Health Care Research Articles

Nurses' experiences and perceptions of running nurse-led clinics: A scoping review.

To explore what is known about nurses' experiences and perceptions of running nurse-led clinics. Nurse-led clinics were established to address health care needs. In collaboration with medical practitioners, advanced practice nurses may take a selected group of patients and manage their ongoing healthcare independently. Their experiences in running nurse-led clinics directly impact patient satisfaction and clinical outcomes. Scoping review of the peer-reviewed literature. Systematic search through CINAHL, Medline, PsycINFO and Web of Science databases from January 2010 to September 2023. This scoping review is guided by the updated methodological guidance for the conduct of scoping review from Joanna Briggs Institute. Of 2747 retrieved articles, 15 were included in this review. Synthesis of the findings revealed that nurses believed implementing nurse-led clinics was beneficial to themselves, patients, and healthcare systems. However, they faced challenges in running nurse-led clinics, including insufficient support, teamwork obstacles and lack of role recognition. Nurses need to be proactive in promoting their clinics and overcoming challenges. Healthcare organizations are responsible for creating a positive culture to support nurse-led services. Future research should focus on ways to increase global awareness of nurse-led clinics.

The identity of clinical associates in psychology: a cross sectional, national survey

BackgroundThe Clinical Associate in Psychology (CAP) is a new psychological profession within the National Health Service (NHS) in the United Kingdom. This paper considers the processes developing the CAPs’ professional identity, specifically how their roles are embedded within services.MethodsThis study utilised an online survey of CAPs and all academic, clinical and managerial staff involved with CAPs. An inductive thematic analysis was undertaken.ResultsA total of 164 participants responded to the survey. Five themes were identified: Widening Access to Psychology, Workforce Development, Navigating the Unfamiliar, Trained [Master’s level] Professionals and An Emerging Ethos. In addition, key skills and unique contributions from CAPs were identified.ConclusionsA clear professional identity is emerging, with CAPs depicted as offering versatile interventions in diverse health care settings, fostering a positive and encouraging integration of psychological expertise into the healthcare service. The study highlights areas for development to facilitate the growth and advancement of the role within the psychological workforce.

COVID-19 Induced Changes in Hygiene, Psychological Factors, Physical Activity and Perceptions of The Health Care System Among Age Groups in South Korea

COVID-19 Induced Changes in Hygiene, Psychological Factors, Physical Activity and Perceptions of The Health Care System Among Age Groups in South Korea

Inequitable access to mental healthcare for socially excluded adolescents.

Adolescence is a critical period for mental health and social exclusion, a key social determinant of mental health. Early intervention approaches are key to mitigating the impact of mental ill-health during adolescence, however social exclusion can create additional barriers to accessing care. We aimed to better understand help-seeking experiences of adolescents facing co-occurring social exclusion and mental ill-health, including sources of support, barriers and preferences for service provision. Cross-sectional data were analysed, from the 2022 Mission Australia Youth Survey (N = 18,800). Adolescents aged 15 to 19 years were recruited from around Australia, through schools, community organisations and digital platforms. Indices of four domains of social exclusion (housing, finances, relational and education/employment) were created using existing Youth Survey variables, and supplemented with demographic characteristics, psychological distress and help-seeking behaviours (perceived need, mental health supports, barriers to access and preferences). Relationships between social exclusion domains, mental health concerns and help-seeking behaviours were explored using logistic regression models. A total of 9,743 young people reported having needed mental health support, yet only 58.1% reportedly sought support (n = 5,565). Social exclusion domains were associated with different help-seeking behaviours: housing challenges with higher help-seeking (OR = 1.28; 95% CI [1.15, 1.42]); relational difficulties and edu-employment issues with lower (OR = 0.75; 95% CI [0.68, 0.83] and OR = 0.82; 95% CI [0.75, 0.89]). Stigma, confidentiality concerns, cost and not knowing where to seek help were common barriers to help-seeking; those experiencing social exclusion more likely to report these. Participants reported a strong preference for face-to-face support. This study highlights the additional needs and challenges faced by adolescents dealing with both social exclusion and mental ill-health. With greater barriers to help-seeking, concerted efforts are needed to reduce stigma, improve mental health literacy and increase access to trusted information sources. Further initiatives should focus on structural factors that socially exclude young people and exacerbate inequitable access to mental healthcare.

Symposium 2: Networked Learning for Life-Long Learning in Swedish Health Care

A healthy work environment in health care requires that staff feel in control and are provided with self-development opportunities, information and adequate resources, all of which lead to job satisfaction. Lifelong learning for health care staff has received increasing attention as a step towards an attractive workplace and safer care. However, people in working life demand conditions that enable them to participate in educational activities. The aim of this paper is to describe experiences of creating and distributing short, flexible and networked courses in higher education, for health care personnel’s lifelong learning. Following research questions are included: what challenges have been identified by higher education staff when creating flexible courses for lifelong learning based on networked learning? and what, in the course design, was essential for the students networked learning? The project was built on the assumption that knowledge is empowering for staff and patients, and that organizational learning and behaviour is central for quality. The sociocultural theory of learning, which claims that all humans are willing and able to learn, and that people learn when they realize that the knowledge is relevant and important to them, has inspired. One pilot course was developed, and this paper focuses on the preliminary findings for the course “Peer learning”. E-mail, memos and notes were used as data and examined with thematic analysis. The findings showed four themes that answered the aim: identifying courses in collaboration; recruiting and maintaining the participants; learning activities in the course design and improving the course. It was important to have flexibility along with some structure in the course. The three components in networked learning contributed to learning and motivation during the course: relationship between educators, gatekeepers and students, the technology in the digital classroom, and a collaborative engagement. It seems successful working together and networking between the two organizations (university and health care) for a common purpose. The conclusion focuses further on the importance of building a robust network as well as bringing new ideas and needs for lifelong learning from the health care to the university. Further data collection is needed to get additional and deeper insights of health care managers along with workforce experiences and wishes for lifelong learning.

Self‑Assessment of the Intercultural Competences of Medical Doctors and Nurses in Poland in the Face of Current Refugee Challenges

Health care is one of the most important systems in both society and the economy. At the same time, it is a highly complex system that is subject to an increasing number of challenges in the contemporary world. For example, the health care system in Poland struggles primarily with inadequate numbers of nurses and medical doctors, as well as insufficient funding. A relatively new challenge is to provide for the health needs of refugees, whose number is increasing due to the war in Ukraine beyond Poland’s eastern border. This raises the question of the substantive preparation of nurses and medical doctors to work in a culturally diverse environment. Have they had the opportunity to train in intercultural competences? How do they assess their own intercultural competences? Do they see challenges in their interactions with foreigners? The aim of this paper is therefore to present a self‑assessment of the intercultural competences of medical doctors and nurses in Poland, in particular in the context of current refugee challenges. In order to achieve the assumed goal, a proprietary questionnaire form was created, and a nationwide survey was conducted among a group of professionally active medical doctors and nurses. The results of the research, in addition to providing valuable knowledge, were used to draw up specific recommendations for improving the continuing education of medical and nursing staff in the area of intercultural competences. Based on the research results, guidelines for better management in public health organisations were also created. This text may be of interest to researchers of management in public health care organisations, and in particular human resources management in health care institutions, as well as practitioners trying to deal with the current problems facing public health management.

Efficacy of Omega-3 in Improving Sleep Quality of Healthcare Workers with Shiftwork Sleep Disorder: Phase III, Double-blind, Placebo-controlled Trial Study Protocol (SLEEP-O3 Trial)

Introduction: Healthcare workers are especially vulnerable to sleep disturbances, including shift work sleep disorder (SWSD). Even though omega-3 supplementation has been studied to enhance sleep quality in different populations, there is lack of evidence to support its effectiveness in SWSD. This trial aims to evaluate this compound potential benefits towards health care personnel suffering from SWSD. Methods: This study protocol consists of a phase III, single-center, double-blind, placebo-controlled randomized clinical trial. Participants will receive sleep hygiene orientation in addition to either omega-3 dietary supplementation or placebo for 8 weeks. The primary outcome will be sleep quality as measured by the Pittsburgh Sleep Quality Index and one of the secondary outcomes would be actigraphy as a reliable sleep assessment. The sample size will be 136 subjects. Discussion: The importance of improving sleep quality of health care workers relies on its impact on their wellness, and on patient safety. Sleep deprivation and disorders are responsible for multiple workplace errors and worse health outcomes alike. This trial can help determine if omega-3 supplementation can contribute to ameliorate sleep disturbances in health care professionals.

THE RISE OF PRIVATIZATION IN HEALTH SECTOR: EXPLORING THE RELATIONSHIP BETWEEN PRIVATE HEALTH CARE AND THE UPPER CLASS

In the past twenty years, the transfer of health care services from public to private ownership has been a topic of significant interest in almost every country worldwide. Privatization and the free-market system have become attractive options for countries dealing with rising healthcare costs, growing dissatisfaction with the effectiveness and quality of care in public health facilities, and limited public resources to support healthcare services. The purpose of the research to explore the relationship between private health care and the upper class. The study identifies the causes of privatization, including globalization, modernization, urbanization, capitalism, neoliberal policy formation, and people's access to it. This study is based on primary data. In order to collect primary data, a comprehensive study questionnaire was designed, including both structured closed-ended and open-ended questions, and data have been collected randomly from ten private hospitals in Madaripur. The research included a sample size of 130 respondents, consisting of 110 patients, 20 nurses, and hospital authorities. The findings conclude that private health care is the outcome of elites’ demand, which is decorated with advanced facilities. In a public hospital, it is impossible for a patient to anticipate a simple pathological or radiological examination. Patients ultimately find themselves compelled to visit private clinics. However, the high cost of these clinics often restricts people's access to them. Aside from this, capitalism has given birth to private ownership and class categorization in society, while neoliberal policy has reduced government control over public expenditure. Market competition, individual responsibility, consumer choice, and lifestyle change have also increased the privatization of health services in Madaripur, as well as in the larger cities of Bangladesh. KEYWORDS: privatization, health care, globalization, capitalism, public health, neoliberal policy

Codesigning culturally safe oral health care with First Nations Kidney Warriors experiencing kidney disease in South Australia

BackgroundThis paper describes how First Nations Kidney Warriors (Aboriginal and Torres Strait Islander people living with kidney disease), dental hygienists, kidney health care professionals, an Aboriginal hostel accommodation manager and researchers co-designed an approach to improve oral health in South Australia. Kidney Warriors have strong connection to Country, Community and family that underpins health, wellbeing and approaches to research. However, significant colonisation, racism and marginalisation have impacted Kidney Warriors’ social, cultural and financial determinants of health, leading to increased chronic conditions including kidney disease. Access to culturally safe, affordable and responsive oral health care is vital but challenging for First Nations Peoples undergoing dialysis and kidney transplantation; Australian oral health care is generally provided privately, in metropolitan centres, by professionals who may hold unconscious bias about First Nations Peoples and incorrect assumptions regarding equal access to care.MethodsThe AKction – Aboriginal Kidney Care Together Improving Outcomes Now kidney care oral health working group codesigned strategies to address disparities and gaps in care, and co-create more accessible, responsive, culturally safe and sustainable models of care. A decolonising and collaborative participatory action research was informed by Dadirri Deep Listening and Ganma Knowledge Sharing with repeated cycles of Look and Listen, Think and Discuss, Take Action Together. A small pilot evaluation survey of clinical placement in an Aboriginal setting was undertaken.ResultsFour phases of collaboration were undertaken. Community and health professional consultations identified key gaps and priorities. Clinical yarning and cultural safety training and an interprofessional skills day was co-facilitated. Dental hygienist student clinical placement at Kanggawodli Aboriginal Hostel was initiated and evaluated. First Nations Kidney Warriors were positioned as educators and experts of their own lives and health care needs. A new framework for kidney health—oral health cultural safety and clinical education was developed.ConclusionThis codesigned approach involving inter-professional collaboration and joint decision making with community members has significantly informed improvements in oral health care information, services and referral with and for First Nations Peoples with kidney disease. This project provides a working example of how to decolonise health service and education programs from the ground up.Trial registrationNHMRC PAR 2004389.

Evaluating the effect of health insurance reform on health equity and financial protection for elderly in low- and middle-income countries: evidences from China

BackgroundTo achieve Universal Health Coverage (UHC), China have implemented health system reform to expend health coverage and improve health equity. Scholars have explored the implementing effect of this health reform, but gaps remained in health care received by elderly. This study aims to assess the effect of implementing health insurance payment reform on health care received by elderly, as well as to evaluate its effect on cost sharing to identify whether improve financial protection of elderly under this reform.MethodsWe identified hospitalization of 46,714 elderly with cerebral infarction from 2013 to 2023. To examine the determinant role played by DRGs payment reform in healthcare for elderly and their financial protection, this study employs the OLS linear regression model for analysis. In the robustness checks, we validated the baseline results through several methods, including excluding the data from the initial implementation of the reform (2021), reducing the impact of the pandemic, and exploring the group effects of different demographic characteristics.ResultsThe findings proposed that implementing DRGs payment reduces drug expenses but increases treatment expense of chronic disease for elderly in China. This exacerbates healthcare costs for elderly patients and seems to be contrary to the original purpose of health care reform. Additionally, the implementation of DRGs payment reduced the spending of medical insurance fund, while increased the out-of-pocket of patients, revealing a shift in health care expenses from health insurance fund to out-of-pocket.ConclusionsThis study shares the lessons from China’s health reform and provides enlightenment on how to effective implement health reform to improve health equity and achieve UHC in such low- and middle-income countries facing challenges in health financing.

State-Level Income Inequality as a Determinant of Suicide Mortality in the United States.

Income inequality has been increasing for decades and is now known to be related to many downstream health outcomes, where greater inequality is a predictor of poorer health. Results of investigations into the relationship between income inequality and suicidality have been mixed. This study leverages the most recent data available from the National Longitudinal Mortality Study to investigate the relationship between state-level income inequality and suicide mortality. A series of rigorously controlled logistic regression models, employing multiple measures of inequality, and various suicide mortality case-control specifications are used to investigate the phenomenon. Results indicate that the odds of suicide mortality increase with inequality, and this result is invariant across all models. A reduction in the Gini coefficient from the highest to lowest values of income inequality observed in U.S. states may reduce the odds of suicide mortality by 20 percent to 55 percent or more. Findings have application for social workers and other mental health professionals with respect to clinical assessment and treatment. Likewise, community organizers, policy advocates, and legislators should be aware that policy solutions reducing income inequality in the United States are a mechanism for alleviating the suicide mortality burden.

Young people's participation in their own mental health care: Session-by-session feedback in youth mental health services (headspace).

Young people's participation in their own mental healthcare requires ways for them to provide feedback to their clinicians on how they are experiencing their treatment. Key dimensions of session experience are willingness to attend, feeling listened to and understood, working on issues important to them, feeling hopeful for the future and feeling that things are improving in their lives. This study reports on young people's session experiences over time and by key demographics for headspace youth mental health services. The sample comprised 16 484 young people aged 12-25 years who commenced an episode of care at one of the 150 headspace centres between 1 July 2021 and 30 June 2022 and who had attended at least two services. Data were collected via the routinely collected headspace minimum data set. Overall, young people reported very positive session experiences over all the session dimensions. Few demographic differences were found: session ratings were more positive for young adults (18+ years) compared with adolescents (under 18 years). Scores on all five dimensions improved with more visits, and willingness to attend and working on issues important to the young person were strong predictors of service engagement. Better session experience scores were associated with more positive ratings of quality of life. Young people experience their headspace sessions very positively, and more positive experiences are associated with better service engagement and quality of life. Routinely collecting session feedback gives young people a valuable way to participate in and inform their own care.

Editorial: Artificial intelligence and mental health care

Editorial: Artificial intelligence and mental health care

From diagnostic conformity to co-narration of self-insight in mental health care

From diagnostic conformity to co-narration of self-insight in mental health care

The relationship between psychiatric inpatient length of stay and suicide prevention

Suicide prevention remains a critical concern within mental health care, particularly for individuals with psychiatric disorders. This review examines the relationship between the length of inpatient psychiatric admission and its effectiveness in preventing suicide. The study analyzes existing literature on admission duration, in-hospital and post-discharge suicide rates, and factors influencing these outcomes such as treatment quality, patient characteristics, and post-discharge support systems. While some evidence suggests longer stays may be beneficial for certain diagnostic groups, the quality and intensity of care during admission and robust post-discharge support appear equally crucial. The review highlights the importance of individualized care plans, comprehensive suicide prevention programs, and strong transitional support. It also discusses international perspectives, ethical considerations, and special populations. The paper concludes that an effective approach to suicide prevention should focus on tailored admission lengths, high-quality care, and seamless transitions to community support, rather than solely on extending lengths of stay.

Assessing how frailty and healthcare delays mediate the association between sexual and gender minority status and healthcare utilization in the All of Us Research Program.

To understand how frailty and healthcare delays differentially mediate the association between sexual and gender minority older adults (OSGM) status and healthcare utilization. Data from the All of Us Research Program participants ≥50 years old were analyzed using marginal structural modelling to assess if frailty or healthcare delays mediated OSGM status and healthcare utilization. OSGM status, healthcare delays, and frailty were assessed using survey data. Electronic health record (EHR) data was used to measure the number of medical visits or mental health (MH) visit days, following 12 months from the calculated All of Us Frailty Index. Analyses adjusted for age, race and ethnicity, income, HIV, marital status ± general MH (only MH analyses). Compared to non-OSGM, OSGM adults have higher rates of medical visits (adjusted rate ratio [aRR]: 1.14; 95% CI: 1.03, 1.24) and MH visits (aRR: 1.85; 95% CI: 1.07, 2.91). Frailty mediated the association between OSGM status medical visits (Controlled direct effect [Rcde] aRR: 1.03, 95% CI [0.87, 1.22]), but not MH visits (Rcde aRR: 0.37 [95% CI: 0.06, 1.47]). Delays mediated the association between OSGM status and MH visit days (Rcde aRR: 2.27, 95% CI [1.15, 3.76]), but not medical visits (Rcde aRR: 1.06 [95% CI: 0.97, 1.17]). Frailty represents a need for medical care among OSGM adults, highlighting the importance of addressing it to improve health and healthcare utilization disparities. In contrast, healthcare delays are a barrier to MH care, underscoring the necessity of targeted strategies to ensure timely MH care for OSGM adults.

Use of an electronic wellness instrument in the integrated health and social care of older adults: a group concept mapping study

BackgroundHealth system fragmentation directly contributes to poor health and social outcomes for older adults with multiple chronic conditions and their care partners. Older adults often require support from primary care, multiple specialists, home care, community support services, and other health-care sectors and communication between these providers is unstructured and not standardized. Integrated and interprofessional team-based models of care are a recommended strategy to improve health service delivery to older adults with complex needs. Standardized assessment instruments deployed on digital platforms are considered a necessary component of integrated care. The aim of this study was to develop strategies to leverage an electronic wellness instrument, interRAI Check Up Self Report, to support integrated health and social care for older adults and their care partners in a community in Southern Ontario, Canada.MethodsGroup concept mapping, a participatory mixed-methods approach, was conducted. Participants included older adults, care partners, and representatives from: home care, community support services, specialized geriatric services, primary care, and health informatics. In a series of virtual meetings, participants generated ideas to implement the interRAI Check Up and rated the relative importance of these ideas. Hierarchical cluster analysis was used to map the ideas into clusters of similar statements. Participants reviewed the map to co-create an action plan.ResultsForty-one participants contributed to a cluster map of ten action areas (e.g., engagement of older adults and care partners, instrument’s ease of use, accessibility of the assessment process, person-centred process, training and education for providers, provider coordination, health information integration, health system decision support and quality improvement, and privacy and confidentiality). The health system decision support cluster was rated as the lowest relative importance and the health information integration was cluster rated as the highest relative importance.ConclusionsMany person-, provider-, and system-level factors need to be considered when implementing and using an electronic wellness instrument across health- and social-care providers. These factors are highly relevant to the integration of other standardized instruments into interprofessional team care to ensure a compassionate care approach as technology is introduced.

The Impact of Gendered Ageism and Related Intersectional Inequalities on the Health and Well-being of Older Women

Gendered ageism contributes to invisibility and homogenization of older women, harming their health, quality of life and limiting their social participation. Health issues related to aging have received increasing attention in the scientific literature. However, studies on aging that include a gender dimension or ethnic aspects remain scarce. This article presents the results of a systematic review on older women’s health and wellbeing, gender inequalities, age discrimination experienced by older women and their intersections with other forms of discrimination. Between January and February 2023, we conducted a literature review using PRISMA in the Web of Science Core Collection, MEDLINE and SciELO Citation Index. We selected 43 empirical studies from different countries focusing on women over 65 years. The findings show the incidence of discrimination and inequality in health care experienced by older women, ageist attitudes among health care providers and other professionals, experiences of abuse and gender-based violence among older women. Additionally, the study examines the impact of ageism and other forms of discrimination on the health of LGBTQ+ older people, ethnic minorities, older women with disabilities, and other non-traditional groups.

Community-based health programme for nurses and midwives: A mixed methods evaluation.

To evaluate a community-based psychological health and well-being programme for nurses and midwives. Mixed methods programme evaluation. Four studies were included: observational descriptive study (cross-sectional survey) of the health, well-being and experiences of previous programme participants (Study 1); observational exploratory prospective cohort study (longitudinal survey) of health, well-being and experiences of participants who engaged in the programme from 2020 to 2023 (Study 2); qualitative descriptive study (interviews) of experiences and perceptions of nurses and midwives who have engaged with the programme as participants or clinicians (Study 3); observational descriptive study (cross-sectional survey) of experiences and perceptions of programme stakeholders (Study 4). Surveys included validated measures. Data were collected online. Descriptive, repeated measures and thematic analyses were conducted. One-hundred and fifteen participants completed Study 1: 20% (n = 23) reported stress in the severe-to-extremely severe category; 22% (n = 25) reported psychological distress in the moderate-to-severe category. Thirty-one programme participants were followed in Study 2: the effect of the programme on participant well-being over time was not significant. Sixteen programme participants and eight programme clinicians were interviewed (Study 3). Experiences of nurses and midwives engaging with the programme were highly positive and strong attributes of the programme included (1) shared professional experience of clinicians and participants which supported a common language and facilitated understanding, and (2) effective programme leadership, and autonomy and flexibility in the clinicians' role which enabled and supported a positive working experience. Thirty-nine broader stakeholders participated in a cross-sectional survey (Study 4). All stakeholders reported high satisfaction with the programme. Participants considered the programme being 'by nurses and midwives, for nurses and midwives' critical to the programme's success and value. The community-based psychological health and well-being programme developed, led and delivered by nurses and midwives, for nurses and midwives, was a highly valued resource. Levels of stress and burnout in the health workforce are high. A community-based psychological health and well-being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives. A programme delivered by nurses and midwives, for nurses and midwives, was considered critical to programme success. Programme leadership, and autonomy and flexibility in the programme clinicians' roles, facilitated and supported a positive working experience for programme clinicians. Quality and safety in patient care is directly impacted by the well-being of nurse and midwives. A community-based psychological health and well-being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives. Survey findings were reported according to STROBE (von Elm etal. in Lancet, 370:1453-1457, 2007) and qualitative findings according to COREQ (Tong etal. in International Journal for Quality in Health Care, 19(6):349-357, 2007). No patient or public contribution.

A Case Report and Review of the Literature of ICU Delirium

This case report focuses on what patients and family members may experience when a neurological trauma transpires and resultant intensive care (ICU) delirium occurs. It is the personal account of the patient (A.B.) and spouse’s (R.G.B.) perspectives when the patient (A.B) suffered a vertebral artery aneurysm and hemorrhage and experienced intensive care unit (ICU) delirium after being in the ICU for 22 days. This case report provides the patient’s and spouse’s perspectives regarding delirium, i.e., A.B.’s inability to discern reality, loss of memory, paranoia and hallucinations, agency and recovery, post-ICU syndrome, and post-traumatic stress disorder (PTSD). Clinical diagnosis by the neurosurgeon indicated delirium, with treatment consisting of sleep sedation and uninterrupted sleep. A.B. was able to regain consciousness yet experienced post-traumatic stress disorder up to one year afterward. Consistent family participation in the patient’s delirium care is crucial. Family member care and family-centered strategies are provided with implications for future research and health care.