression, anxiety and post-traumatic stress. There is now a well-established literature into the experiences of expectant parents, with dozens of studies conducted since the 1990s. However, over this period there has been notably less research conducted into the experiences of the professionals who care for these women. Addressing this is crucial; healthcare professionals are the greatest asset that healthcare systems have. Providing better support for them is the best route to improving care for expectant parents. The studies which have been conducted suggest the emotional toll on professionals can be significant. Emotions described can reflect those of expectant parents, including sadness, grief, and anger. One study suggested that delivering this care can be like ‘working in darkness’; another found that delivering news of losses to expectant parents on a regular basis can cause an emotional ‘repetitive strain injury’ for some. This talk will tackle this topic, providing updates and insights from recent studies which have investigated the experiences of healthcare professionals who undertake the emotional work of caring for expectant parents who are experiencing loss. It will take an interactive approach, using audience feedback to understand and learn from the experiences shared by those in the room. The importance and value of professionals who work in this area will be highlighted; coping strategies and self-care activities will be considered.

Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals.

Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices. We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis. We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making. Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists.

Understanding how children and young people with chronic non-cancer pain and their families experience living with pain, pain management and services: a meta-ethnography.

Childhood chronic pain is a widespread public health issue. We need to understand how children with chronic pain and their families experience chronic pain and its management. To conduct a meta-ethnography on the experiences and perceptions of children with chronic pain and their families of chronic pain, treatments and services. We investigated how children and their families conceptualise and live with chronic pain; what they think of and want from health and social care services; and what they conceptualise as 'good' pain management. Meta-ethnography with stakeholder and patient and public involvement in the design, search and sampling strategies, analysis and dissemination. Review strategy: comprehensive searches of 12 bibliographic databases and supplementary searches in September 2022, to identify qualitative studies with children aged 3 months to 18 years with chronic non-cancer pain and their families. We included studies with rich explanatory data; appraised methodological limitations using the Critical Appraisal Skills Programme tool; and extracted, analysed and synthesised studies' findings. We used Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research to assess confidence in review findings. We integrated findings with 14 Cochrane treatment effectiveness reviews on children's chronic non-cancer pain. We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Studies had minor (n = 24) or moderate (n = 19) methodological limitations. Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research assessments of review findings were high (n = 22), moderate (n = 13) or very low confidence (n = 1). Moderate and severe chronic pain had profound adverse impacts on family members' well-being, autonomy and self-identity; family dynamics; parenting approaches; friendships and socialising; children's education and parental paid employment. Most children and families sought a biomedical cure for pain. They experienced difficulties seeking and receiving support from health services to manage pain and its impacts. Consequently, some families repeatedly visited health services. Cochrane reviews of intervention effects and trials did not measure some outcomes important to children and families, for example effects of pain on the family and resolution of pain. Reviews have mainly neglected a biopsychosocial approach when considering how interventions work. There were limited data on common pain conditions like migraine/headache, abdominal pain; some rarer conditions; children with learning disabilities and under-fives; siblings; fathers and experiences of treatments/services. We excluded studies on cancer, end-of-life pain and experiences of healthcare professionals. We developed the family-centred theory of children's chronic pain management, integrating health and social care with community support. Future research should explore families' experiences of services and treatments, including opioids, and social care services; experiences of children with autism and learning disabilities, under 5 years old and with certain common pain conditions. We need development and testing of family-centred interventions and services. This study is registered as PROSPERO (CRD42019161455) and Cochrane Pain, Palliative and Supportive Care (623). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128671) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 17. See the NIHR Funding and Awards website for further award information.

Liberation from Mechanical Ventilation in Critically Ill Patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines.

Successful liberation from mechanical ventilation is one of the most crucial processes in critical care because it is the first step by which a respiratory failure patient begins to transition out of the intensive care unit and return to their own life. Therefore, when devising appropriate strategies for removing mechanical ventilation, it is essential to consider not only the individual experiences of healthcare professionals, but also scientific and systematic approaches. Recently, numerous studies have investigated methods and tools for identifying when mechanically ventilated patients are ready to breathe on their own. The Korean Society of Critical Care Medicine therefore provides these recommendations to clinicians about liberation from the ventilator. Meta-analyses and comprehensive syntheses were used to thoroughly review, compile, and summarize the complete body of relevant evidence. All studies were meticulously assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method, and the outcomes were presented succinctly as evidence profiles. Those evidence syntheses were discussed by a multidisciplinary committee of experts in mechanical ventilation, who then developed and approved recommendations. Recommendations for nine population, intervention, comparator, outcome (PICO) questions about ventilator liberation are presented in this document. This guideline includes seven conditional recommendations, one expert consensus recommendation, and one conditional deferred recommendation. We developed these clinical guidelines for mechanical ventilation liberation to provide meaningful recommendations. These guidelines reflect the best treatment for patients seeking liberation from mechanical ventilation.

HELP PHARMACEUTICAL INDUSTRY TO BUILD MEANINGFUL PERSONALIZED HEALTHCARE PROFESSIONAL EXPERIENCE

Unlike the consumer industry, biopharma, medical technology, and wellness companies have struggled to build meaningful, personalized patient and healthcare professional (HCP) experiences. The increase in drug launches and growing competition across therapy areas has made it challenging for brands and organizations to stand out from the crowd, whether for new molecules vs. legacy brands in an established treatment area and their generic counter-parts or for new molecules in a rare disease where trust is not yet earned. The customers’ needs and preferences are changing at lightning speed. The hierarchy of engagement has transformed, disrupting the dynamic between patients and healthcare professionals. Studies (1, 2) show that drug marketers too often turn various aspects of their product profile into signals – and may inadvertently “reinforce the habitual behavior the marketer is trying to change”. We encourage pharmaceutical companies to use a “data-driven approach to uncover new opportunities for growth” and improvement, and we’re committed to delivering results that make a difference for the patient, HCPs and for the system (value-based healthcare approach). Applying the Brand Leadership Circle, a new strategic tool, will help understand the patients’ journey and other stakeholders’ needs to implement successful approaches in marketing, communications and services using systematic research methods and techniques.

Clinical learning experiences of healthcare professional students in a student-led clinical learning environment (SLCLE) – A mixed methods evaluation

AimTo evaluate healthcare professional (HCP) students clinical learning experiences’ whilst undertaking placements in a student-led clinical learning environment (SLCLE) and any changes in self-reported ratings of confidence. BackgroundThe English NHS Long Term Workforce Plan (2023) highlights the need to expand domestic education of HCPs to meet workforce shortages. The demand for quality clinical placements to support the preparation of HCP students remains a challenge globally. A creative solution has been the development of student-led learning clinical environments in healthcare settings. SLCLEs provide high-quality learning experience, increase clinical placement capacity whilst maintaining patient care standards. A multisite NHS Trust adopted this model as evidence suggests HCP students will be better prepared on qualification to adopt registered practitioner professional responsibilities. This model has been integrated across three hospital sites within a large teaching hospital, providing care for a diverse population and designed to accommodate students from a range of HCP disciplines and higher educational institutions. DesignA mixed methods convergent design. MethodsAn online survey was administered to SLCLE allocated nursing and allied health profession (AHP) undergraduate and graduate-entry first, second and third-year students (n=132). Face to face focus groups/individual interviews were undertaken with a purposive sample of student participants (n=80) to evaluate their experiences of clinical learning in SLCLEs. Survey data were analysed using descriptive statistics and paired t-tests, interviews using framework method. ResultsUndergraduate and graduate-entry students from four UK universities completed the survey (n=132), 103 students (78 %) responded. Most were year 2 students (n=43/42 %), pursuing nursing programmes (n=82/80 %). Most considered the SLCLE met their expectations (n=76/74 %), reported increased confidence post-placement (n=84/82 %), felt supported by staff (n=80/78 %), peers (n=93/90 %) and clinical educators (n=93/90 %). Self-reported confidence scores post-SLCLE were significantly higher than pre-SLCLE. On-line pre-placement information was infrequently accessed yet identified as an omission. Four themes were identified: (i) preconceptions and initial anxiety; (ii) empowerment, growth and a unique learning experience; (iii) collaborative inter-professional learning and support; and (iv) insights and anticipations. ConclusionsThe SLCLE allocation enhanced students’ confidence and knowledge. Support from clinical educators, ward staff and doctors was perceived as invaluable for creating a positive learning culture. Peer support and opportunities to lead care delivery contributed to students’ professional development. The format and method for providing pre-placement information needs review as do strategies for avoiding delays in completing assessment documentation. Overall, the SLCLE experience offers much potential as a nurturing and effective learning environment for HCP students.

Experiences of restrictive interventions in psychiatric health care from the perspectives of patients and health care professionals: Meta-synthesis of qualitative evidence.

Following their experience, patients with physical restraints often experienced traumatic sensations. The experiences of healthcare professionals' (HCPs') are primarily concerned with moral distress or conflicts between loyalty to the treatment and oppression of the patient's freedom when implementing RIs. Improving the competency of HCPs can help establish therapeutic relationships rooted in compassionate care and facilitate appropriate assessments to determine whether and how often RIs are necessary. Furthermore, fostering an environment that guarantees patient safety and dignity, assuring a sufficient staffing ratio, and providing opportunities to share RI experiences can help improve the quality of care and build safe environments for RIs. Effective interaction between HCPs and patients, thorough patient assessment, and compassionate patient care may improve competency of HCPs intervene RIs procedures. Creating a safe therapeutic environment, including improvements to structural environments, increasing the staff-to-patient ratio, establishing organizational policies that guarantee staff debriefing, provide emotional support, provide appropriate training programs to HCPs to their coping skills during RIs also reduce the use of RIs and improve the quality of mental health care. INTRODUCTION: Restrictive interventions (RIs) are used in psychiatric inpatient units for ensuring safety. However, few studies have comprehensively reviewed physical restraint and seclusion experiences from the perspectives of both patients and healthcare professionals' (HCPs'). This study aims to gain an in-depth understanding of the RI experiences of mental health inpatients and HCPs. A meta-synthesis was undertaken of qualitative studies exploring the RI experiences. Five electronic databases were searched and additional manual searches were performed for studies published within the last decade. Twelve articles were included, and a thematic analysis was conducted. The Critical Appraisal Skills Program (CASP) checklist was used to assess data quality. Two main subthemes were identified: 'Competency of HCPs' (three subthemes: interaction between patients and HCPs, assessment methods, and care) and 'systems' (three subthemes: environment, protocols with training, and debriefing), including both positive and negative experiences. The Competency of HCPs and the ward environment are critical factors related to patients' unmet needs. Effective interactions between HCPs and patients, thorough patient assessments, and compassionate patient care are important elements of RI implementation. An environment that guarantees safety and care with dignity, sufficient staffing ratios, and opportunities to share RI experiences may improve quality of care and create safe environments for RIs.

Experiences of patients, parents, and healthcare professionals in the process of transitioning from hospital to community after inpatient pediatric rehabilitation among children with special health care needs

Purpose Children with Special Health Care Needs (CSHCN) may experience disruptions in education due to extended hospitalizations. The purpose of this study was to describe how CSHCN experience educational supports during inpatient rehabilitation and identify the ongoing challenges when planning to return to school. Materials and methods Semi-structured focus groups were conducted with parents (n = 12), former patients (n = 20), and rehabilitation professionals (n = 8). Results Through qualitative thematic analysis based on descriptive phenomenology, we developed three themes: 1) Inpatient educational support such as instruction and schoolwork helped reduce the learning loss during hospitalization. However, these supports were sometimes complicated by lags in school approvals and challenges in coordination between systems. 2) Transition planning involved establishing necessary services to support CSHCN’s educational and healthcare needs at school re-entry. However, families reported limited information and guidance as key barriers. 3) Dynamic courses of school re-entry required continued support after discharge. The participants recommended that reassessment and adjustment of transition plans were often necessary to account for evolving developmental and educational needs but were not always received. Conclusions There is an ongoing need to improve communication between clinicians and educators, information for families, and long-term follow-up on the changing educational needs for CSHCN after rehabilitation.

Desired dementia care towards end of life: Development and experiences of implementing a new approach to improve person‐centred dementia care

AbstractAimsTo describe the co‐creation of the ‘Desired Dementia Care Towards End of Life’ (DEDICATED) approach to improve person‐centred palliative care for individuals with dementia and to describe the experiences of healthcare professionals during the approach's implementation.MethodsA needs assessment, comprising both qualitative and quantitative studies, informed palliative care needs of healthcare professionals, family caregivers and individuals with dementia. The approach was co‐created with healthcare and education professionals, guided by the findings. Then, healthcare professionals were trained to implement the approach in their organizations. From April to June 2022, semi‐structured interviews with actively engaged professionals were analysed using Conventional Content Analysis.ResultsThe needs assessment yielded six key themes: (1) raising palliative care awareness, (2) familiarization with a person with dementia, (3) communication about future care preferences, (4) managing pain and responsive behaviour, (5) enhancing interprofessional collaboration in advance care planning and (6) improving interprofessional collaboration during transitions to nursing homes. Interviews with 17 healthcare professionals revealed that active involvement in co‐creating or providing feedback facilitated implementation. Overall, the DEDICATED approach was perceived as a valuable toolkit for optimizing palliative care for people with dementia and their loved ones.ConclusionCo‐creating the DEDICATED approach with healthcare professionals facilitated implementation in daily practice. The approach was considered helpful in enhancing person‐centred palliative dementia care.Impact StatementThis study underscores the importance of active involvement of healthcare professionals in the research and development of new interventions or tools for palliative care, which can influence the successful implementation, dissemination and sustained usage of the developed tools.Implications for the Profession and Patient CareThe developed approach can improve person‐centred palliative care for individuals with dementia, ultimately improving their quality of life and that of their loved ones.Reporting MethodThis study used the Consolidated Criteria for Reporting Qualitative Research.Patient of Public ContributionNo patient or public contribution.