Hospital Stakeholders Research Articles

Benefits and challenges for hospital nurses engaged in formal mentoring programs: A systematic integrated review.

To explore the overall benefits and challenges for the mentee, the mentor, and the hospital (stakeholders) in hospital-sponsored mentoring programs. Formal mentoring programs are widely used to assist nurses to adapt to clinical practice, facilitate their career development, and improve workforce retention. However, the overall benefits and challenges for stakeholders involved in formal mentoring programs remain largely unknown due to a lack of systematic reviews to synthesize relevant studies in this important area. A systematic integrated review. A systematic search of six databases including CINAHL, Web of Science, MEDLINE, Scopus, Science Direct, and ProQuest was undertaken. Studies that met the inclusion criteria were assessed for methodological quality using the Joanna Briggs Institute critical appraisal tools. Findings from qualitative, quantitative, and mixed-methods studies were extracted and synthesized thematically using a convergent synthesis method. Twenty-two original studies were included in the review. Findings are presented under five themes: the benefits for mentees, the benefits for mentors, the benefits for the hospital, challenges perceived by mentees and mentors, and mismatched mentor-mentee pairs. Mentoring programs that build on reciprocal relationships among mentees and mentors generate substantial benefits for all if mentees are able to navigate the challenges of the complex and dynamic nature of the clinical practice environment. Organizational support is important in overcoming these challenges.

192 USING A COLLABORATIVE APPROACH TO IDENTIFY WAYS TO STRENGTHEN ENHANCED CARE PRACTICES IN A GENERAL HOSPITAL WHILE BUILDING RESEARCH CAPACITY

Abstract Background The Nursing department within an acute general hospital wished to illuminate and build on positive local enhanced care practices. A collaborative research team was formed between academics in the linked higher education institution and nurses within the hospital to address this intent by building nurse-led research capacity, while addressing the practice derived research question. Methods A mixed methods approach was employed involving; site visits, audit of enhanced care staffing requirements, documentary and activity box analyses and use of appreciative inquiry (AI) methodology. AI is a collaborative and strengths-oriented approach supporting organisational development. It was implemented via three World Café events (www.theworldcafe.com 2021) bringing together hospital stakeholders (n = 17) with direct experience of delivering enhanced care, to consider pre-defined questions. Thematic analysis was used to analyse the resultant data. Ethical approval was obtained. Results Overall, the findings demonstrated a positive focus on implementing therapeutic enhanced care within the hospital in contrast to a more passive primarily observational orientation. The site visits facilitated shared learning. Thematic findings from the World Cafés identified positive care practices and enabled a multidisciplinary, inclusive approach, which facilitated pragmatic suggestions on how to plan for, and build on existing foundations of, enhanced care practice. Conclusion Both the study approach and outcome resulted in positive impacts. Working collaboratively supported research capacity building for hospital-based members of the research team. Using AI supported constructive and inclusive stakeholder participation in the World Cafés with a focus on good practices and ways in which they could be strengthened. One year post completion, study recommendations have led to:

Social Media as a Tool for Consumer Engagement in Hospital Quality Improvement and Service Design: Barriers and Enablers for Implementation.

Social media can be used to engage consumers in hospital service design and quality improvement (QI) activities, however its uptake may be limited by a lack of guidance to support implementation. This article presents the perceived barriers and enablers in using social media for consumer engagement derived from an interview study with public hospital stakeholders. Semi-structured interviews with 26 Australian hospital service providers and consumer representatives. Data were analysed using a deductive content analysis method. Data were collected between October 2019 and April 2020. Facebook was the platform most commonly used for consumer engagement activities. Barriers and enablers to social media-based consumer engagement were identified. The barrier themes were (1) fears and concerns; (2) lack of skills and resources for social media engagement; (3) lack of organisational processes and support; and (4) problems with social media platforms and the changing social media landscape. The enabler themes were: (1) hospitals facilitating access and use; (2) making discussions safe; (3) cultivating a social media community; and (4) building on success. Using social media to facilitate consumer engagement in hospital service design and QI activities is feasible and acceptable to service providers and consumers. Hospitals and their executives can create a supportive environment for social media-based engagement activities through developing clear governance systems and providing training and support to all users. Consumers need to be involved in co-designing social media-based activities and determining which forms of engagement are accessible and acceptable. For some consumers and service providers, barriers such as a lack of resources and distrust of social media companies might mean that social media-based engagement will be less acceptable for them. Because of this it is important that hospitals provide complementary methods of engagement (eg, face-to-face) alongside social media-based methods.

The Promise for Reducing Healthcare Cost with Predictive Model: An Analysis with Quantized Evaluation Metric on Readmission.

Quality of care data has gained transparency captured through various measurements and reporting. Readmission measure is especially related to unfavorable patient outcomes that directly bends the curve of healthcare cost. Under the Hospital Readmission Reduction Program, payments to hospitals were reduced for those with excessive 30-day rehospitalization rates. These penalties have intensified efforts from hospital stakeholders to implement strategies to reduce readmission rates. One of the key strategies is the deployment of predictive analytics stratified by patient population. The recent research in readmission model is focused on making its prediction more accurate. As cost-saving improvements through artificial intelligent-based health solutions are expected, the broad economic impact of such digital tool remains unknown. Meanwhile, reducing readmission rate is associated with increased operating expenses due to targeted interventions. The increase in operating margin can surpass native readmission cost. In this paper, we propose a quantized evaluation metric to provide a methodological mean in assessing whether a predictive model represents cost-effective way of delivering healthcare. Herein, we evaluate the impact machine learning has had on transitional care and readmission with proposed metric. The final model was estimated to produce net healthcare savings at over $1 million given a 50% rate of successfully preventing a readmission.

Do medical students and residents impact the quality of patient care? An assessment from different stakeholders in an Italian academic hospital, 2019.

Medical students and residents play an important role in patient care and ward activities, thus they should follow hospital procedures and ensure best practices and patient safety. A survey concerning staff on training was conducted to assess the perceived quality of healthcare from healthcare workers (HCWs), residents, medical students and patients in Udine Academic Hospital, Italy. Between December, 2018 and March, 2019, a 5-point Likert-scale questionnaire was administered in 21 units, covering four thematic areas: patients and medical staff satisfaction with the quality of care provided by residents and students, patient privacy, clinical risk management, patient perception of staff on training. Data analysis included descriptive analysis and ordered logistic regressions. A total of 596/1,863 questionnaires were collected from: HCWs (165/772), residents (110/355), students (121/389), and patients (200/347). Residents were rated high both by patients (median = 5, IQR = 4-5, OR 0.49, 95%CI 0.26-0.93) and HCWs (median = 4, IQR = 3-5, OR 0.14, 95%CI 0.08-0.26), with a lower score for medical students on the same topic, both by patients (median = 4, IQR = 3-5, OR 2.94, 95%CI 1.49-5.78) and HCWs (median = 3, IQR = 2-3, OR 0.41, 95%CI 0.25-0.67). Therefore, the role of staff on training in quality and safety of healthcare deserves integrated regular evaluation, since direct interaction with patients contributes to patients' perception of healthcare.

How can communication to GPs at hospital discharge be improved? A systems approach.

BackgroundPoor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries that are commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue’s resistance to decades of improvement work.AimTo understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement.Design & settingA qualitative exploration of the secondary-to-primary care communication system surrounding a large UK hospital.MethodA systems approach, recently defined for the healthcare domain, was used to structure and thematically analyse interviews (n = 18) of clinical and administrative staff from both sides of the primary–secondary care interface, and a subsequent focus group.ResultsThe largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance when using standardised communication templates.ConclusionFacilitating the sharing of performance insights between stakeholder groups emerged as the key theme of how communication might be improved. The empirical measures proposed have the potential to mitigate the safety risks of key barriers to performance such as patient complexity.

A bibliometric review of research on COVID-19 and tourism: Reflections for moving forward

By adopting a bibliometric analysis approach, this study systematically reviews and retrospectively analyses the rapidly emerging literature on COVID-19 in tourism and hospitality. A co-word analysis revealed the intellectual structure of 177 papers (published until January 2021) consisting of four major themes discussing the following various issues: 1) the impact of COVID-19 on tourist decision-making, destination marketing, technology adoption, and tourists' well-being; 2) the future of tourism post COVID-19; 3) managing change in tourism; and 4) the COVID-19's impacts on tourism and hospitality stakeholders. The findings show that preliminary publications tend to be descriptive, pre-mature and theoretical, i.e. most studies advocate and re-imagine a more sustainable, responsible and equitable post-pandemic tourism, but almost no research investigates in-depth whether, why and how such theoretical proclamations are being materialized or not and/or whether they will remain a COVID-19 induced fuss. The paper concludes by offering various directions and propositions for future research.

A Physical-organizational Method for the Functionality Assessment of A Hospital Subjected to Earthquakes

ABSTRACT Hospitals play vital roles in mitigation and recovery in earthquake-hit communities. This paper aims to clarify the effect of physical damage on hospital organizations and represent a holistic method for the functionality assessment of a hospital. The efficiency of the method is demonstrated based on the case study of a general hospital. The results indicate that the functionality of hospitals would be significantly affected after the maximum considered earthquake. A considerable gap exists between the hospital treatment capacity and the patient demand for medical services. The method will assist hospital stakeholders and managers in design and upgrade criteria selection. Abbreviation: CT: Imaging Procedure; DBE: Design Basis Earthquake; DES: Discrete Event Simulation; DR: Digital Radiography; EDPs: Engineering Demand Parameters; HVAC: Heating Ventilation and Air Conditions; MCE: Maximum Considered Earthquake; OR: Operation Room; PFA: Peak Floor Acceleration; PFV: Peak Floor Velocity; PIDR: Peak Inter-story Drift ratio; RC: Reinforced Concrete; RIDR: Residual Inter-story Drift Ratio; RR: Resuscitation Room; SLE: Service Level Earthquake; UPS: Uninterruptible Power Supply; US: Ultrasound Room; WT: Waiting Time

The risks and benefits of using social media to engage consumers in service design and quality improvement in Australian public hospitals: findings from an interview study of key stakeholders

BackgroundEngaging consumers - patients, families, carers and community members who are current or potential service users - in the planning, design, delivery, and improvement of health services is a requirement of public hospital accreditation in Australia. There is evidence of social media being used for consumer engagement in hospitals internationally, but in Australia this use is uncommon and stakeholders’ experiences have not been investigated. The aim of the study was to explore the experiences and beliefs of key Australian public hospital stakeholders around using social media as a consumer engagement tool. This article focuses on the study findings relating to methods, risks, and benefits of social media use.MethodsSemi-structured interviews were conducted with Australian public hospital stakeholders in consumer representative, consumer engagement/patient experience, communications or quality improvement roles. Qualitative data were analysed using a deductive content analysis method. An advisory committee of consumer and service provider stakeholders provided input into the design and conduct of this study.ResultsTwenty-six Australian public hospital service providers and consumers were interviewed. Participants described social media being used to: recruit consumers for service design and quality improvement activities; as an online space to conduct consultations or co-design; and, to gather feedback and patient experience data. The risks and benefits discussed by interview participants were grouped into five themes: 1) overcoming barriers to engagement, 2) consumer-initiated engagement; 3) breadth vs depth of engagement, 4) organisational transparency vs control and 5) users causing harm.ConclusionsSocial media can be used to facilitate consumer engagement in hospital service design and quality improvement. However, social media alone is unlikely to solve broader issues commonly experienced within health consumer engagement activities, such as tokenistic engagement methods, and lack of clear processes for integrating consumer and patient feedback into quality improvement activities.

Implementation of Islamic Values in Hospital Management: Islamic General Hospital Boyolali’s Case

Islamic General Hospital X Boyolali applies Islamic-based HR management to his company. The purpose of this paper is to determine the implementation of Islamic values which had been applied by HR management in the process of employee selection and development. This research uses descriptive qualitative method with interviews, observations and documentations collecting data tools. Informants are people in HR department from lowest level to highest level management. As an Islamic hospital whose mission is to provide quality, shar'i and fair health services, the management of hospital always applies Islamic values in developing its human resource potential. Through the inculcation of Islamic values, it is expected that the quality of hospital human resources will improve in terms of devotion, professionalism of work, and welfare for all hospital stakeholders. The results of this study stated that Islamic values can improve discipline and productivity of employee performance. The Islamic aspect is shown by including the criteria for reading the Al-Qur'an and the compulsory reading prayer test in the selection and Al-Qur'an study and daily worship monitoring in employee development.

An exploratory study of hospital stakeholders' perceptions on the introduction of advanced practice nurses

Introduction: One solution proposed by the authorities to address public health issues is to deploy a new category of professionals with a greater range of skills: advanced practice nurses (APNs). The literature identifies the complexity of the deployment projects of these professionals. The PEPPA model approved by the International Council of Nurses is the reference model for the introduction of APNs. The objectives of this study were to explore various stakeholders' perceptions on the introduction of APNs into health institutions, in order to propose recommendations to support the institutions.Method: A multicenter qualitative study was conducted in France's Provence-Alpes-Côte d'Azur region with physicians, managers, nurses, patients, and advanced practice students.Results: APNs are beneficial for patients and the health system, but their introduction into health institutions brings with it risks, primarily linked to their integration. APN introduction projects need to be well planned and should prioritize their integration.Discussion: Results consistent with the PEPPA model identified seven recommendations to facilitate the successful introduction of APNs into hospitals.Conclusion: This work needs to be continued with studies related to the out-of-hospital setting and the evaluation of the successfulness of APNs' introduction.

Towards sustainable tourism development: an evaluation of the current state of energy efficiency in North Cyprus

PurposeThis paper aims to review the current state of energy efficiency in North Cyprus and the extent to which this supports small island sustainable tourism development, together with related policy implications.Design/methodology/approachDocumentary analysis is used to evaluate energy efficiency studies in North Cyprus.FindingsResults of this study reveal that the legal framework relating to energy efficiency and stakeholder reports about the level of energy efficiency falls short of expectations for sustainable tourism practices from an energy efficiency perspective.Practical implicationsPolicymakers should consider revising the current draft energy efficiency law to take into account the needs and views of hospitality and tourism stakeholders. This could be accomplished by involving them in discussions about how enhanced energy efficiency could contribute to economic, social and environmental development. Further, policymakers and these industry stakeholders in North Cyprus should develop common goals to harmonise tourism and energy regulations in support of sustainable development.Originality/valueThis study evaluates current energy efficiency developments and possible contributions to sustainable tourism development in North Cyprus. Energy efficiency policy has not yet been applied in North Cyprus, and a broad-ranging policy could help to prevent future environmental problems in North Cyprus.

Domestic Tourism challenges: Tourist misbehavior

Domestic tourism in the Alexandria governorate suffers from many challenges as challenging tourist behaviors. The aim of the study is to investigate existing proper behavior instructions in hotels, beaches, and archaeological sites in Alexandria Governorate show the frequent tourist misbehavior and activate the role of tourism and hotel stakeholders in avoiding these behaviors; highlight the domestic tourism challenges and eventually, present recommendations on improving services provided to the tourists in Alex. A quantitative survey with a questionnaire was targeted domestic tourists who had previously spent their holidays in Alexandria Governorate and stayed in its hotels. The sample consisted of 354 participants. Data revealed the inadequate of existing proper behavior instructions and the weak role of tourism and hospitality stakeholders to increase awareness of domestic tourists towards proper behaviors on tourist beaches, in hotels, and archeological places. The study also found out occurrences frequencies of improper behaviors of the domestic tourists that merit the most immediate attention before its exacerbation. The study also revealed challenges related to tourism of beaches as inadequate services and the absence of many tourist facilities. The study recommends firstly, developing the infrastructure services that are right for the customers' need; setting ground rules for visitor behavior to crack down on tourist misbehaving tourists, and finally, encouraging and supporting positive behaviors among domestic tourists through announcing periodic competitions among Egyptian visitors in touristic places and choosing the perfect local tourist.

ED1 Antimicrobial Resistance in US Hospitals: Burden and VALUE of Investment in Developing New Treatments

This research aims to quantify the burden of antimicrobial resistance (AMR) from the perspective of hospital stakeholders and the value of continued investment in developing new treatments. A dataset representative of the US population demographics and health characteristics was constructed by merging the American Community Survey, Behavioral Risk Factor Surveillance System and data on nursing home residents. Prediction equations linking patient demographics and health characteristics to likelihood of hospitalization within hospital service lines were generated using the Medical Expenditure Panel Survey and applied to the population file. Data from the National Healthcare Safety Network were used to calculate state-specific rates of AMR in hospitalized patients experiencing an infection. Peer-reviewed published research provided estimates for AMR-attributable outcomes, including mortality, inpatient days, and direct & indirect costs. Results were calculated under a base case scenario reflecting current rates of infection continuing into the future, and alternative scenarios reflecting changes in future rates of infection and resistance. Base case results suggested approximately 4,100 AMR-attributable deaths would occur in the base modeling year, resulting in over $700 million in direct costs, increasing to 5,300 deaths and $907 million in direct costs by 2035. Under a scenario in which rates of resistance increase to 100%, reflecting a hypothetical scenario where alternative antimicrobial treatments are no longer effective, projected 2035 AMR-attributable deaths increase to 30,700 (480% increase from base case) and direct costs of $8.4 billion (826% increase from base case). Infections are projected be highest in general surgery and thoracic surgery service lines, where high infection risk could potentially make surgeries too risky to perform. Though its current burden is substantial, AMR’s potential future burden is significantly more concerning. Investing in AMR prevention strategies will be necessary to reverse course with respect to increasing resistance.

Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done.

Globally, 5–15% of hospitalized patients acquire infections (often caused by antimicrobial-resistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira University hospital (LUH), a teaching hospital in Uganda. We also characterized challenges in completing the tool. This was a hospital-based, cross-sectional study conducted in November 2020. The IPC focal person at LUH completed the WHO IPCAF tool. Responses were validated, scored, and interpreted per WHO guidelines. The overall IPC compliance score at LUH was 225/800 (28.5%), implying a basic IPC compliance level. There was no IPC committee, no IPC team, and no budgets. Training was rarely or never conducted. There was no surveillance system and no monitoring/audit of IPC activities. Bed capacity, water, electricity, and disposal of hospital waste were adequate. Disposables and personal protective equipment were not available in appropriate quantities. Major challenges in completing the IPCAF tool were related to the detailed questions requiring repeated consultation with other hospital stakeholders and the long time it took to complete the tool. IPC compliance at LUH was not optimal. The gaps identified need to be addressed urgently.

Prevalence and predictors of work-related depression, anxiety, and stress among waiters: A cross-sectional study in upscale restaurants

Poor mental health often interrupts people's regular activities making them unable to work effectively resulting in poor performance and high turnover intention. We examined the prevalence and predictors of depression, anxiety and stress among waiters in upscale restaurants. This descriptive cross-sectional study involved 384 waiters in upscale restaurants in the Accra Metropolis. Data were collected using a pre-tested questionnaire which embedded DASS-21 (Cronbach Alpha = 0.815). The analysis included descriptive and inferential statistics using STATA 15. Statistical significance was set at p-value <0.05 at 95% confidence interval. The prevalence of depression was 38.3%, while anxiety and stress were 52.3% and 34.4% respectively. Females (AOR = 1.69, 95%CI = 1.02-2.79), waiters who foresee a better remuneration (AOR = 3.09, 95%CI = 1.95-4.87), consume caffeine (AOR = 1.44, 95%CI = 0.90-2.32), and use non-prescription drugs (AOR = 2.22, 95%CI = 1.39-3.55) were more likely to have depression. Females (AOR = 1.86, 95%CI = 1.17-2.96), those who foresee better remuneration (AOR = 2.85, 95%CI = 1.82-4.49), and those who use non-prescription drugs (AOR = 2.13, 95%CI = 1.38-3.28) were more likely to have anxiety. Females (AOR = 1.74, 95%CI = 1.01-2.99), waiters who are positive of career success (AOR = 1.70, 95%CI = 0.99-2.91), who foresee better remuneration (AOR = 2.99, 95%CI = 1.85-4.83), consume caffeine (AOR = 1.54, 95%CI = 0.93-2.54), and who use non-prescription drugs (AOR = 3.16, 95%CI = 1.93-5.17) were more likely to be stressed. There is a high prevalence of poor mental health among waiters. Urgent intervention by hospitality stakeholders is needed to improve their working conditions and psychosocial health to accelerate progress towards the Sustainable Development Goal of promoting mental health and wellbeing.

Stand by me: analyzing the tourist–intelligent voice assistant relationship quality

PurposeThis paper aims to explore tourist perceived value and attachment to intelligent voice assistants (IVAs) as antecedents of the quality of the human–IVA relationship in the hospitality domain. This research also examines the moderating role of psychological factors (self-esteem) and knowledge factors (past experience and technology expertise) in the relationships between antecedents and relationship quality.Design/methodology/approachThe researchers conducted two quantitative studies, collecting data via online surveys in Mechanical Turk (n1 = 124 and n2 = 281). The proposed model was tested using partial least squares structural equation modeling.FindingsThe first study uncovers that tourist perceived value is the main influence on the quality of the relationship between tourists and IVAs. The second study confirms the direct relationships of the first and shows that self-esteem and technology expertise act as moderators.Practical implicationsThis study advances the understanding of the tourism and hospitality stakeholders in using modern technologies (e.g. IVAs). Through comprehending the relationship building between individuals and IVAs, the stakeholders will be able to craft better strategies.Originality/valueThe study extends the attachment and social exchange theories to the tourist–IVA relationship context. Specifically, this research demonstrates the impact of tourist perceived value on the quality of the relationship with the IVA. It also points out that tourists’ self-esteem and technology expertise can weaken the tourist–IVA relationship.

Protocol for implementation of an evidence based parentally administered intervention for preterm infants

BackgroundMulti-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents’ interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidence-based standardized early behavioral interventions as routine care. Lack of implementation is a major gap between research and clinical practice. H-HOPE, is a standardized behavioral intervention with an infant- directed component (Massage+) and a parent-directed component (four participatory guidance sessions that focus on preterm infants’ behaviors and appropriate responses). H-HOPE has well documented efficacy. The purpose of this implementation study is to establish H-HOPE as the standard of care in 5 NICUs.MethodsThe study employs a Type 3 Hybrid design to simultaneously examine the implementation process and effectiveness in five NICUs. To stagger implementation across the clinical sites, we use an incomplete stepped wedge design. The five participating NICUs were purposively selected to represent different acuity levels, number of beds, locations and populations served. Our implementation strategy integrates our experience conducting H-HOPE and a well-established implementation model, the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies influences (facilitators and barriers) that affect successful implementation within five domains: intervention characteristics, outer setting (the hospital and external events and stakeholders), inner setting (NICU), implementers’ individual characteristics, and the implementation process. NICUs will use the CFIR process, which includes three phases: Planning and Engaging, Executing, and Reflecting and Evaluating. Because sustaining is a critical goal of implementation, we modify the CFIR implementation process by adding a final phase of Sustaining.DiscussionThis study builds on the CFIR, adding Sustaining H-HOPE to observe what happens when sites begin to maintain implementation without outside support, and extends its use to the NICU acute care setting. Our mixed methods analysis systematically identifies key facilitators and barriers of implementation success and effectiveness across the five domains of the CFIR. Long term benefits have not yet been studied but may include substantial health and developmental outcomes for infants, more optimal parent-child relationships, reduced stress and costs for families, and substantial indirect societal benefits including reduced health care and special education costs.Trial registrationClinicalTrials.gov registration number NCT04555590, Registered on 8/19/2020.

Challenges and solutions in nurse practitioners’ work for interprofessional collaboration at rural community hospitals: The grounded theory approach

Interprofessional collaboration is vital for the treatment of elderly patients, especially in rural community hospitals. However, the application of nurse practitioners (NPs) can induce various issues, including conflicts with other professionals. The purpose of this study was to clarify a productive process for the application of NPs in community hospitals. Semi-structured interviews were conducted with registered nurses , advanced practice registered nurses , an NP, and physicians at a rural community hospital. The transcripts were analyzed utilizing the grounded theory approach. Three themes appeared: conflict management, moderation through participation, and seamless nursing care. Differences in the nursing and environmental cultures induced misunderstandings between the NP and nurses. General physicians facilitated continual dialogue with nurses to clarify the role of the NP. Effective collaboration among nurses and the NP could lead to effective consultations with physicians. To drive this process, general physicians and hospital stakeholders should collaborate continuously. • Nurse practitioners can perform nursing work to reduce interprofessional conflicts. • Nurse practitioners can facilitate collaboration by providing education to nurses. • General physicians and stakeholders should drive the collaborative process.

Perceptions of a comprehensive dental care teaching clinic among stakeholders in a dental teaching hospital in South India: A baseline assessment

BackgroundWhen the dentist starts practicing independently, they need to plan and treat comprehensively and prioritise the procedures accordingly. This contrasts with dental students learning years where they deal with only a clinical subject during a fixed period. To improve this scenario a comprehensive dental care teaching clinic was introduced, and baseline assessment was performed. MethodsThe perceptions of patients, dental undergraduate students, clinical instructors, and clinic co-ordinators regarding Comprehensive Dental Care was evaluated by a cross sectional survey. The questionnaire was developed through a focus group discussion and content validation was performed by experts. Three domains including orientation to the clinics, clinical training of undergraduates and clinic management were assessed. Descriptive statistics were performed using SPSS. ResultsThe results reveal, 53.5% of undergraduate students and 61.3% of clinic instructors agreeing that students trained under comprehensive system can confidently manage patients independently. Good collaboration (80%) among the dental team and regular monitoring of the clinic management (80%) were reported by clinic co-ordinators. The challenges ahead for this teaching clinic includes instrument and facilities availability, which has found to higher disagreement percentages by undergraduate students (43.7%), clinic instructors (38.7%) as well as clinic co-ordinators (50%). Patient satisfaction for all three domains were noted to be high. ConclusionWith the introduction of the comprehensive dental care teaching clinic better patient management and improved clinical training of undergraduate students were reported by the stakeholders. This new system is a major shift in dental service delivery and can be adopted to similar settings to improve patient care and dental education.