Multidisciplinary Health Research Articles

The police as formal agents of change: Assisting desistance in individuals convicted of sexual offences

Comprehensive and multi-disciplinary public health approaches are necessary to prevent sexual re-offending. However, criminal justice solutions continue to dominate and the arrangement in England and Wales is no exception. The introduction of the Multi-Agency Public Protection Arrangements (MAPPA) in 2003 brought together the work of the police, prison and probation services in order to manage violent and sexual offenders. This paper focuses specifically on the work of the specialist police officers who are tasked under MAPPA with the Management of Sexual or Violent Offenders (MOSOVO) and whether or not they can assist desistance in those who have been convicted of a sexual offence. We argue that the risk-based, highly politicized model of public protection that MOSOVO staff operate within creates tensions more likely to hinder than facilitate desistance. As indicated by findings in an independent review of the police’s management of registered sex offenders (2023), successful desistance journeys are found in people who are supported by formal agents who actively promote hope and optimism and convey a belief that the person attempting desistance can change. In conclusion, we recommend that MOSOVO staff be willing and resourced to help individuals with sexual convictions develop a non-offending lifestyle and identity and support them in achieving this goal, which requires the provision ofcomprehensive support beyond risk management.

Characteristics of older patients in the largest French psychiatric emergency centre.

Despite an increasing number of adults older than 60 years with psychiatric disorders, there are few studies on older patients in psychiatric emergencies and no European data. We aimed to describe the population of patients aged 60 years and older who presented to the main French psychiatric emergency centre and identify predictors of psychiatric hospitalization. This monocentric study included 300 consecutive patients aged 60 years and older. Patients presenting because of psychiatric emergencies were frequently female and lived autonomously. More than 40% had a history of at least one psychiatric hospitalization and 44% had consulted a psychiatrist in the previous 6 months. The most common reasons for consultation were depression, anxiety, sleep disorders and suicidal thoughts. Psychiatric disorders were mainly mood disorders; neurotic, stress-related and somatoform disorders; and schizophrenic, schizotypal and delusional disorders. Only 10% had a diagnosis of organic mental disorders. Overall, 39% of the patients were admitted to the psychiatric hospital. Factors predicting hospitalization were a history of psychiatric hospitalization, suicidal thoughts and a diagnosis of a mood disorder or schizophrenia/schizotypal/delusional disorder. In conclusion, among people aged 60 years and older who consulted for psychiatric emergencies, 39% had to be hospitalized in psychiatry and only psychiatric factors influenced the decision to hospitalize. Our study highlights the need for further studies of older people in psychiatric emergencies in Europe, to anticipate the needs of this specific population and adapt multidisciplinary mental health care.

Selection of Quality Indicators to Evaluate Quality of Care for Patients with Esophageal Atresia Using a Delphi Method.

Survival of neonates with esophageal atresia (EA) is relatively high and stable, resulting in increased attention to optimizing care and longer-term morbidity. This study aimed to reach consensus on a quality indicator set for benchmarking EA care between hospitals, regions, or countries in a European clinical audit. Using an online Delphi method, a panel of EA health care professionals and patient representatives rated potential outcome, structure, and process indicators for EA care identified through systematic literature and guideline review on a nine-point Likert scale in three questionnaires. Items were included based on predefined criteria. In rounds 2 and 3, participants were asked to select the five to ten most essential of the included indicators. An international panel of 14 patient representatives and 71 multidisciplinary health care professionals representing 41 European hospitals completed all questionnaires (response rate: 81%), eventually including 22 baseline characteristics and 32 indicators. After ranking, 10 indicators were prioritized by both stakeholder groups. In addition, each stakeholder group highly prioritized one additional indicator. Following an additional online vote by the other group, these were both added to the final set. This study established a core indicator set of twenty-two baseline characteristics, eight outcome indicators, one structure indicator, and three process indicators for evaluating (quality of) EA care in Europe. These indicators, covering various aspects of EA care, will be implemented in the European Pediatric Surgical Audit to enable recognition of practice variation and focus EA care improvement initiatives.

English

The sports medical examination is considered a starting point for any athlete before taking up physical or sporting activity. Its main objective is to detect pathologies that could put your life at risk and those that, once corrected, can enhance physical performance. This is why it must be carried out by a multidisciplinary health team with expertise in the area. In this way, it is important to review the scientific evidence and learn directly about the health status of a group of adult and child athletes, their incidence of cardiovascular diseases and the role of nursing in their application. This study evaluated a sample of 7340 athletes aged between 3 and 17 years, composed of 1693 females and 5647 males, who underwent a sports medical examination, according to a registered and previously established protocol in sports clubs in 2 Spanish provinces with the support of nursing staff during the year 2021. Of these, a total of 112 cases of cardiac pathologies were obtained, of which 54% were known to have a cardiac pathology and 64% were unknown. Of this group of unknown cardiac pathologies, 5.9% of the cases required surgical intervention, 21.1% are under review and 73% were discharged. The total number of cases with unknown cardiac pathologies represents 0.70% of the sample. The fundamental role of nursing in the application of this protocol was also determined.

Applied improvisation and transdisciplinary simulation: a necessity for any health curriculum?

From practising a procedure, such as a lumbar puncture, to explaining the aim and method and listening to concerns, the practice of health professionals requires a range of skills, often classified into technical and non-technical skills. Just as gestures and procedures can be taught, so can empathy and communication skills. This article introduces an innovative approach that unites both necessary types of skills. The specific framework of improvisational theatre ("improv") has widespread application, including the training of health professionals (health training improv). By sharing close contexts and skills, health training improv provides a valuable, safe, and effective learning environment that allows practitioners to practice exercises and situations that align with particular objectives. We created a transdisciplinary team to develop a programme of Health Professional Training Improv (HPTI), bringing together the fields of health, psychology, simulation, and arts. Since 2019, various health student groups (nurses, midwives, medical doctors, and speech therapists) have participated in a 16-h applied improv training workshop under the supervision of a professional improv facilitator. Additionally, drama students completed applied improv for health courses, which trained them to act as simulated patients, with a view to the implementation of transdisciplinary improv simulation sessions at SimUSanté (a multidisciplinary health simulation facility located in France). Students' feedback emphasized their interest in HPTI, the realism of the simulation sessions, and the skills they felt had improved. This feedback needs to be supplemented with quantitative data from standardised assessments. The development of this rich pedagogical and research framework, based on a transdisciplinary approach, has brought different fields together to prepare students for real patient encounters. It is essential to continue this training and conduct research to evaluate the curricula developed.

Change in the motivation pattern of adolescents before and after participation in a multidisciplinary health promotion program

Introduction: there is evidence that multidisciplinary interventions are an efficient approach to achieving weight loss and other health-related goals. However, dropout rates of these programs are high among adolescents. The suggestion is that understanding the motivation of individuals to participate in these projects is fundamental to developing strategies for permanence and, consequently, promoting better results. Objective: the main aim of this study was to describe the motivations of overweight adolescents participating in a multidisciplinary health promotion project. Methods: this qualitative study was conducted from March to July 2021 using the Bardin content analysis technique. The tool used for data collection was the semi-structured interview, analyzed means by the software QSR NVivo 11 by grouping the speech into clusters. These, in turn, were evaluated in three categories: (1) motivation, (2) food, and (3) physical exercise. Results: the age of the participants was 13.8 ± 2.4 years old, with body mass index of 31.8 ± 8.5 kg/m². Regarding family income, 41.66% had a monthly payment of 3 to 6 minimum wages. Regarding parents’ educational level, 70.83% of mothers had completed higher education, while 29.16% had completed high school. According to the respondent’s answers, weight loss was the greatest motivation to participate in a multidisciplinary obesity treatment program. In category 2, it was observed that adolescents associated the act of eating with feelings such as anxiety and nervousness. In category 3, the impact of the pandemic was found under the modalities of physical exercise practiced. Conclusion: the results describe the motivation of overweight adolescents to participate in a multidisciplinary program, in addition to elucidating participants’ perception of their health and related habits, strategies for health promotion, and consequent improvement of the quality of life of these individuals.

P106: Palliative care for people with advanced dementia

Objective:Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among elderly. In Taiwan, there are at least 300,000 people live with dementia. However, only 1.64% of people with dementia received palliative care. In this paper, we describe a real-world experience of palliative care for people with advanced dementia.Method:Case report.Result:Mrs. H, A 90-year-old illiterate woman, was referred to Home Care team after several admissions for urinary tract infection. Her past medical history included cerebral infarction with left hemiparesis 4 years ago. Over one year prior our first visit, her family had begun to notice a problem with her recent memory. Thorough investigation for dementia was arranged. She scored 11/30 on the Mini-Mental State Examination. Mixed Alzheimer’s and vascular dementia was impressed.The Home Care service consisted of a once-monthly visit by physician and nurse. In the first year of service, we delivered active directed treatment for dementia. We also discussed nonpharmacological approaches for dealing with physical and behavior symptoms in each visit.Then Mrs. H was hospitalized again due to fever and abdominal pain. Abdominal aortic aneurysm was diagnosed along with urinary tract infection. She had hypoactive delirium for two months after discharge. Meanwhile, Home Care team arranged a family meeting to discuss prognosis and appropriateness of palliative care. In the following two years, we focused on deprescribing and interventions for pain, dyspnea, eating problem, infection, and agitation to promote Mrs. H’s comfort and quality of life. Psychological support was crucial to facilitate continuity in carer and care setting. Mrs.H did not have burdensome transition anymore and passed away peacefully at home as her preference.Conclusion:The need for palliative care in dementia is anticipated to increase over the next decades in Taiwan. In the patient presented, Home Care team acknowledged and offered palliative care to help her to live as comfortably as possible until death and to help carers cope during the course. A multidisciplinary health care is highly recommended for complex needs in dementia.

Usefulness of oral health assessment performed by multiple professionals using a short video recording acquired with a tablet device

Background/purposeAppropriate oral health assessment and management can improve the oral health and nutritional status of hospitalized patients. The active participation of dental professionals in the nutritional support team (NST) can help achieve this outcome. However, the participation of dental professionals in NSTs is often limited, indicating the requirement for establishing a remote oral health assessment method. This study aimed to establish a multidisciplinary oral health assessment system using short video recordings with a tablet device. Materials and methodsFifty inpatients receiving NST aid at the Tokyo Medical and Dental University Hospital were included in this study. The degree of agreement between the oral health assessment performed at the bedside and using the short video recordings of the oral health acquired with a tablet device by a single dentist and the degree of agreement for evaluations performed using the video recordings between multiple professionals were evaluated. The oral health status was assessed using the Oral Health Assessment Tool (OHAT). ResultsThe intraclass correlation coefficient (ICC) of the OHAT total scores for oral health assessment performed at the bedside and using the videos by a single dentist was 0.914 (95% confidence interval [CI], 0.854–0.950). ICCs of the OHAT total scores for the video assessment performed by dentists and multiple professionals were 0.904 (95% CI, 0.838–0.944) and 0.802 (95% CI, 0.676–0.883), respectively. ConclusionComprehensive oral health assessment of patients can be performed by multiple professionals using the short video recordings of the oral health acquired with a tablet device.

Community Pharmacists' Role in Reducing the Incidence of Cardiometabolic Adverse Drug Events in Schizophrenia: Insights from Mental Health Professionals.

Background and Objectives: Schizophrenia, a debilitating mental illness, is often associated with significant physical health risks. Many second-generation antipsychotics increase the risk of metabolic syndrome and cardiovascular disease. Community pharmacists are highly accessible and could play a role in monitoring cardiometabolic adverse drug events in people with schizophrenia. However, it remains uncertain whether mental health professionals perceive this as valuable. This study aimed to explore the opinions of mental healthcare professionals regarding the role of community pharmacists in reducing the incidence of cardiometabolic adverse events in people with schizophrenia and their integration into a multidisciplinary mental health team. Materials and Methods: Qualitative semi-structured interviews were conducted with Australian psychiatrists, mental health nurses and mental health pharmacists. Transcription of the interviews underwent thematic analysis using an inductive approach. Results: Eleven mental healthcare professionals from metropolitan and regional areas across Australia were interviewed, leading to the identification of five overarching themes. These themes encompassed the following aspects: the benefits of community pharmacists' involvement in managing cardiometabolic adverse drug events in people with schizophrenia, improving communication pathways with community pharmacists, defining roles and responsibilities for monitoring cardiometabolic parameters and managing adverse cardiometabolic drug events, fostering collaboration between community pharmacists and mental health care professionals, and recognising the acceptance of community pharmacists' integration within a multidisciplinary team. Mental health professionals believed that community pharmacists could play a role in reducing the incidence of cardiometabolic adverse events in schizophrenia. However, they underscored the need for enhanced communication and collaboration pathways with other healthcare professionals, emphasised the importance of more comprehensive mental health first aid training, and identified potential barriers for community pharmacists such as remuneration, workload, and staff resources. Conclusions: Mental health professionals acknowledged the benefits of incorporating community pharmacists into multidisciplinary teams as a strategy to reduce the incidence of adverse events among individuals with schizophrenia. They recognise the competence of community pharmacists in monitoring cardiometabolic adverse events. However, these professionals have also highlighted specific perceived barriers to the complete integration of community pharmacists within these teams. Notably, there are concerns related to remuneration, staff resources, time constraints, acceptance by other healthcare professionals and patients, and the need for improved communication pathways. Addressing these barriers and providing targeted training could facilitate the valuable inclusion of community pharmacists in the comprehensive care of people with schizophrenia.

Retrospective audit of a school-based integrated health-care model in a specialised school for children with externalising behaviour.

Problematic externalising behaviours in adolescents are associated with high individual and societal burden. A school-based multidisciplinary health clinic, Ngaramadhi Space (NS), was developed at Yudi Gunyi School, a specialised behavioural school in Sydney, Australia, to improve access to holistic health-care and behavioural support. This evaluation aimed to describe the demographics, clinic attendance, health screening, recommendations made, and changes in Strengths and Difficulties Questionnaire (SDQ) scores of students attending the clinic. Retrospective evaluation of students including changes in SDQ scores using descriptive statistics (26 July 2016 to 14 May 2019; n = 79). Prior to the assessment, few students engaged with a paediatrician or mental health professional (22.8%; 27.8%, respectively). Child protection services were involved with 76%. NS attendance was high (failure-to-attend = 7.6%; cancellations = 8.9%). New issues found at the assessment included: parental separation (31.6%); trauma history (27.8%); substance use (19%); emotional wellbeing concerns (16.5%), learning difficulties (12.7%), domestic violence (12.7%) and medical conditions (10.1%). SDQ teacher reports showed a significant decrease in total difficulties scores (M = 6.2, SD = 6.165, P < 0.05, eta squared = 1.013 (large effect)) and all subsets. No significant differences in parent and self-reported SDQ. Students with problematic externalising behaviour have unmet health and social needs. The NS school-based integrated health-care model offers a novel, convenient and innovative way to engage these students. This approach has high initial attendance rates with teacher-reported SDQ results showing some behavioural improvement. Further qualitative studies are required.

Clinical Pharmacology and Infection Control Department in a Multidisciplinary Health Care Organization: Peculiarities of Work Organization

Clinical Pharmacology and Infection Control Department in a Multidisciplinary Health Care Organization: Peculiarities of Work Organization

Personalised care and support planning in Singapore: qualitative interviews with people living with diabetes.

Personalised care and support planning (CSP) is a person-centred approach for the care of people living with long-term conditions. Patient Activation through Community Empowerment/Engagement for Diabetes Management (PACE-D) adapts the Year of Care Partnerships (YOCP) approach to CSP in the UK for people living with diabetes at Singapore polyclinics. Polyclinics are multi-storey primary care hubs that provide affordable, multidisciplinary, comprehensive, and high-throughput public health care for the multi-ethnic, multilingual Singapore population. To explore the experience of PACE-D-enrolled people living with diabetes with personalised CSP at Singapore polyclinics. Qualitative interviews of people living with diabetes who experienced personalised CSP at National University Polyclinics (NUP) in Singapore between July 2020 and November 2021. PACE-D-enrolled people living with diabetes who experienced personalised CSP were purposively sampled. In-depth semi-structured interviews were recorded, transcribed, and analysed using Braun and Clarke's reflexive thematic analysis. Fifty-two patients participated in the study. Four main themes were identified. Theme 1 was the importance of the care-planning letter. Patients reported that the CPL prompted reflection and patient preparation for CSP conversations. Theme 2 was the role of the programme coordinator. PACE-D programme coordinators amplified self-management by playing advocate and confidant beyond administrative duties. Theme 3 was the value of the personalised CSP conversation. CSP providers were perceived as partners in care, with more time to listen compared with usual consultations. Patient engagement was affected by language confidence. Theme 4 was agency in self-management. With adequate time and support, patients increased in confidence and agency both in CSP engagement and diabetes self-management. While language confidence may affect patient engagement, personalised CSP shows promise for strengthening patient engagement and self-management among people living with diabetes at Singapore polyclinics.

Double diamond approach helping multidisciplinary health research team to mitigate infrastructure limitations

The Double Diamond approach was used to creatively solve problems during bioengineering projects and facilitate a bioprinting protocol in the hard science. Users reported difficulties while using a inkjet bioprinter for specific research involving overprint and predefined location in ophthalmic applications. Given the laboratory’s limited financial resources, the pursuit of low-cost solutions became essential, and the Double Diamond approach played a pivotal role in finding them. This method was chosen due to its high resolubility focused on generating creative solutions. Moreover, its emphasis on User Experience made it an accessible design process, benefiting both designers and non-designers and enhancing user adherence while enabling easy application within the multidisciplinary team. As a result of this research, a solution was discovered, allowing researchers to overcome the problem and continue their ongoing work while also facilitating the development of new projects. In conclusion, the successful implementation of the Double Diamond approach in this specific application highlights its potential to address challenges across diverse projects. Its adaptable nature and emphasis on user-centricity make it a valuable tool in tackling complex issues in various fields of development.

A Web-Based Patient Empowerment to Medication Adherence Program for Patients With Rheumatoid Arthritis: Feasibility Randomized Controlled Trial.

Living with a chronic illness such as rheumatoid arthritis (RA) requires medications and therapies, as well as long-term follow-up with multidisciplinary clinical teams. Patient involvement in the shared decision-making process on medication regimens is an important element in promoting medication adherence. Literature review and needs assessment showed the viability of technology-based interventions to equip patients with knowledge about chronic illness and competencies to improve their adherence to medications. Thus, a web-based intervention was developed to empower patients living with RA to adhere to their disease-modifying antirheumatic drugs (DMARDs) medication regimen. This study aims to discuss the intervention mapping process in the design of a web-based intervention that supports patient empowerment to medication adherence and to evaluate its feasibility among patients living with RA. The theory-based Patient Empowerment to Medication Adherence Programme (PE2MAP) for patients with RA was built upon the Zimmerman Psychological Empowerment framework, a web-based program launched through the Udemy website. PE2MAP was developed using a 6-step intervention mapping process: (1) needs assessment, (2) program objectives, (3) conceptual framework to guide the intervention, (4) program plan, (5) adoption, and (6) evaluation involving multidisciplinary health care professionals (HCPs) and a multimedia team. PE2MAP is designed as a 4-week web-based intervention program with a complementary RA handbook. A feasibility randomized controlled trial was completed on 30 participants from the intervention group who are actively taking DMARD medication for RA to test the acceptability and feasibility of the PE2MAP. The mean age and disease duration of the 30 participants were 52.63 and 8.50 years, respectively. The feasibility data showed 87% (n=26) completed the 4-week web-based PE2MAP intervention, 57% (n=17) completed all 100% of the contents, and 27% (n=8) completed 96% to 74% of the contents, indicating the overall feasibility of the intervention. As a whole, 96% (n=24) of the participants found the information on managing the side effects of medications, keeping fit, managing flare-ups, and monitoring joint swelling/pain/stiffness as the most useful contents of the intervention. In addition, 88% (n=23) and 92% (n=24) agreed that the intervention improved their adherence to medications and management of their side effects, including confidence in communicating with their health care team, respectively. The dos and do nots of traditional Chinese medicine were found by 96% (n=25) to be useful. Goal setting was rated as the least useful skill by 6 (23.1%) of the participants. The web-based PE2MAP intervention was found to be acceptable, feasible, and effective as a web-based tool to empower patients with RA to manage and adhere to their DMARD medications. Further well-designed randomized controlled trials are warranted to explore the effectiveness of this intervention in the management of patients with RA.

The Education Effect of AADE7TM Model on Self-Care Activities in Type 2 Diabetes Mellitus Patients

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by high blood glucose levels due to a lack or ineffective use of the hormone insulin. If not treated properly, it will result in complications, even amputation and death. However, many patients still do not understand their disease, lack motivation, and have poor self-care activities. Therefore, it is important to provide education on the AADE7TM model, namely 7 tips for self-care habits, which have become a trademark of AADE, an organization consisting of multidisciplinary health professionals who are experts in diabetes education and diabetes self-care management. An organization comprises multidisciplinary health professionals who are experts in diabetes education and diabetes self-care management. The Seven tips include (1) eating healthy, (2) being active, (3) monitoring, (4) taking medication, (5) problem solving, (6) healthy coping, and (7) reducing risks so that there will be increased self-care activities. Objective to determine the effect of AADE7TM model education on self-care activities in type 2 diabetes mellitus patients. Research methods: Quantitative research type with quasi-experiment method, nonrandomized control group pre-test and post-test design. With purposive sampling on 30 patients, 15 patients in the experimental group and 15 in the control group. The experimental group was given AADE7TM model education, and the control group received conventional education. Data analysis techniques t-test. There was a difference in mean self-care in the experimental group in the pre-test, with a score of 19,800, and in the post-test, 33,066, with a p-value of 0.001.There was no difference in mean self-care in the control group at the initial and final measurements, with a p-value of 0.060. There was a difference in self-care activities after the AADE7TM model education in the experimental group compared to the final measurement in the control group, with a p-value of 0.001.Conclusion: there was an influence of AADE7TM model education on self-care activities in type 2 diabetes mellitus patients. Keywords: AADE7TM, self-care activities, diabetes mellitus.

Knowledge, familiarity, and impact of the COVID-19 pandemic on barriers to seeking mental health services among older people: a cross-sectional study.

The COVID-19 pandemic caused drastic changes in older people's daily activities with a negative impact on their mental health, yet older people are less likely to seek mental health services. This study aims to explore the relationship between knowledge of and familiarity with mental health services, along with the impact of the COVID-19 pandemic, and barriers to seeking mental health services among older people. A descriptive cross-sectional study was conducted with a convenience sample of 352 older people, recruited among community-dwelling adults who attended randomly selected postal offices and pension outlets. Three tools were used: a structured interview schedule for sociodemographic and clinical characteristics of older people, the revised version of the Knowledge and Familiarity of Mental Health Services Scale (KFFMHS-R), and the Barriers to Mental Health Services Scale Revised (BMHSS-R). All participants reported experiencing mental health distress during the COVID-19 pandemic. Intrinsic barriers had a higher mean score than extrinsic barriers, and 27.4% of the variance of overall barriers to seeking mental health could be explained through regression analysis by familiarity, knowledge of mental health services, and age. Overall barriers explained 24.4% of the variance of older people's perceived distress as an impact of the COVID-19 pandemic (F = 22.160, P < 0.001). Knowledge of mental health services was the most significant predictor of barriers to seeking mental health services during the COVID-19 pandemic. Higher barriers predicted higher distress as an impact of the COVID-19 pandemic. The results of the study suggest the need for a multidisciplinary mental health team for older people.

Patient and multidisciplinary health professional perceptions of an Australian geriatric evaluation and management and rehabilitation hospital in the home service.

Hospital in the Home models are rapidly expanding in response to increasing bed pressures. This study examined patient and multidisciplinary health professional perceptions of a new geriatric evaluation and management and rehabilitation hospital in the home service in Australia. The service was unique, as adults of all ages with a variety of rehabilitation or geriatric evaluation and management needs were within scope. A qualitative descriptive approach was used with a consumer co-researcher and a consumer advisor being integral to decision-making. Patient feedback was collected via a paper-based patient satisfaction survey between August 2020 and February 2022. Additionally, interviews with current and past staff were conducted from July to November 2021. Reflexive thematic analysis was conducted for qualitative data and descriptive statistics used for quantitative data. Patient surveys were analysed (n = 199, 42.2% response rate) with 60.8% of participants aged 75years or over and 26.6% speaking a language other than English. High satisfaction was expressed. Feelings of comfort, familiarity, convenience, and reassurance were voiced. A person-centred approach enhanced involvement in care. Challenges included carer burden and clear communication. Sixteen staff (33% response rate) were interviewed. In general, staff said the service was inclusive and responsive, and the home environment beneficial, particularly for patients from culturally diverse backgrounds. A strong hospital partnership and comprehensive multidisciplinary approach were vital. Challenges included fragmentation due to part-time roles and combining with a pre-existing acute hospital in the home service. This qualitative exploration of staff and patients' perceptions of a geriatrician-led, multidisciplinary geriatric evaluation and management and rehabilitation hospital in the home service demonstrated that it was person-centred and optimised patients' control and ownership of care. The inclusive service parameters ensured responsiveness to diverse needs whilst allowing earlier return home from hospital, both of which are vital for quality patient care.

Regional public health staff workplace psychosocial risk assessment and health promotion initiative

Abstract Psychosocial work conditions can be detrimental to worker wellbeing with 70% of healthcare workers reporting work related stress, which may lead to burnout. Despite European health and safety legislation, managers rarely assess and manage workplace psychosocial risks. The Public Health workforce in Ireland, already impacted by the pandemic, is currently experiencing major organisational change as a result of the ongoing Public Health Reform Process. This paper describes the structures, processes and outcomes involved in a Public Health staff (n = 56) workplace psychosocial risk assessment, guided by the European Framework for Psychosocial risk Management: PRIMA-EF, using the HSE Work Positive CI psychosocial risk assessment survey. The establishment of a multidisciplinary Health &amp; Wellbeing (H&amp;W) group, under the governance of the Area Senior Management Team, was key to guide the process, including a workplace health promotion initiative, influenced by Positive Psychology framework (PERMA). The response rate to the survey was 70% (n = 40), with half of staff reporting psychological distress. Work stressors included role clarity, demand, change and control, scoring below average compared to Irish organisational norms. Relationships and manager support scored highly. The H&amp;W group shared results promptly with all staff and formulated iterative mitigation measures, including HSE Change Management and HSE Health &amp; Wellbeing consultants, based on the survey action plan and staff feedback. Five months later a repeat survey revealed continuing issues around role clarity and demands, with change and control showing an improvement. Further exploration of these results, and an evaluation, informed by staff feedback is ongoing and iterative. Lessons learnt include the importance of embedding a dedicated H&amp;W multidisciplinary group to lead the continuous process; senior management support; employee involvement and effective utilisation of existing organisational tools and supports. Key messages • It is a public health imperative to promote risk assessment and mitigation of healthcare workplace stressors to safeguard employee wellbeing and ensure health service resilience and patient safety. • Effective workplace psychosocial risk assessment and implementation of targeted mitigation measures requires management support and a continuous iterative collaborative quality improvement process.

Guideline documents on caesarean section on maternal request in Sweden: varying usability with a restrictive approach

BackgroundGlobally, studies illustrate different approaches among health care professionals to decision making about caesarean section (CS) and that attitudes regarding the extent to which a CS on maternal request (CSMR) can be granted vary significantly, both between professionals and countries. Absence of proper regulatory frameworks is one potential explanation for high CSMR rates in some countries, but overall, it is unclear how recommendations and guidelines on CSMR relate to CSMR rates. In Sweden, CSMR rates are low by international comparison, but statistics show that the extent to which maternity clinics perform CSMR vary among Sweden’s 21 self-governing regions. These regions are responsible for funding and delivery of healthcare, while national guidelines provide guidance for the professions throughout the country; however, they are not mandatory. To further understand considerations for CSMR requests and existing practice variations, the aim was to analyse guideline documents on CSMR at all local maternity clinics in Sweden.MethodsAll 43 maternity clinics in Sweden were contacted and asked for any guideline documents regarding CSMR. All clinics replied, enabling a total investigation. We used a combined deductive and inductive design, using the framework method for the analysis of qualitative data in multi-disciplinary health research.ResultsOverall, 32 maternity clinics reported guideline documents and 11 denied having any. Among those reporting no guideline documents, one referred to using national guideline document. Based on the Framework method, four theme categories were identified: CSMR is treated as a matter of fear of birth (FOB); How important factors are weighted in the decision-making is unclear; Birth contracts are offered in some regions; and The post-partum care is related to FOB rather than CSMR.ConclusionIn order to offer women who request CS equal and just care, there is a pressing need to either implement current national guideline document at all maternity clinics or rewrite the guideline documents to enable clinics to adopt a structured approach. The emphasis must be placed on exploring the reasons behind the request and providing unbiased information and support. Our results contribute to the ongoing discussion about CSMR and lay a foundation for further research in which professionals, as well as stakeholders and both women planning pregnancy and pregnant women, can give their views on this issue.

The Effect on Home Caregivers of a Family Support Program Based on a Nurse-Led Case Management Model: A Randomized Controlled Pilot Trial

Home caregivers have a large amount of responsibility, and many have difficulty in fulfilling their care-giving roles. Previous studies have shown that when caregivers are supported socially, psychologically, and culturally, there is a positive improvement in caregivers’ coping skills, quality of live, and a decrease in health problems. The purpose of this study was to evaluate the effect of a family support program based on the nurse-led case management model on home caregivers by measuring quality of life, caregiver burden, and family functionality level. In this study 27 home caregivers were randomly divided into intervention and control groups. The family support program based on a 5-stage nurse-led case management model was administered for the caregivers in the intervention group (n = 13) for 6 months. The caregivers in the control group (n = 14) were monitored by home health services through routine follow-ups. Baseline and postintervention assessments included the Zarit Caregiver Burden Scale, the World Health Organization Quality of Life–Brief Turkish Form, and the Family APGAR Scale. It was found out that there was a statistically significant difference among caregiver burden, quality of life, and family functionality level total scores of caregivers in the intervention and control groups ( p &lt; .05). A family support program based on nurse-led case management model has a supportive role for caregivers, where web-based education and counseling services are available, patients and their relatives are monitored by a multidisciplinary health team, and their educational needs are met.