Inadequate Staffing Research Articles

Factors affecting utilization of male sexual and reproductive health services: a qualitative description of males in Anambra State, Southeast Nigeria

IntroductionThe utilization of sexual and reproductive health (SRH) services by males globally is significantly low despite their considerable sexual and reproductive health needs. This study aimed to understand the factors that influence the utilization of male sexual and reproductive health SRH services.MethodsWe used an explanatory sequential mixed methods research design, with qualitative description to explore the perceptions of males (15-49years) on the utilization of male SRH services in Anambra State, Nigeria. In October 2021, 56 males participated in seven focus group discussions conducted across seven communities. The data were analysed by thematic analysis. A composite narrative was used to report the results.ResultsMales in both urban and rural areas of Anambra State preferred informal health facilities; male-focused health facilities and male health workers. The participants perceived services as costly; and criticized healthcare workers’ attitudes. Some rural areas had inadequate SRH facilities, staff and commodities. The participants exhibited varying levels of SRH awareness.ConclusionTo improve male SRH service utilization, clinics should be more male-centric and cost-effective. Healthcare providers require retraining to offer patient-centered care. Additionally, ward development committees should advocate for better staffing and the availability of SRH commodities.

Association between nursing workload and staff size with the occurrence of adverse events and deaths of patients with COVID-19: A retrospective cohort study.

The safety of patients in the intensive care unit (ICU) is significantly impacted by inadequate staffing of nursing professionals to meet the demand for care of critically ill patients. COVID-19 patients increased nurses' workload, particularly in high-intensity care settings like the ICU. To evaluate the association of workload and number of patients per nursing professional with the occurrence of adverse events and death in critically ill patients with COVID-19 in the ICU. This is a retrospective cohort study. This study analysed patients with COVID-19, aged 12 years or older, admitted between 1 April 2020 and 31 May 2021 in the ICU of a hospital in Brazil. Nursing workload was measured by the Nursing Activities Score (NAS). The independent variables were the ratio of the NAS score per nursing professional (NNR) and the ratio of the number of patients per nursing professional (PNR). Dependent variables included adverse events (pressure injuries and health care-associated infections-HAIs) and death in the ICU. Of the 386 included patients, 59.59% were male and the median age was 60.5 years. The median NAS, NNR and PNR values were 72.81%, 128% and 1.64, respectively. The frequency of pressure injuries (31.09%) exceeded that of HAIs (16.06%), and 218 patients (56.48%) died. The NNR was associated with HAIs (OR 1.006; CI95% 1.001-1.012; p = .012), pressure injury (OR 1.005; CI95% 1.000-1.010; p = .033) and death (OR 1.010; CI95% 1.005-1.015; p < .001) in the ICU. There was no association between PNR values and the study's dependent variables. A high workload per nursing professional was associated with the occurrence of adverse events and deaths of patients with COVID-19 in the ICU, while the nursing staff sizing was not. The results reinforce the importance of evaluating the workload of nursing professionals to establish safety measures for the care of patients with infectious diseases.

IMPACT OF THE WAR AND THE COVID-19 PANDEMIC ON THE MORTALITY RATE OF CHILDREN UNDER THE AGE OF 1 YEAR IN UKRAINE IN UKRAINE

Background. The war and the consequences of the COVID-19 pandemic have an extremely negative impact on the morbidity and mortality of the child population. The aim of the study is to analyse the impact of the war and the consequences of the COVID-19 pandemic on the dynamics of infant mortality and its components in Ukraine from 2020 to 2023.Study materials and methods. Retrospective analysis and assessment of infant mortality and its components in Ukraine for theperiod from 2020 to 2023 was carried out on the basis of the data of the sectoral statistics of the state institution «Public Health Centre of the Ministry of Health of Ukraine». The methods of systematic approach, statistical data processing and epidemiological analysis of graphical representation were used.Results and discussion. In 2023, after three years of the COVID-19 pandemic and against the background of the ongoing Russian invasion of Ukraine, the infant mortality rate increased to 7.45 ‰ or 11.69 % compared to 2020. This increase was mainly due to a relatively higher increase in postneonatal mortality and late neonatal mortality in the current environment compared to early neonatal mortality. Certain conditions occurring in the perinatal period, congenital anomalies (malformations), malformations and chromosomal disorders, respiratory diseases, especially acute respiratory diseases of the upper airways, pneumonia, infl uenza, some infectious and parasitic diseases and diseases of the nervous system are the main causes of mortality in children in the fi rst year of life in 2023. In the structure of infant mortality, the proportion of deaths of children under 1 year of age due to infectious and parasitic diseases, respiratory diseases and external causes (injuries, poisoning, accidents), diseases of the nervous system and diseases of the circulatory system has increased signifi cantly in the last 4 years, which may also be a result of the direct and indirect synergistic eff ects of the war and the COVID-19 pandemic. The highest infant mortality rates were observed in Kherson (28.27 per cent), Zakarpattia (11.5 per cent), Dnipropetrovsk (9.29 per cent), Kirovograd (9.19 per cent), Donetsk (9.12 per cent), Zhytomyr (8.93 per cent) and Chernihiv (8.71 per cent) regions, which may indicate inadequate staffi ng and resources for paediatric services, particularly as a result of the war. Of particular concern is the 11.5 per cent increase in out-of-hospital mortality in the fi rst year of life compared with 2020, which may be due to the deterioration in the availability of medical care for children as a result of the hostilities in the east and south of the country.Conclusion. After three years of the COVID-19 pandemic and against the background of the ongoing Russian invasion, Ukraine has experienced an increase in infant mortality, with an increase in the incidence of children under one year of age and a greater increase in postneonatal and late neonatal mortality compared with a relatively small increase in early neonatal mortality.

An Investigation of the Barriers to Care of Adult Patients With a Tracheostomy in Intensive Care Units and General Wards: Secondary Analysis of Qualitative Interview Data

ABSTRACTAims and ObjectivesTo investigate the barriers experienced by intensive care nurses and registered nurses and to provide optimal nursing for adult patients with a temporary tracheostomy in intensive care and general wards.BackgroundTracheostomy is widely used in intensive care units, around 20% of intensive care unit patients undergo tracheostomy insertions and expect high quality of care. Caring for patients with a tracheostomy is complex and challenging task. An investigation of barriers to care for adult patients with a temporary tracheostomy in a hospital setting is essential to ensure that these patients receive the highest quality of care and to identify areas for improvement.DesignThis paper applied secondary analysis to data from two qualitative studies, including narrative interviews and maximum variation sampling.MethodsSecondary analysis of primary qualitative datasets is appropriate when the analysis extends rather than exceeds the primary. The analysis was based on interview data collected from six intensive care nurses and six registered nurses from two university teaching hospitals in Norway. The interviews were audio‐recorded and transcribed. The data was analysed using the qualitative analysis suggested by Graneheim and Lundman. This study adhered to the consolidated criteria for reporting in a qualitative research (COREQ) checklist.ResultsFour main themes were identified as barriers to care for adult patients with a temporary tracheostomy in the hospital: encountering ambivalence, inadequate staffing levels, lack of patient continuity of care and lack of systematic follow‐up.ConclusionsUnderstanding barriers to care is crucial for hospitals and healthcare organisations to develop targeted interventions and educational programs to address these barriers and improve the care provided to adult patients with tracheostomies in hospital settings.

Behind closed doors: Freelance nurses and the reality of unmet care needs in Italian home care setting. Insight from a phenomenological descriptive study.

The term 'Missed Nursing Care' (MNC) refers to any aspect of nursing care that is not delivered, partially delivered, or delayed. MNC has significant negative consequences, including adverse patient outcomes, safety risks, and decreased job satisfaction. While extensively studied in hospitals, MNC in community healthcare settings, remains under-researched, especially in Italy. This study aims to explore the phenomenon of MNC in Italian home care settings by documenting and analyzing the lived experiences of freelance nurses, focusing on the characteristics, influencing factors, and consequences of MNC as perceived by these healthcare professionals. This is a descriptive phenomenological study. Using snowball sampling, 12 Italian freelance nurses were recruited and interviewed from November 2022 to February 2023. Data collection was based on in-depth interviews, that have been transcribed and analyzed using Giorgi's phenomenological framework. The study report adhered to the COREQ-32 checklist for qualitative research. Thematic analysis revealed four main themes: dimensions of MNC, organizational challenges, consequences of MNC, and family-nurse collaboration. Freelance nurses frequently addressed unmet fundamental and complex nursing needs, highlighting significant clinical, psychological, and economic impacts on patients and families. Organizational issues, such as rigid public service schedules and inadequate staffing, were identified as primary contributors to MNC. Families played a crucial role in managing care and collaborating with freelance nurses to ensure continuity. This study provides novel insights into MNC in Italian home care settings, emphasizing the critical role of freelance nurses in filling care gaps. The findings suggest the need for systemic changes to improve flexibility, staffing, and integration of public and private nursing services. Further research, particularly quantitative studies, is essential to validate these findings and explore broader implications for patient care and health outcomes.

Interpreting Context in Rural and Remote Aged Care Facilities in Readiness for a New Care Model: A Mixed Method Study.

Geographical isolation compounds limited access to healthcare services and skilled workforce for the provision of rural aged care. Residents have complex chronic disease management and end-of-life care needs. An undersupply of general medical practitioners due to retirement, attrition or unfilled training places in Australia has impacted recruitment to rural areas. Nurse practitioners have been identified as a potential solution. To describe and explore the inner (local and organisational) and outer (wider health system) contexts of healthcare, from the perspective of care staff and residents' families. This, in turn, aims to inform the planned implementation of a nurse practitioner model, in several aged care facilities, operating within rural and remote settings, in Queensland Australia. A convergent mixed methods design. Qualitative data were collected, in 2022-2023, using semistructured interviews with staff focusing on role, knowledge development, workplace culture and care relationships with local community. Resident's family's perspectives were obtained as a secondary analysis of organisational feedback data. Quantitative data were collected from direct care workers using the Alberta Context Tool for Long-Term Care. Data were analysed according to type and integrated. Relational care for residents and families is highly valued but provision of quality is challenging where time-poor staff are perceived to be doing the best they can. Scarce local healthcare services make it difficult to meet resident healthcare needs. Despite the supportive organisational culture, evolving policy requirements have impacted already difficult staff recruitment in rural settings. Identifying contextual needs of organisations in readiness for change highlights geographical and sectoral nuances influencing any future implementation. As government policy changes to improve the older adult care sector, rural and remote facilities are forced to increasingly adapt. Context-specific needs extend far beyond a nurse practitioner providing additional expertise in care provision. What problem did the study address? Nurse practitioners have been successfully implemented into residential aged care facilities in metropolitan and major regional centres but translating this role into rural and remote Australia requires being cognisant of the needs, unique challenges and context of this setting. What were the main findings? In an organisational culture of support, the importance of staff providing relational care and having connection with older adult residents and families was a central driver. It was challenging for staff to meet complex care requirements in the absence of local healthcare options and support. Time pressures, from inadequate staffing and changing structural aged care sector, force the prioritising of care requirements. Where and on whom will the research have an impact? Older adults, policy makers and aged care providers will benefit from understanding the context of rural and remote settings, particularly in identifying potential solutions when there are gaps in primary and secondary healthcare. The GRAMMS checklist was followed in reporting of this study. Two lived experience consumers were involved as research team members. One was involved during the development and submission of the funding application and another during project activities including data collection and analysis and the development of publications.

Examining Factors Influencing the Use of Health Management Information Systems Data for Health Facility Planning in Kigoma Ujiji Municipal and Kigoma District Councils, Tanzania

Background: Tanzania has adopted an open-source Health Management Information System (HMIS) to help understand health patterns, make informed decisions, and take action to improve the quality of health services through effective planning. However, generating and utilizing health data in most facilities presents significant challenges. This study examined factors influencing the use of HMIS data for health facility planning in Kigoma Ujiji Municipal and Kigoma District Councils. Methods: This cross-sectional explanatory study was conducted using a qualitative approach in two districts of the Kigoma region—Kigoma and Ujiji district councils. Participants included members of the Council Health Management Teams and staff from six healthcare facilities. The study employed the PRISM framework to explore how technical, organizational, and behavioral factors influence the use of data in health facility planning. Data was collected through in-depth interviews and focus group discussions. Thematic analysis, supported by NVivo software, was applied to manage and analyze the data. Results: A total of 32 participants were involved in this study. Most reported that health facilities had standard indicators, data collection forms, and established data analysis and reporting procedures, with clear HMIS roles and responsibilities. However, challenges such as poor data quality, insufficient IT resources, inadequate staff training, limited financial support, and unsupportive organizational culture were reported to affect the effective use of data in planning. Conclusions: Poor data quality, inadequate training, inadequate HMIS staff, and poor information culture, motivation, attitudes, and values limited data use. This study calls for health system interventions to address staffing, training, information culture, data quality, and individual attitudes and behaviors to improve the use of data in health facility planning and decision-making.

Understanding modifiable barriers to human milk donation in the United Kingdom.

When premature infants cannot receive their own mother's milk, donor human milk (DHM) is the first-line recommended option, with growing demand for DHM use outside of neonatal units. To meet the potential need, we need to consider whether DHM supply can increase. This study aimed to explore the reasons that prevent women who wish to donate their milk in the United Kingdom from doing so to understand which barriers may be modifiable. Women who wanted to donate their milk but did not do so completed an online survey. Open and closed questions examined the response they received, their reasons for not donating and what they did with any milk that they had already stored. Out of 732 mothers, 391 (53.4%) did not enquire as they did not think it was possible for them, 218 (29.8%) enquired but were told that they could not donate, 59 (8.1%) enquired but decided not to proceed and 64 (8.7%) received no response. Reasons for being told they could not donate included the use of certain medications, infant age, inadequate staffing, geographic barriers and incorrect storage. Process aspects (e.g., blood tests, practicalities) and lifestyle limitations led mothers to decide not to donate. Although some women will be prevented from donating due to medication or health issues, investment in milk banking staffing and infrastructure and awareness campaigns could increase DHM supply, enabling guidelines to extend eligibility criteria for receiving DHM such as for late preterm infants, gestational diabetes or to support low maternal milk supply.

Middle-grade led Expedited Gall bladder lists: Is it safe and feasible?

Gallstone-related acute admissions account for a significant percentage of acute general surgery admissions. Providing a dedicated expedited gall bladder list service to deal with these cases appears to be not only clinically effective but also cost-effective. There are various logistical reasons why hospitals are unable to provide such dedicated lists, inadequate surgical staff being one of them. We initiated a middle-grade-led expedited gall bladder list with indirect consultant oversight at our hospital as a consultant-led list was not feasible. This study evaluates the safety and efficacy of this service post-implementation. A retrospective analysis was conducted on prospectively collected data from February 2022 to September 2023. Patients were triaged using a dedicated questionnaire and operated on within 2-8 weeks of admission. The outcomes measured included complications, readmissions and the need for consultant opinion and assistance. Amongst 101 patients, the mean age was 50.59 ± 15.25 years, with a majority being female and having an American Society of Anaesthesiologists grade of 2. Consultant assistance was required in 14 cases, with 9 requiring active participation. Complications were comparable to national averages, with four cases of bile leaks and one small bowel injury. Six readmissions were recorded for various postoperative issues. The middle-grade led expedited gall bladder service demonstrated a safe and effective alternative to consultant-led lists, offering a pragmatic approach to addressing surgical demands within the constraints of staff and facility limitations.

Exploring Managers' Insights on Integrating Mental Health into Tuberculosis and HIV Care in the Free State Province, South Africa.

The integration of mental health (MH) services into tuberculosis (TB) and HIV care remains a significant challenge in South Africa's Free State province. This study seeks to understand the perspectives of public health programme managers on the barriers to such integration and to identify potential strategies to overcome these challenges. Data were collected between February and October 2021 using qualitative methods including four individual semi-structured interviews and two focus group discussions with a total of 15 managers responsible for the MH, primary healthcare, TB, and HIV programmes. Thematic data analysis was guided by an adapted version of the World Health Organization's "building blocks" framework encompassing "service delivery", "workforce", "health information", "essential medicines", "financing", and "leadership/governance". Additionally, the analysis underscored the crucial role of "people", acknowledging their significant contributions as both caregivers and recipients of care. Managers highlighted significant concerns regarding the insufficient integration of MH services, identifying structural barriers such as inadequate MH management structures and staff training, as well as social barriers, notably stigma and a lack of family treatment adherence support. Conversely, they recognised strong management structures, integrated screening, and social interventions, including family involvement, as key facilitators of successful MH integration. The findings emphasise the need for a whole-system approach that addresses all building blocks while prioritising the role of "people" in overcoming challenges with integrating MH services into TB and HIV care.

Exploring the barriers to the development of organizational health literacy in health institutions to meet the needs of older patients from multiple perspectives: a mixed-methods study

BackgroundThe latest evidence on health literacy in China revealed that only 8% of individuals aged 65–69 years, a segment of the geriatric population, possess adequate health literacy levels, indicating a low level in China. Studies have demonstrated that improving the organizational health literacy of healthcare institutions is a crucial approach to addressing low health literacy among older patients.ObjectiveTo explore the obstacles hindering the advancement of organizational health literacy in healthcare institutions in meeting the needs of older patients.DesignA mixed-methods approach was employed to investigate both the status and barriers to the establishment of organizational health literacy within two healthcare institutions.ParticipantsParticipants included older individuals aged over 60, clinical staff, and managerial personnel from these two health institutions.MethodsThis research utilized the social-ecological model as its theoretical foundation and utilized a mixed-methods approach to examine the current status and challenges in developing organizational health literacy within healthcare institutions. Initially, a survey using a questionnaire (n = 178) was conducted among older patients to evaluate the establishment of organizational health literacy from their perspective. Following this, interviews (n = 22) were carried out with administrators, clinical personnel, and elderly patients to identify the barriers hindering the development of organizational health literacy within healthcare institutions.ResultsQuantitative research indicates that health institutions have been less accommodating to the requirements of older patients, with health information dissemination and communication emerging as the weakest areas. Qualitative investigations revealed three key influencing factors: patient-related factors, including physiological and cognitive decline, as well as low educational attainment among older patients; organizational factors, including inadequate clinical staff numbers, deficient long-term systematic training, and a digital divide resulting from health institutions’ digital advancements; and policy-related factors indicating a lack of regulations governing the establishment of organizational health literacy within healthcare institutions.ConclusionThe two most vulnerable aspects of OHL in medical institutions regarding the needs of older patients are health information and communication. The factors influencing the construction of OHL in medical institutions are multifaceted, encompassing micro, meso, and macro levels. At the macro level, it is essential for medical institutions to enhance leadership awareness of OHL and to incorporate its development into institutional strategic plans. At the meso-level, medical institutions should be made to optimize the medical environment for elderly patients and to prioritize health literacy training for medical staff. At the micro level, attention must be given to the characteristics and needs of elderly patients. Ultimately, by implementing a comprehensive construction of intervention strategies, the response ability of medical institutions to the needs of elderly patients can be enhanced.

Qualitative evaluation and corrective planning for centrifugal pump maintenance at Soekarno-Hatta airport

This study focuses on enhancing the maintenance processes of centrifugal pumps at Soekarno-Hatta Airport’s Water Treatment Unit in Indonesia, crucial for meeting the clean water needs of the airport, which served around 19.8 million passengers in 2022. Using a qualitative methodology, the research involved focus group discussions with the unit’s operators, technicians, and engineers to pinpoint maintenance challenges and devise solutions. Key findings reveal issues such as insufficient routine maintenance, unplanned repairs, and inadequate staffing, leading to operational disruptions and pump failures. The study highlights the role of Total Productive Maintenance (TPM) in reducing machine breakdowns and improving efficiency. It emphasizes the critical role of centrifugal pumps in the airport’s water supply system. The research proposes several corrective measures, adhering to the 5W + 1H framework, including regular lubrication, bearing replacements, hiring more staff, and advanced training on PLC systems. These actions aim to rectify immediate maintenance problems and establish a foundation for the long-term effectiveness of the pump systems. Conclusively, the study underscores the need for a comprehensive maintenance strategy that aligns with standard operating procedures and preventive maintenance. This approach is essential for boosting the operational performance and reliability of the Water Treatment Unit. It has broader implications for similar infrastructure facilities, underscoring the importance of efficient maintenance management.

Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation

BackgroundInfection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown.MethodsWe conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively.ResultsThirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators.ConclusionsEfforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.

Information Literacy Skills And Service Delivery Of Librarians In State Universities In South-West, Nigeria

Service delivery is the interaction between librarians and the users of the library in order to satisfy their academic objectives. Nevertheless, past studies have shown low library service delivery as revealed in the impatient and unwillingness of librarians to assist information seekers, harsh and unpleasant attitude of librarians, uncomfortable infrastructure and inadequate staff strength. Though studies have been done to examine information literacy skills) and service delivery, they are scanty. It is on this note that this study investigated the influence of information literacy skills on service delivery of librarians in state university libraries in South-West, Nigeria. Survey research design was adopted for this study. The population of the study was 90 librarians from six state universities in South-West Nigeria. Total enumeration was used for the study. Adopted questionnaire was used to obtain data. Cronbach’s alpha reliability coefficient for the constructs ranged from 0.72 to 0.86. A response rate of 89% was achieved. Data were analyzed using descriptive and inferential (simple and multiple regression) statistics at 5% level of significance. Findings revealed that information literacy skills had no significant influence on service delivery of librarians in state universities in South-West, Nigeria. The study concluded that information literacy skill did not enhance service delivery of librarians in state universities in South-West, Nigeria. The study recommended that the management of the state university libraries should explore other factors that could enhance service delivery other than information literacy skills

EVALUATING CUSTOMER SATISFACTION IN A PRIVATE BANK: INSIGHTS FROM A SURVEY IN BANGLADESH

Customer satisfaction is essential for a bank's success and loyalty. Satisfied customers are more likely to be loyal and recommend the bank to others. This study explores customer satisfaction at a branch of a private bank in Bangladesh. A survey questionnaire was utilized, and feedback was received from 100 customers. The analysis, based on mean and standard deviation, shows overall high satisfaction but highlights several areas of concern. Key issues include limited branch space, inadequate staffing, and dissatisfaction with cleanliness and customer service. The customers were largely neutral in their opinions on debit/credit card services and online banking. By improving poor areas, the bank can foster stronger customer loyalty and better service experiences.

Is the delivery of National Disability Insurance Scheme in Australia through quasi markets achieving the right outcomes in vision rehabilitation services? A qualitative study

Purpose Despite being a pioneering social initiative worldwide, Australia’s National Disability Insurance Scheme (NDIS) still presents unresolved issues for individuals with vision-related disability regarding its processes and outcomes. This study evaluates how well the NDIS markets are perceived to achieve efficiency, responsiveness, choice, quality, and equity within the vision rehabilitation sector, and identified factors facilitating or hindering desired outcomes. Materials and methods This qualitative study conducted 22 semi-structured interviews involving individuals with vision disability, service providers, peak-body and professional-body representatives, and an NDIS planner. Results Findings across stakeholder groups show minimal variation. The NDIS’s quasi-market approach has improved participants’ choices over ways to utilise and manage their funding and consequently provided them with a sense of control and empowerment. However, inefficiencies persist due to insufficient competition, workforce shortages, price caps, information asymmetry, high transaction costs, gaming behaviour, inadequate staff training, complex and lengthy processes, and eligibility concerns. Supportive factors include effective advocacy, pragmatic regulations to maintain quality, opportunities for innovation, and service providers’ motivation for cost-effectiveness. Conclusions While NDIS markets have made significant strides in enhancing participants’ choice and control, our findings underscore the need for continued refinement to achieve broader social objectives and long-term sustainability for individuals with vision-related disability.

Nurses’ experiences in neonatal sepsis prevention and management: a qualitative cross-sectional study at selected hospitals in a metropolitan area

BackgroundNeonatal sepsis represents a significant cause of morbidity and mortality among infants in healthcare settings. This study explored nurses’ experiences in preventing and managing neonatal sepsis in the Tamale metropolis.MethodsAn exploratory, descriptive qualitative cross-sectional study design was used, and data was collected using semi-structured interviews. The sample size was determined at the point of data saturation of fifteen participants. Thematic analysis was employed to identify codes, subthemes, and themes within the interview transcripts.ResultsThree major challenges nurses face in preventing and managing neonatal sepsis, including (1) the absence of a protocol for handling newborns upon admission, (2) an excessive workload that made it difficult for staff to follow infection prevention protocols, and (3) inadequate, obsolete and/or lack of equipment that caused devices to be overused. The nurses also identified critical psychological and emotional difficulties they encounter as a result of working within such a stressful environment. Other activities nurses conducted were handwashing before and after every procedure, infection prevention, and separating the babies in the incubator. In managing babies with neonatal sepsis, nurses provided daily treatment, hygiene care, and supported activities of living. The nurses also assert that the availability of resources, appropriate staff, and critical skills are important for preventing and managing neonatal sepsis.ConclusionThe lack of basic working consumables like gloves, syringes, and needles, inadequate staff, and lack of defined protocol of care were identified as critical challenges that hamper the care provided in neonatal care units. Hospital authorities must focus attention on addressing the critical challenges faced by neonatal care units. Also, measures should be instituted to address the emotional and psychological concerns associated with nursing care. Future research must consider the level of influence of each of the challenges enumerated on nurses’ overall health.

Does staffing impact health and work conditions of staff in long-term care homes?: a scoping review

Abstract Background Long-Term Care (LTC) homes are highly regulated and task oriented, with demanding work and insufficient resources. Chronic underfunding of the sector, coupled with increased complexity of care, has deteriorated working conditions, resulting in precarious employment, intensified and stressful work, and decreased job satisfaction. These work conditions have contributed to severe staffing shortages of healthcare workers globally. To meet increased labour demands, OECD countries on average will need to increase the proportion of overall employment dedicated to LTC by 32% over the next decade. While reviews of literature have examined the association between staffing and care outcomes for residents in LTC, they have not examined how staffing structures affect the healthcare staff themselves. This scoping review asks: How does staffing impact the health of staff and working conditions in LTC? Methods A scoping review of empirical peer reviewed and grey literature was conducted to examine the association between LTC staffing practices and how they impact working conditions and the health and well-being of staff. PubMed, CINHAL, and Scopus databases were searched for relevant articles published within the past 10 years. Results Searches yielded 3994 unique articles, which were independently screened by pairs of reviewers. Preliminary results highlight that staffing levels are not optimized for healthy, sustainable work conditions. The level of staff, their skill mix, and ratios all impact the ability to provide care. In circumstances where there is inadequate staffing, care workers are more likely to experience stress, burnout, job dissatisfaction, and increased injury and illness. Conclusions Staffing practices shape working conditions which impact healthcare workers own health outcomes. To facilitate a strong LTC workforce, working conditions and occupational health need to be a priority in improvement initiatives. Key messages • With extreme staffing shortages challenging the healthcare sector, this review highlights the need for heightened attention to the impact of staffing practices on the healthcare workforce. • Improving working conditions and attuning to the needs of the workforce, ultimately improves quality of care.

Implementing national care guidelines in local authorities in England and Wales: a theory-of-change

BackgroundThe delivery of high-quality services in chronically underfunded social or long-term care systems is a major challenge internationally. National guidelines, developed by the National Institute for Health and Care Excellence, set out how local authorities in England and Wales should fund and provide care based on best available evidence. Theoretical and participatory approaches can usefully inform the design and evaluation of implementation strategies for guidelines. The aim of the study is to develop a Theory-of-Change for how the implementation of these guidelines is expected to lead to impacts from a local authority perspective.MethodsAs part of a comparative case study (The ‘Valuing Care Guidelines’ study; February 2022 to April 2024) with three local authority sites in England and Wales, we involved altogether 17 participants in two Theory-of-Change online workshops per site, each of 2 hours. Additional data gathered from the same participants as part of the overall study were used to conceptualise and enrich information from the workshops.ResultsParticipants described the Theory-of-Change map as follows: A wide range of activities (categorised in stages of ‘pre-implementation’, ‘implementation’, ‘sustainment and scaling’) and skills were required to implement guidelines, and achieve long-term organisational sustainability and service delivery outcomes, leading to final impacts for service users and carers. Participants described a co-creation implementation model, led by ‘Implementation Support Practitioners’, who utilised relational skills to achieve motivation, trust, and confidence at different organisational levels, addressing contextual barriers such as inadequate staffing, lack of resources and of organisational support systems. Consistent use of guidelines by frontline staff could only be achieved if the value of guideline implementation was promoted widely, and if consideration was given to the roles of stakeholders, such as the inspection body, local health care providers, users and carers.ConclusionsOur study is the first to investigate the implementation of national social care guidelines by local authorities in England and Wales. It generates insights that can guide implementation practice as well as inform the evaluation of future implementation strategies.

Institution-Wide Moral Distress Among Nurses.

Moral distress is the inability to do the right thing due to imposed constraints. Explore the presence of moral distress among nurses. A quantitative, exploratory, cross-sectional study at a level 1 trauma center using the Measure of Moral Distress for Healthcare Professionals (MMD-HP). Ninety-seven nurses completed the MMD-HP. The top 3 items contributing to moral distress included inadequate staffing, inadequate resources, and lack of administrative support. Nurses who considered leaving had more moral distress. Moral distress explained 28.5% of the variance associated with nurses' "intent to leave" and "primary unit" ( P < 0.001). Moral distress for nurses 40 to 49 years of age was higher compared with nurses 50 years or older. Moral distress involved deficiencies in staffing, resources, and administrative support. Research should explore interventions to mitigate moral distress among nurses by promoting safe staffing levels, the provision of adequate resources, and increased administrative support.