Healthcare Staff Members Research Articles

Communication With Ventilated Patients In ICU: Perceptions On Existing Communication Methods And Needs

Introduction: Recent research has highlighted the need to improve communication with mechanically ventilated patients. There are a number of studies currently evaluating the usefulness of augmentative and alternativen communication methods (AACs), but a significant gap still exists in understanding patients’ key needs during the ventilation period.Aims: 1) To determine the perceptions of patients and healthcare staff on the use of AACs. 2) To find out patients’ key needs during ventilator treatment, within the context of Ward 118 in the Royal Infirmary of Edinburgh. 3) To use the results of this study to propose larger scale research into adapting a specific electronic device (Predictable) to aid communication.Methods: This qualitative study adopted semi-structured interviews lasting 10–20 minutes with 13 patients and 18 members of healthcare staff and applied thematic analysis in interpreting interview findings.Results: There was a mismatch between patient and staff perceptions on the usefulness of closed yes/no questions and lip reading. Aided AACs, such as picture boards, pen and paper, and sketch boards are also underused. Most patients and staff used a combination of methods rather than any one method alone. This study also found that patients’ key needs include addressing discomfort related to the ventilator, bed or breathing, emotional needs, trust building with healthcare staff and the need for more information.Conclusion: This study highlights the need for personalized, patient-centred care to facilitate effective communication with ventilated patients.

The Smart Floor: How a Public-Private Partnership co-developed a heterogeneous healthcare technology system.

Currently, a wide variety of healthcare technologies are being implemented in private homes, hospitals, nursing homes, etc. with the triple aim of improving people's health, improving the quality of care, and reducing costs related to healthcare services. In this chapter, we discuss how different actors in a public-private partnership co-developed a heterogeneous system around the Smart Floor to ensure that both new healthcare practices and residents' routines were inscribed into the new healthcare technology. We argue that implementing the Smart Floor was not just a question of buying a technology and integrating it during construction-it required co-development with the healthcare staff. The floor is more than a technology placed under the floor surface in a resident's apartment; rather, it is a heterogeneous network of human and non-human actors communicating with each other. In this chapter, we illustrate how the heterogeneous technological system was co-developed and redesigned during knowledge sharing processes with companies, lead-users, and healthcare staff. We also discuss how care practices have changed as a result of the Smart Floor system. In particular, healthcare staff members no longer feel a need to disturb elderly residents with routine in-person checks. Domesticating the technologies for different groups of actors required not only coordinating communication among sensors, the interface, the portable nurse call (smartphones), and alarms, but also accepting the use of surveillance technology.

Impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this systematic review is to examine the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants. INCLUSION CRITERIA Types of participants This review will consider studies that include infants who have undergone cleft lip repair. The review will exclude studies that include patients who have undergone cleft lip or palate repair over the age of one year. Types of intervention(s) This review will consider studies that evaluate the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants. Particular focus will be given to studies in which the same feeding method (breastfeeding or bottle-feeding) as that used preoperatively is compared with alternative feeding methods (spoon-, cup-, or syringe-feeding). Types of outcomes This review will consider studies that include the following outcome measure: incidence of surgical wound dehiscence as ascertained by health professionals. Secondary outcomes include weight gain, length of postoperative stay and hospital discharge, if enough data is available.

Development and validation of the Medical Home Care Coordination Survey for assessing care coordination in the primary care setting from the patient and provider perspectives.

BackgroundCommunity health centers are increasingly embracing the Patient Centered Medical Home (PCMH) model to improve quality, access to care, and patient experience while reducing healthcare costs. Care coordination (CC) is an important element of the PCMH model, but implementation and measurability of CC remains a problem within the outpatient setting. Assessing CC is an integral component of quality monitoring in health care systems. This study developed and validated the Medical Home Care Coordination Survey (MHCCS), to fill the gap in assessing CC in primary care from the perspectives of patients and their primary healthcare teams.MethodsWe conducted a review of relevant literature and existing care coordination instruments identified by bibliographic search and contact with experts. After identifying all care coordination domains that could be assessed by primary healthcare team members and patients, we developed a conceptual model. Potentially appropriate items from existing published CC measures, along with newly developed items, were matched to each domain for inclusion. A modified Delphi approach was used to establish content validity. Primary survey data was collected from 232 patients with care transition and/or complex chronic illness needs from the Community Health Center, Inc. and from 164 staff members from 12 community health centers across the country via mail, phone and online survey. The MHCCS was validated for internal consistency, reliability, discriminant and convergent validity. This study was conducted at the Community Health Center, Inc. from January 15, 2012 to July 15, 2014.ResultsThe 13-item MHCCS - Patient and the 32-item MHCCS - Healthcare Team were developed and validated. Exploratory Structural Equation Modeling was used to test the hypothesized domain structure. Four CC domains were confirmed from the patient group and eight were confirmed from the primary healthcare team group. All domains had high reliability (Cronbach’s α scores were above 0.8).ConclusionsPatients experience the ultimate output of care coordination services, but primary healthcare staff members are best primed to perceive many of the structural elements of care coordination. The proactive measurement and monitoring of the core domains from both perspectives provides a richer body of information for the continuous improvement of care coordination services. The MHCCS shows promise as a valid and reliable assessment of these CC efforts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0893-1) contains supplementary material, which is available to authorized users.

Boundaries and conditions of interpretation in multilingual and multicultural elderly healthcare.

BackgroundElderly migrants who do not speak the official language of their host country have increased due to extensive international migration, and will further increase in the future. This entails major challenges to ensure good communication and avoid communication barriers that can be overcome by the use of adequate interpreter services. To our knowledge, there are no previous investigations on interpreting practices in multilingual elderly healthcare from different healthcare professionals’ perspectives. This study examines issues concerning communication and healthcare through a particular focus on interpretation between health professionals and patients of different ethnic and linguistic backgrounds. The central aim of the project is to explore interpretation practices in multilingual elderly healthcare.MethodsA purposive sample of 33 healthcare professionals with experience of using interpreters in community multilingual elderly healthcare. Data were collected between October 2013 and March 2014 by 18 individual and four focus group interviews and analysed with qualitative content analysis.ResultsThe main results showed that interpreting practice in multilingual elderly healthcare was closely linked to institutional, interpersonal and individual levels. On the organizational level, however, guidelines for arranging the use of interpreters at workplaces were lacking. Professional interpreters were used on predictable occasions planned long in advance, and bilingual healthcare staff and family members acting as interpreters were used at short notice in everyday caring situations on unpredictable occasions. The professional interpreter was perceived as a person who should interpret spoken language word-for-word and who should translate written information. Furthermore, the use of a professional interpreter was not adapted to the context of multilingual elderly healthcare.ConclusionThis study found that interpreter practice in multilingual elderly healthcare is embedded in the organizational environment and closely related to the individual’s language skills, cultural beliefs and socio-economic factors. In order to formulate interpreter practice in the context of multilingual elderly healthcare it is important to consider organizational framework and cultural competence, cultural health knowledge, beliefs and customs.

How to cope with anxiety in hospital settings: Evaluation of a professional training

The objective of the present study was to examine the impact of a communication-oriented approach to disease and anxiety management in hospitals. Based on a five-step model of short-termed communication, we describe the importance of supportive relationships for health care staff, patients, and family members by means of selected examples. The study has wider implications for pastoral care.

PTH-133 Electronic Personal Health Records For Patients On Home Parenteral Nutrition: A Patient Satisfaction Survey

IntroductionThe public demand for flexible access to health information and services is growing, encouraged by Intnet trends and policies promoting patient involvement. Patients Know Best® (PKB) is an electronic patient...

The need for palliative care education, support, and reflection among rural nurses and other staff: A quantitative study

Many people now die in community care, and, considering the aging population, all healthcare staff members must be prepared to provide palliative care. Our objectives were to describe the total staff working in different care organizations in a rural community in Sweden and to explore palliative care competence, to describe educational gaps and the need for support and reflection, and to determine whether there are differences in care organizations, professions, age, and gender. A 4-section 20-item questionnaire was distributed to 1686 staff (65% response rate): in nursing homes (n = 395), home care (n = 240), and group residential settings (n = 365). Registered nurses (n = 70), assistant nurses (n = 916), managers (n = 43), and paramedics (n = 33) participated. Descriptive and correlational statistics were employed. Significant differences were found, and 40% (53% among men) lacked palliative care education, Fewer than 50% lacked education in the spiritual/existential areas, and 75% of those aged 20-66 (75% women, 55% men) needed further education. More women than men and staff aged 50-59 had an increased need to reflect. Our study may provide guidance for managers in rural communities when planning educational interventions in palliative care for healthcare staff and may support direct education with content for specific professions.

Spatial Experiences of Female Cancer Survivors

A phenomenological approach of the home can inspire research of the ways in which female cancer survivors experience the transition from the oncology care setting to home. Ten gynecological cancer survivors were interviewed. The analysis was inspired by the hermeneutic approach described by Ricoeur, and followed an interpretive structure that consisted of naïve reading, structural analysis, and comprehensive understanding. Based on the women’s stories, we argue that we are beings for whom home is a developed extension of ourselves, and one that is particularly significant insofar as it provides us with a basis from which we find ourselves able to expand into a larger “space”—a world. Information from this study could provide guidelines for health care staff members.

Disciplinary Procedures Against Israeli Nurses

In Israel, the Ministry of Health's Nursing Division, the regulating authority for the nursing profession, is responsible for every nurse's professional competence and fitness to practice. Disciplinary proceedings in the Israeli nursing profession are similar to those in other health care professions.The primary aim of the proceedings is to maintain levels of professional competence and ethics. However, to date, no Israeli publication has reported the findings on formal complaints against nurses, physicians, or other health care staff members in Israel. This article reviews the disciplinary decisions of the last decade and examines the sentencing policies of the Ministry of Health regarding the nursing profession.

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Introduction: Communication between ICU patients, healthcare staff, and family members is crucial to relay information about basic needs and decision making. The ability to communicate bolsters the patient's psychological well-being and draws attention to patient discomfort, which positively affects the patient's hospital stay and recovery. ICU patients that are conscious but unable to speak and write currently lack a means to effectively communicate. Methods: Non-verbal, non-writing patients were recruited from the Surgical Intensive Care Unit (SICU), Medical Intensive Care Unit (MICU), and Neurosciences Critical Care Unit (NCCU) at Johns Hopkins Hospital. Occupational Therapy and Speech Language Pathology trained the patient on the Tobii C12 eye tracking computer for a minimum of 3 sessions and 90 minutes before administering the assessment. The patient completed the Psychosocial Impact of Assistive Devices Scale (PIADS) after usage. Each patient rated the device's affect on 26 items relating to the core dimensions of psychological well-being, from -3 (significantly decrease) to 0 (no change) to +3 (significantly increases) with assistance from a caregiver or trainer. The 26 items are categorized into 3 sub-scales: competence, adaptability, and self-esteem. Results: Of 14 patients assessed and trained on the device, 4 patients (28.6%) were able to complete the minimum session and time requirements. Patients rated the device as having a moderate positive effect on their competence (Mean 2.14, S.D .72), between strong and moderate positive effect on their adaptability (Mean 2.42, S.D .59), and between a slight and moderate positive effect on their self-esteem (Mean 1.38, S.D .71). None of the patients rated the device as having a negative impact on any of the 3 subcategories. Conclusions: Patient response to the device was universally positive; patients outfitted with the C12 eye-tracking computer in the ICU experienced increased feelings of competence, adaptability, and self-esteem. All patients were able to communicate a minimum of their basic needs to healthcare staff and family members. Some patients had significant discussions regarding their care. The device has an overwhelmingly positive effect on the patient's psychological state in the ICU environment; patients are afforded greater independence, consequently reducing stress and feelings of helplessness. The Tobii C12 eye-tracking computer is a viable and effective assistive technology for patients in the acute care setting.

Stakeholders' Perceptions of the Development and Implementation of a Cardiovascular Risk Reduction Program in Rural Tennessee

To explore stakeholders’ perceptions on the development and implementation of a cardiovascular risk reduction program. Research suggests a high prevalence and greater risk of cardiovascular disease in rural communities, including regions of Appalachia. Focus groups were conducted with 35 health care professionals and staff members in 3 clinics in rural East Tennessee communities. Participants in the 3 groups included primary care professionals, behavioral health providers, case managers, office staff, and an administrator. The majority of participants (83%) were female. The outcome of this study was stakeholders’ needs and perceptions. Focus groups were audio-taped and transcribed verbatim. Text instances related to the research aim were identified, coded, and sorted into categories of similar responses. Potential target groups, barriers to implementation and behavior change, and strategies to overcome barriers were discussed. Patients with low-income, mental or behavioral illness, obesity, and diabetes were identified as high risk. Participants stated that patient non-adherence to treatment, low program participation and retention rates, limited provider time, and lack of transportation were potential implementation-related barriers. Finances, personal issues, and social and cultural influences were perceived to be major deterrents to behavior change. Participants suggested strategies to address the barriers, including hands-on education, a focus on children and families, use of groups, and transportation assistance. Stakeholders identified potential target populations, implementation barriers, and strategies for a cardiovascular risk reduction program. Findings will be used in the design of an intervention appropriate to the population.

Mother to Mother (M2M) Peer Support for Women in Prevention of Mother to Child Transmission (PMTCT) Programmes: A Qualitative Study

IntroductionMother-to-Mother (M2M) or “Mentor Mother” programmes utilise HIV positive mothers to provide support and advice to HIV positive pregnant women and mothers of HIV exposed babies. Médecins Sans Frontières (MSF) supported a Mentor Mother programme in Bulawayo, Zimbabwe from 2009 to 2012; with programme beneficiaries observed to have far higher retention at 6–8 weeks (99% vs 50%, p<0.0005) and to have higher adherence to Prevention of Mother to Child Transmission (PMTCT) guidelines, compared to those not opting in. In this study we explore how the M2M progamme may have contributed to these findings.MethodsIn this qualitative study we used thematic analysis of in-depth interviews (n = 79). This study was conducted in 2 urban districts of Bulawayo, Zimbabwe’s second largest city.ResultsInterviews were completed by 14 mentor mothers, 10 mentor mother family members, 30 beneficiaries (women enrolled both in PMTCT and M2M), 10 beneficiary family members, 5 women enrolled in PMTCT but who had declined to take part in the M2M programme and 10 health care staff members. All beneficiaries and health care staff reported that the programme had improved retention and provided rich information on how this was achieved. Additionally respondents described how the programme had helped bring about beneficial behaviour change.ConclusionsM2M programmes offer great potential to empower communities affected by HIV to catalyse positive behaviour change. Our results illustrate how M2M involvement may increase retention in PMTCT programmes. Non-disclosure to one’s partner, as well as some cultural practices prevalent in Zimbabwe appear to be major barriers to participation in M2M programmes.

Situación actual de los comités de Bioética clínico-asistenciales en la ciudad de Cartagena

The relevance of this project is rooted in the enormous benefit the acquisition of fundamental knowledge for identification andassessment by bioethics committees has for health-care staff members with respect to their practice.The aim of this project is to discover the features of bioethics committees in the city of Cartagena in terms of their identity and howthey function. To do so, a descriptive, cross-sectional, retro prospective study was done using a semi-structured questionnaire as abasis for assessing the ethics and bioethics committees that operate at each health care institution of high and medium complexitythe city of Cartagena. The study demonstrated the existence and extent of the institutional support they receive. Their limitationsinclude, among others, a lack of education on the topic, recommendations on action plans, and case review. The conclusion is thatthe study is important because of the need for a theoretical reference on these committees that in turn will guide the creation ofothers and improve the conditions for those now operating at health-care institutions in Cartagena.

Prevalence of burnout among home health care staff members in Saudi Arabia, 2010

Prevalence of burnout among home health care staff members in Saudi Arabia, 2010

Pediatric first aid knowledge and attitudes among staff in the preschools of Shanghai, China

BackgroundUnintentional injury remains the leading cause of morbidity and mortality among children worldwide. The aims of this study were to assess a baseline level of first aid knowledge and overall attitudes regarding first aid among staff members in Shanghai preschools.MethodsA cross-sectional study was carried out among the staff members at selected preschools. A stratified random sampling method was first used to identify suitable subjects. Data were obtained using a multiple-choice questionnaire. A standardized collection of demographics was performed and participants were given the aforementioned questionnaire to indicate knowledge of and attitudes toward first aid.Results1067 subjects completed the questionnaire. None of the surveyed employees answered all questions correctly; only 39 individuals (3.7%) achieved passing scores. The relative number of correct answers to specific questions ranged from 16.5% to 90.2%. In particular, subjects lacked knowledge regarding first aid for convulsive seizures (only 16.5% answered correctly), chemical injuries to the eye (23%), inhaled poison (27.6%), and choking and coughing (30.1%). A multiple linear regression analysis showed scores were significantly higher among staff members with more education, those who had received first aid training before or were already healthcare providers, younger employees, and staff members from rural districts. Most employees agreed that giving first aid was helpful; the vast majority felt that it was important and useful for them to learn pediatric first aid.ConclusionsThe level of first-aid knowledge among preschool staffs in Shanghai was low. There is an urgent need to educate staff members regarding first aid practices and the various risk factors relating to specific injuries.

Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study

BackgroundTelehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that are not well understood. This paper reports from a qualitative study nested within a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD) project. It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial.MethodsQualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention (n = 19), or who withdrew from the intervention arm (n = 3). Participants were recruited from the four trial groups (with diabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and all came from the three trial areas (Cornwall, Kent, east London). Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home. Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes.ResultsBarriers to adoption of TH and TC associated with non-participation and withdrawal from the trial were identified within the following themes: requirements for technical competence and operation of equipment; threats to identity, independence and self-care; expectations and experiences of disruption to services. Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderstandings. Respondents’ views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance, and views that interventions could undermine self-care and coping. Finally, participants were reluctant to risk potentially disruptive changes to existing services that were often highly valued.ConclusionsThese findings regarding perceptions of potential disruption of interventions to identity and services go beyond more common expectations that concerns about privacy and dislike of technology deter uptake. These insights have implications for health and social care staff indicating that more detailed information and time for discussion could be valuable especially on introduction. It seems especially important for potential recipients to have the opportunity to discuss their expectations and such views might usefully feed back into design and implementation.

Innovative Health Information Technology Training

Healthcare staff members are faced with an ever-increasing technology-enabled care environment as hospitals respond to financial and regulatory pressures to implement comprehensive electronic health record systems. Health information technology training may prove to facilitate user acceptance and overall adoption of advanced technologies. However, there is little evidence regarding best methods of providing health information technology training. This study retrospectively examined the difference in staff satisfaction between two training methods: traditional instructor-led and blended learning and found that participants were equally satisfied with either method. Furthermore, regardless of how much time was provided for practice, participants expressed a desire for more. These findings suggest that healthcare staff are open to new methods of training delivery and that, as adult learners, they desire increased opportunities to engage in hands-on activities.

Psychological and Health Impact of Working with Victims of Sex Trafficking

The UK is a major destination country for trafficking for sexual exploitation, and so increasing numbers of victims of trafficking are managed within health and social services. This study aims to assess the psychological and physical impact on health and social care staff working with an identified sex-trafficked population in a Northern City within England and identify methods to assist staff to manage this complex population. This research is a qualitative study of 12 members of health and social care staff through semi-structured interviews. The subjects were identified using purposive sampling, and data were analyzed using thematic analysis. Staff found working with sex-trafficked populations more difficult than with other vulnerable groups. They frequently described burnout and other adverse effects on their psychological and physical health. In general, staff felt undersupported and undertrained by their organizations. This led to concerns about the quality and sustainability of the service. Working with victims of sex trafficking significantly impacts on the physical and psychological health of staff. Staff working with such vulnerable groups require training and high levels of support to ensure that they are not adversely affected by their work and to ensure that high quality services are maintained. Practices to promote occupational health must be instilled within workplace policy and the organizational culture to limit the impact on psychological and physical health in staff working with vulnerable populations.

The need for a ‘Patient Safety in Dentistry Initiative’ in the Gulf States

Patient safety is gaining increased attention throughout the world and especially since the establishment of the World Health Organization’s (WHO) World Alliance for Patient Safety (WHO, 2008). However, patient safety in dentistry is still in its infancy. In the Gulf States with the diversity of its dental workforce, many of whom were trained overseas, monitoring adverse incidents in dentistry is essential. The publication in 1999, To Err is Human (Kohn et al., 1999) followed by Crossing the Quality Chasm (Institute of Medicine, 2001) galvanised domestic and international healthcare authorities into prioritising the reduction of iatrogenic harm caused by medical intervention. This mandate was further emphasised by medicine and in particular surgery have embraced the importance of reducing the burden of iatrogenic harm through the development of patient safety reporting systems. Dentistry has lagged behind its medical colleagues in developing patient safety programmes. Some dentists may reflect that issues of patient safety pertain solely to hospital-based medicine and surgery. However, general dentistry does involve penetrating surgery such as implants along with deep injections removal or draining of infections and health monitoring, all of which can and do lead to possible avoidable iatrogenic harm to the patients. With the current trend of more complex dental procedures being undertaken in community-based practices, the potential for iatrogenic harm increases. The need for a country based and in the future a Gulf wide patient safety Reporting and Learning System is needed. In England and Wales, there is one of the largest and most comprehensive reporting systems in the world; it has recorded over 6.7 million incidents over the past 8 years (2003–present) (Lamont and Scarpello, 2009). Staff report incidents through their hospital or primary care organisation so that local action can be taken when needed. These incidents are uploaded to the national database. Healthcare staff, patients, and other members of the public can also report incidents independently through the website. Each National Reporting and Learning System report refers to an unintended or unexpected incident that could have or did lead to harm for one or more patients receiving National Health Service funded care. It includes the reporting of those incidents which did not lead to harm because an error took place but it did not harm the patient, and those which did not lead to harm because an incident was prevented from reaching the patient. These incidents are further stratified into different levels of harm. So what is needed? First, a culture shift in reporting patient safety incidents and doing so to help raise standards in dental care as well as better focused continuing education programmes and the creation of a professional understanding of common errors and incidents in dental provision. Second, strong leadership within the profession to raise patient safety higher up the dental political agenda. Thirdly, sophisticated analyses of these incidents, akin to public health surveillance methods are required to understand the burden of harm in dentistry and develop ameliorative solutions. A Gulf wide Dental Patient Safety Agency’s Reporting and Learning System should be established based upon a web-based open access method whereby the reports are submitted in an anonymous fashion from the individual organisations local risk management system. This would put the region at the forefront of patient safety in dentistry around the world and usher in a new culture of safety into the dental services.