Needs-based Care Research Articles

Acute exacerbation of COPD: Physiotherapy practice and factors that influence management

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of morbidity and mortality in South Africa. Physiotherapy practice and factors that influence management of patients with AECOPD are unknown.Objectives: To explore physiotherapy practice in the management of patients with AECOPD in South African private healthcare settings and to identify and describe factors that influence physiotherapy patient management.Method: The study adopted a qualitative descriptive design using semi-structured interviews. Purposive and snowball sampling was used to identify physiotherapists working in private healthcare in three South African provinces. Individual interviews were conducted face-to-face or via telephone and transcribed verbatim. Content analysis was done using an inductive approach.Results: Participants (n = 9) working in private hospitals reported that their management is based on patient-specific needs assessment. Treatment interventions included various respiratory physiotherapy techniques and exercise rehabilitation strategies. Patient education on self-management of disease symptoms featured prominently. Enablers of physiotherapy management included supportive workplace relations, conducive work environment, physiotherapists’ competence, familial support and patient cooperation. Barriers identified included limited communication, nurses’ attitudes, work environment, disease burden, mental health challenges and limited professional development opportunities.Conclusion: Physiotherapists provide individual needs-based care to patients with AECOPD. Various enablers and barriers to physiotherapy patient management have been identified.Clinical implications: Advocacy for physiotherapy, better communication between multidisciplinary team members and recognition of the need for psychological support are important factors to address to enhance the care provided to patients with AECOPD.

Infant care transfers: simulating neonatal infant pathways and transfers across a neonatal network

Neonatal care for preterm and sick babies is organised into local areas around the United Kingdom, called Operational Delivery Networks. These networks coordinate between providers to ensure babies have the required care, close to home. There are three types of Neonatal Units offering distinct levels of needs-based care. The networks need to ensure that each unit operates at optimal cot levels, and the best quality care is provided. The possible impact of any changes to a network’s configuration on transfers and infant care, must be considered before any changes are implemented. Our simulation model reflects the infant pathways within a network allowing users to evaluate a variety of possible changes within the network. The model builds on previous literature by incorporating the ability to move an existing infant from a unit to release capacity as well as moving new arrivals between units. We also consider the potential environmental impact of the additional travel for parents visiting infants who have been transferred. We demonstrate how the model can be applied with a case network within which approximately 60,000 babies are born annually, a tenth of whom requiring some Neonatal Care. Of these infants, approximately 12% are transferred to another unit.

Building bridges: mobile mental health care units in four European countries

Abstract Background Individuals living in rural and remote areas may have limited access to mental healthcare due to lack of facilities, socioeconomic reasons, stigma and lack of mental health literacy. To meet the needs and provide needs-based care care mobile mental health care clinics were established in some countries in Europe, including in Belgium, Germany, Greece and in Moldowa. A mobile clinic is a customized motor vehicle that travels to communities to provide mental health care. The mobile clinics are an integral part of the health care system and help ensure access to mental care. Aims To describe mobile care clinics in two countries in Europe using a case study design. Results Mobile clinics deliver a wide variety of mental health services, are heterogeneous and consist of multidisciplinary teams, including physicians, social workers, and other health professionals. The organization and financing of the Mobile mental health clinics is different in the four countries (e.g. part of the mental health care system in Belgium, and Moldova, part of initiatives in Germany and Greece). Due to data protection no detailed data on patients can be provided at the moment. The structures on mental health care mobile clinics in the four countries will be described in detail in the talk. Discussion Mobile clinics often serve as a bridge between communities and the mental health care system. Another important issue in rural areas is the ongoing aging of the population. The number of Elderly patients is expected to rise in the future. The care of those patients is challenging for the mental health and the primary care system. There is a necessity for establishing bridges between mobile clinics and hospital care.

Needs of children with neurodevelopmental disorders and medical complexity: Caregiver perspectives

BackgroundCaregivers of children with neurodevelopmental disorders and medical complexities (NDD-MC) coordinate care across complex multisectoral systems. Often NDD-MC children have complex behaviors, however there is limited information on coordination needs for families. Aim: The objective of this mixed methods study was to understand the needs of families with NDD-MC children. Methods and Procedures: This sequential exploratory study obtained the perspectives of 67 caregivers of NDD-MC children using semi-structured interviews and validated questionnaires to measure family quality of life, care integration, and resource use. An adapted model using Maslow’s hierarchy of needs was integrated, to understand the impacts of caregiving on quality of life. Outcomes and Results: Lack of support in caring for NDD-MC children negatively impacted family quality of life, resulting in various unmet needs, including caregiver burden, behavioural challenges, financial losses, and mental health issues. Caregivers dealt with a fragmented healthcare system that offered limited support to address coordination challenges. Conclusions and Implications: The implementation of a needs-based care coordination program is recommended to consider the health, educational, and social needs of NDD-MC children and their families. Effective care for children with complex needs should tailor support for families using Maslow’s hierarchy to enhance quality of life.

Optimale Versorgung am Lebensende aus der Angehörigenperspektive – eine qualitative Interviewstudie in zwei niedersächsischen Landkreisen

BackgroundEstablished as health insurance benefit in 2007, Specialized Palliative Home Care (SPHC) has been continuously expanded. At the same time, health policy initiatives intended to promote general outpatient palliative care. In comparison to urban centers, the development of palliative care networks in rural areas appears to be more difficult. In addition, there is an increasing shortage of family doctors in primary care. Family members play a key role in the home care for seriously ill patients. This paper therefore investigated the experiences of relatives with the end-of-life (EoL) care for family members with life-limiting chronic diseases in more rural regions. The aim was to determine aspects that, from the relatives’ point of view, are essential for optimizing EoL care. MethodsQualitative after-death interviews with relatives in two districts were conducted in the first six months of 2019, who were recruited by the deceased patients’ family doctor. Relatives (age ≥18 years) of patients who died in 2018 were included. The interviews were digitally recorded, transcribed and analyzed using content analysis. ResultsIn the first half of 2019, 28 after-death interviews were conducted with 30 relatives (77% female, age: 32 to 83 years) from rural (n=8) and urban communities (n=22) in two Lower Saxonian counties. They were mostly in a partnership or parent-child relationship with the deceased person.The central categories and needs that emerged in the analysis were: (1) communication about dying and death, (2) information and enabling, (3) support of and relief for relatives, and (4) continuity and cooperation of the services involved in EoL care. The results underline the fact that family caregivers in particular find open communication, information to provide them with the confidence to act, recognizing and responding to support needs and continuity in the course helpful in coping with EoL care situations. Access problems to specialist medical care, deficiencies in care coordination and bureaucratic hurdles in the provision of medical aids proved to be an additional burden. DiscussionThe results underline the importance of open communication and the integration of relatives into the care process for optimal care at the end of life. Close cooperation between the services involved and proactive support for relatives are essential, too, especially in rural areas where the challenges of accessing and coordinating care services are a major concern. ConclusionThe identification and communication of complex problems, the needs of patients and their relatives and possible barriers to accessing care services are prerequisites for the timely initiation of palliative care measures and support for family caregivers. In addition to needs-based care structures, the optimization of EoL care in home settings requires cooperation and networking between professional stakeholders.

Health literacy of patients with chronic diseases – quantitative results of a mixed methods study in primary healthcare / Gesundheitskompetenz von Menschen mit chronischer Erkrankung – quantitative Ergebnisse einer Mixed-Methods-Studie in der Primärversorgung

Abstract Background In research and practice to promote health literacy, people with chronic illnesses represent an important target group. They are confronted with complex demands during the course of their illness. And, they utilize healthcare services more frequently. Patients are often dependent on the support of healthcare professionals. Population-based studies in Germany conducted that the majority of people find it most difficult to assess health information. The studies emphasize the enhancement of professional‘s health literacy, e. g. in nursing profession, as a prerequisite for improving capabilities in the population. In order to achieve better access and a needs-based care for people with chronic illnesses, a project in northern Germany has developed and offered a care-led concept. Methods As part of this project, data on self-assessed health literacy of chronically ill patients from a community health center was collected and analyzed using a quantitative survey in a mixed-methods study. Results The data analysis shows that more than half of the participants, regardless of gender and age, rate their health literacy as inadequate. On every level of information requirements and areas difficulties were reported. Conclusion The involvement of patients is needed in order to establish suitable strategies to empower health literacy for people with chronic illnesses. Particularly, the promotion of professional and organizational health literacy is essential for this.

"Building More Connected Primary Care: Improving Connections between Primary Care and Community Care, Specialists and Hospitals for Timely and Appropriate Care"

Although strong, well connected primary care results in better health outcomes and health equity at a lower cost, most family physicians in Ontario, Canada are not supported by teams and have variable connections to other system sectors resulting in variable access and quality of care. A continuous relationship with a family physician and primary care team facilitates access to timely care, appropriate preventive care, reduced acute care utilization and costs, reduced mortality and more satisfied patients. This was further confirmed during the COVID 19 pandemic when patients who were attached to primary care teams had superior care for both COVID and non-COVID health issues.
 Together with patients, families, family physicians and all health care sectors, we co-created and evaluated efficient models of connecting family physicians to: specialists for just in time advice, virtual and in-person consults; to interprofessional teams tailored to the needs of their practices and to navigation services tailored to primary care. These models were co-designed with family physicians and continue to evolve based on their evolving needs:
 SCOPE (Seamless Care Optimizing the Patient Experience) connects primary care providers (PCPs) in the community to real-time supports through a single point of access, Co-designed with local PCPS, SCOPE improves access to an interprofessional team who can help with urgent medical consultations, diagnostic imaging, curated home and community care, mental health, and navigation of other services available in the hospital or in the community.
 TIP (Telemedicine IMPACT PLUS) TIP (Telemedicine IMPACT Plus) provides rapid access to case consultation by a virtual team of health care professionals to enable proactive health and social care for patients living with multi-morbidity. The case conference involves the patient/caregivers, family physician and TIP RN along with the consulting team that consists of: Psychiatrist, Internist, Pharmacist, Social Worker, Home Care Coordinator, Dietitian and others as required. The purpose of this consultation is to coordinate care and derive new solutions for addressing chronic conditions. A dedicated
 TIP nurse facilitator prepares the case, facilitates the consultation with one of 12 available teams, summarizes a coordinated care plan and coordinates the patient’s circle of care.
 Building interprofessional primary care teams based on family physician patient roster needs relies on nourishing foundational relationships with local PCPs to help identify gaps in care, engaging PCPS in continuous program improvement and developing partnerships with key stakeholders: leadership from the anchor hospital and their specialist groups, home and community care and community organizations. Joint implementation is based on the value proposition that all sectors win when care is appropriately triaged and managed in the community.
 When combined, connected and integrated into primary care practices, these initiatives build the Patient Medical Home, with the PCP at the centre of care, support to more effectively co-manage patients using existing resources more efficiently mapped to patient needs. These initiatives support relationship-based navigation, the underpinning of team-based primary care essential to improving system navigation for timely access to needs-based care.
 The target audience: patients, families, interprofessional primary care providers, specialists, home care and community providers, and hospitals.
 
 
 

Integrating health and social care in the community to support a new model of Long-term Life Care at home.

Background: Long-term care (LTC) reform was an international priority well before the COVID-19 pandemic. While strategies to promote de-institutionalization, rehabilitation, caregiver support and enhanced home and community care have varied by country in terms of implementation and success, the pandemic universally reinforced existing system-specific barriers and weaknesses. In Canada, heightened access issues and silo-ed delivery of community-based medical, functional and social care and support services contributed to increased caregiver burnout and growing residential care waitlists.
 Aims: This study aimed to develop an alternative model to residential LTC that would enable older adults to live, age and receive care at home long-term. The specific objectives were to: 1) describe variation in medical, functional and psychosocial ‘life care’ needs of community-dwelling older adults; 2) develop a model of needs-based care with packages to support variation in needs; and 3) to assess preliminary feasibility of the model using the Ontario, Canada (population 15 million) health care market. 
 Approach: An exploratory, sequential, mixed methods design was applied (5). Phase 1 involved historical analysis of 2017-18 Ontario interRAI home care assessments (n=283,601) and 2018-19 Ontario service utilization data (n=115,000) to develop unique patient vignettes. Phase 2 was a 6-week modified eDelphi process with interdisciplinary home care clinicians (n=42) to develop care packages for the model, including types and dose of care and services. Six focus groups (n=67) were then conducted with older adults, caregivers and health and social care providers across Ontario to validate and refine the model. Phase 3 explored feasibility of the emerging model through comparison of the home care patient vignettes with the needs of the residential LTC population using 2017-18 Ontario interRAI data (n=115,000). Preliminary costing of the model was based on existing system per diems and direct care costs in comparable transitional care models.
 Results: A model of ‘Long-term Life Care’ at home (LTLifeC model) includes care packages to meet the dominant life care needs of 6 unique patient groups representing known predictors of LTC home admission: social frailty, caregiver distress, chronic disease, cognition/ behaviours, medical complexity, and geriatric syndromes. Overlap in care needs of home care and LTC populations confirms potential to shift care to the community; yet current home care clients receive six times less daily care hours on average, compared to residential LTC standards. New LTLifeC packages of home-based interdisciplinary care ranged from 3.1-8.9 hours daily, including comprehensive assessment, integrated care planning, direct care provision and community referral(s). Initial cost comparisons suggest plausible short and long-term system benefits of model adoption.
 Learnings: Evidence-informed decision making for sustainable home and community care as part of an integrated system of LTC requires attention to both routinely collected health information, or ‘big data’, and expertise by lived-experience. Adoption of the LTLifeC model will require decision-making to prioritize societal values for living and aging at home and in community. 
 Next Steps: An evaluation framework will be developed to guide pilot implementation and testing of the LTLifeC model through the lens of the quadruple aim.

The impact of need-based care on formal caregivers' wellbeing in nursing homes: A cluster randomized controlled trial

BackgroundNeed-based care is a structured and standardized model that supports formal caregivers in nursing homes in delivering person-centered care by responding with tailored non-pharmacological interventions on residents' unmet needs as well as having positive effects on behavioral and psychological symptoms on residents with dementia. However, limited resources as well as the shortage of caregivers in nursing homes make the implementation of need-based care challenging, especially when it comes to finding ways to spend more time with residents. The aim of this study is to evaluate the impact of the implementation of need-based care in nursing homes on formal caregivers' wellbeing. MethodsA three-arm cluster randomized controlled trial was set up in 24 Belgian nursing homes: formal caregivers in the ‘need-based care’ group (intervention; n = 195) spent time twice a week with residents who had behavioral and psychological symptoms according to the principles of need-based care while formal caregivers in the ‘time’ group (n = 257) filled in the way they spent time twice a week; a third group delivered standard care (n = 299). An implementation strategy was built upon the Implementation Quality Framework and used in the ‘need-based care group’. A total of 741 formal caregivers completed the digital questionnaire at one or more of the five time points (every nine weeks) between November 2021 and July 2022; they rated their sense of competence in dementia care, level of burnout, and, level of engagement. Moments of time were registered in a printed registration book. ResultsOnly formal caregivers from the ‘need-based care’ group experienced a higher sense of competence in dementia care at time points three (p = 0.010) and four (p = 0.001) compared with baseline with an increase of respectively 1.5 (95 % confidence interval [0.25, 2.84]) and 2.4 (95 % confidence interval [0.77, 4.04]) points. No differences in scores on burnout and engagement were found. ConclusionDespite challenging workforce circumstances in nursing homes, caregivers in the need-based care group as well as in the time group were able to spend time twice a week with residents with behavioral and psychological symptoms. No negative effects were found on formal caregivers' wellbeing after the implementation of need-based care in nursing homes. However, it requires strong leadership and the use of well-considered implementation strategies including reflective practice. Trial registryTrial registration number ISRCTN56768265 (10/08/2023).

Allocation of Users of Mental Health Services to Needs-Based Care Clusters: An Italian Pilot Study

In Italy, despite strong community-based mental health services, needs assessment is unsatisfactory. Using the Mental Health Clustering Tool (MHCT) we adopted a multidimensional and non-diagnosis dependent approach to assign mental health services users with similar needs to groups corresponding to resources required for effective care. We tested the MHCT in nine Departments of Mental Health in four Italian regions. After a brief training, 318 professionals assessed 12,938 cases with a diagnosis of schizophrenia, depression, bipolar disorder and personality disorder through the MHCT. 53% of cases were 40–59 years, half were females, 51% had a diagnosis of schizophrenia, 48% of cases were clinically severe. Clusters included different levels of clinical severity and diagnostic groups. The largest cluster was 11 (ongoing recurrent psychosis), with 18.9% of the sample, followed by cluster 3 (non-psychotic disorders of moderate severity). The MHCT could capture a variety of problems of people with mental disorders beyond the traditional psychiatric assessment, therefore depicting service population from a different standpoint. Following a brief training, MHCT assessment proved to be feasible. The automatic allocation of cases made the attribution to clusters easy and acceptable by professionals. To what extent clustering provide a sound base for care planning will be the matter of further research.

Perceived Roles and Barriers in Delivering Community-Based Care: A Qualitative Study of Health and Social Care Professionals.

As healthcare systems increasingly embrace population health management, the integration of health and social care to improve the health and well-being of individuals is crucial. Thus, we conducted a qualitative study in Singapore to understand health and social care professionals' (HCPs and SCPs) perception of the roles they played in delivering community-based care. A descriptive phenomenological research design was adopted. HCPs and SCPs (n = 53) providing services in community settings were recruited purposefully and interviewed through eleven focus group discussions. Each session was recorded and transcribed. Thematic analysis was applied. Our results revealed eight themes in three main categories describing the roles played by HCPs and SCPs, including: (1) delivering needs-based care in community settings; (2) activating and empowering clients in health care, and (3) fostering community-based sustainable support networks. Six barriers encountered while performing these roles were also identified. Our results highlight that the roles of HCPs and SCPs go beyond the provision of direct medical and social care. They were involved in activating and empowering clients to take care of their health, and importantly, fostering community-based sustainable support networks to better empower individuals in coping with health challenges. The identified barriers shed light on areas for potential improvements for integrated community care.

Modelling the effect of demographic change and healthcare infrastructure on the patient structure in German hospitals – a longitudinal national study based on official hospital statistics

BackgroundEffects of demographic change, such as declining birth rates and increasing individual life expectancy, require health system adjustments offering age- and needs-based care. In addition, healthcare factors can also influence health services demand.MethodsThe official German hospital statistics database with odd-numbered years between 1995 and 2011 was analysed. This is a national comprehensive database of all general hospital inpatient services delivered. Official data from hospital statistics were linked at the district level with demographic and socio-economic data as well as population figures from the official regional statistics. Panel data regression, modelling case numbers per hospital, was performed for 13 diagnosis groups that characterised the patient structure. Socio-demographic variables included age, sex, household income, and healthcare factors included bed capacity, personnel and hospital characteristics.ResultsThe median number of annual treatments per hospital increased from 6 015 (5th and 95th percentile [670; 24 812]) in 1995 to 7 817 in 2011 (5th and 95th percentile [301; 33 651]). We developed models characterising the patient structure of health care in Germany, considering both socio-demographic and hospital factors. Demographic factors influenced case numbers across all major diagnosis groups. For example, the age groups 65–74 and 75 + influenced cerebrovascular disease case numbers (p < 0.001). Other important factors included human and material resources of hospitals or the household income of patients. Distinct differences between the models for the individual diagnosis groups were observed.ConclusionsHospital planning should not only consider demographic change but also hospital infrastructure and socio-economic factors.

Measures and Recommendations for Ensuring Adequate Inpatient Care Capacities for Pandemic Management within a Region: Results of a Hybrid Delphi Method

Since the beginning of the pandemic in spring 2020, inpatient healthcare has been under enormous burden, which is reflected especially in overworked staff, imprecise bed planning and/or data transfer. According to the recommendation of the Science Council, university clinics should play a controlling role in regional healthcare and act in conjunction with surrounding hospitals and practices. In September 2021, 31 representatives from 18 university hospitals were invited to a hybrid Delphi study with a total of 4 survey rounds to discuss criteria for effective inpatient care in a pandemic situation, which were extracted from previous expert interviews. Criteria that were classified as very important/relevant by≥75% of the participants in the first round of the survey (consensus definition) were then further summarized in 4 different small groups. In a third Delphi round, all participants came together again to discuss the results of the small group discussions. Subsequently, these were prioritized as Optional ("can"), Desirable ("should") or Necessary ("must") recommendations. Of the invited clinical experts, 21 (67.7%) participated in at least one Delphi round. In an online survey (1st Delphi round), 233 criteria were agreed upon and reduced to 84 criteria for future pandemic management in four thematic small group discussions (2nd Delphi round) and divided into the small groups as follows: "Crisis Management and Crisis Plans" (n=20), "Human Resources Management and Internal Communication" (n=16), "Regional Integration and External Communication" (n=24) and "Capacity Management and Case & Care" (n=24). In the following group discussion (3rd Delphi round), the criteria were further modified and agreed upon by the experts, so that in the end result, there were 23 essential requirements and recommendations for effective inpatient care in a pandemic situation. The results draw attention to key demands of clinical representatives, for example, comprehensive digitization, standardization of processes and better (supra) regional networking in order to be able to guarantee needs-based care even under pandemic conditions. The present consensus recommendations can serve as guidelines for future pandemic management in the inpatient care sector.

Effect of need-based care on behavioural and psychological symptoms in residents with dementia and formal caregivers' distress in nursing homes: a three-arm cluster randomized controlled trial.

To evaluate to what extent the standardized concept of need-based care on Behavioural and Psychological Symptoms of Dementia (BPSD), and formal caregiver distress, is superior when compared to spending more time or standard care with residents with BPSD. A longitudinal cluster randomized controlled study in 23 nursing homes in Belgium with 3 parallel groups was set up. A total of 481 residents with dementia participated. Formal caregivers in the need-based care group treated residents who displayed agitated or aggressive behaviour with a non-pharmacological intervention, tailored to unmet needs, twice a week with re-evaluation every 8weeks. In the time group, formal caregivers spent 'extra time'. In the standard care group, it was 'care as usual'. Outcomes were measured at four different time points with the Doloplus-2 (to assess pain behaviour), Cohen-Mansfield Agitation Inventory (CMAI) for agitation, the Neuropsychiatric Inventory (NPI-NH) for BPSD and formal caregivers' distress. Need-based interventions had a significant effect on residents' levels of pain behaviour. In the need-based care group, scores on overall BPSD (agitation and aggression, depression, euphoria, irritability, sleep and night-time behaviour) improved significantly from baseline when compared to other timepoints. No significant different interactions over time were found between all three groups for categorized versions of NPI scores (ever versus never). Need-based care reduced the level of BPSD in residents with dementia as well as formal caregivers' distress. The study supports the importance of tailored non-pharmacological interventions in the residential care for people with dementia. Trial registration number B300201942084 (18/11/2019).

Screening and assessment for cancer patients' psychosocial support needs: Development and validation of the psychosocial risk questionnaire.

Psychosocial factors can negatively influence the ability to cope with cancer-specific therapy. To identify high-risk patients and to offer need-based care concerning social issues, valid, reliable, and economic instruments are needed. This study aims to develop a tool assessing psychosocial support needs and analyze its psychometric properties. Based on an extensive literature search, items for the scale of psychosocial risks (PSR) were developed to assess the need for psychosocial support. Overall, N=343 participants with cancer took part in the study to investigate the psychometric properties of the PSR. The factor structure was examined by using a principal component analysis. Correlations with criteria-related constructs determined the convergent validity. Cut-off scores for the PSR were selected based on receiver-operating characteristics and the calculation of Youden indices. The principal component analysis suggests a two-factor structure: (1) Psychosocial support need to ensure medical and social care services, and (2) Support need for coping with problems. The predicted correlations confirm the convergent validity. Both scales showed excellent internal consistency (Ensure medical and social care services: Omega=0.94) and (Coping with problems: Omega=0.90). The newly developed scale can provide helpful information regarding psychosocial support needs to professionals (psychotherapists, psychologists, physicians, and social workers) in the psycho-oncological field. Based on this information, specific and personalized interventions for cancer patients can be offered. The PSR is appropriate for assessing specific psychosocial needs to support cancer patients.

Bereavement care and the interaction with relatives in the context of euthanasia: A qualitative study with healthcare providers

BackgroundA recent review shows an interdependence between healthcare providers and relatives in the context of euthanasia. Belgian guidelines do focus on the role of certain healthcare providers (physicians, nurses, and psychologists), yet they hardly specify bereavement care services before, during and after the euthanasia. PurposeA conceptual model showing underlying mechanisms of healthcare providers' experiences regarding the interaction with and the provision of bereavement care to relatives of cancer patients throughout a euthanasia process. Methods47 semi-structured interviews with Flemish physicians, nurses and psychologists working in hospitals and/or homecare, conducted from September 2020 to April 2022. Transcripts were analyzed using the Constructivist Grounded Theory Approach. ResultsParticipants experienced the interaction with relatives as very diverse, which can be visualized as a continuum ranging from negative to positive, depending on each unique case. The achieved degree of serenity was the main contributor in determining their position on the aforementioned continuum. To create this serene atmosphere, healthcare providers undertook actions underpinned by two attitudes (wariness and meticulousness), which are guided by different considerations. These considerations can be categorized into three groups: 1) ideas about a good death and its importance, 2) having the situation well under control and 3) self-reassurance. ConclusionsIf relatives were not at peace, most participants said that they deny a request or formulate additional requirements. Moreover, they wanted to ensure relatives can cope with the loss, which was often experienced as intense and time-consuming. Our insights shape needs-based care from healthcare providers' perspective in the context of euthanasia. Future research should explore the relatives' perspective regarding this interaction and the provision of bereavement care. Tweetable abstractProfessionals strive for a serene atmosphere throughout a euthanasia process to ensure relatives can cope with the loss, and the way in which the patient died.

Development and psychometric evaluation of the need assessment tool for women survivors of rape: Protocol for a mixed methods study.

Rape can lead to various physical and psychological consequences. Thus, survivors should receive immediate interventions and need-based care. The present study aims to design and psychometric evaluation of needs in women survivors of rape. This mixed methods study is conducted using a sequential exploratory approach. In the first phase, the participants (women survivors of rape and healthcare providers) are selected through purposive sampling in Isfahan. Data are collected through in-depth semi-structured interviews and field notes and are analyzed using conventional qualitative content analysis. The draft of the questionnaire is prepared based on the findings of the qualitative phase and literature review. Then, the face validity, content validity, and reliability of the questionnaire are assessed. Construct validity is assessed using the exploratory factor analysis through a descriptive cross-sectional study on women survivors of rape in the quantitative phase. Using a convenience sampling method, the data are collected in the research environment and analyzed via descriptive and inferential statistical methods. Cronbach's alpha coefficient is used to assess the internal correlation of the questionnaire. The valid and reliable questionnaire that is developed in this study can be used by planners to provide services and care according to the needs of women survivors of rape.

Quality of government secondary school services in regional Bangladesh

This research investigated the service quality of government secondary schools (GSS) in Bangladesh. A mixed methods research design combining quantitative and qualitative methods was applied for gathering and analyzing data. Quantitative data was collected from 601 randomly selected clients using a structured interview schedule developed based on the five-dimensional SERVQUAL instrument. Qualitative data was obtained through focus group discussions and interviews of students, teachers, headteachers, guardians, assistant school inspectors, and the deputy director of secondary and higher education working in the selected region. Quantitative data were analyzed using descriptive statistics and bivariate analysis, while qualitative data was transcribed and labeled into emerging themes. The study found that the quality of secondary education in the GSSs of the study area failed to meet the demand of the clients in terms of all the quality dimensions of SERVQUAL, where t-values revealed a significant gap between expectation and perception in Tangibles, Responsiveness, Reliability, Assurance and Empathy dimensions. Data from qualitative methods showed that all the stakeholders agreed with the gap in tangibles and empathy dimension claimed by the respondents in the quantitative survey. However, teachers and guardians showed differential opinions regarding the gaps in responsiveness, reliability, and assurance. It was also found that 40% of the respondents were either neutral or dissatisfied with the education service of GSSs. Logistic regression output shows that among the dimensions of SERVQUAL, tangibles, responsiveness, assurance, and empathy can significantly influence a respondent’s overall satisfaction with GSS services. One-way ANOVA results show that schools from at least two districts differ significantly in terms of the mean score of overall satisfaction and the perceived mean score of tangibles, responsiveness, reliability, assurance, and empathy dimensions. The schools lack teaching, learning and recreational facilities such as laboratory, library, common room, and sports. The students did not receive individual need-based care for academic performance improvement and did not participate in lesson planning, preferring teaching methods and deciding assessment strategies. The teachers were not sufficiently skilled in delivering intelligible lectures and didn’t give time to students outside of formal classes. A sizeable gap in the SERVQUAL dimensions indicates that a comprehensive all-out effort is necessary to improve the service quality of GSSs. Consequently, improving teaching learning facilities, student participation in the lesson plan and deciding on teaching methods, teachers' training in pedagogy, and school-specific quality improvement measures are imperative.

Providing "Compassionate Care" in the Neonatal Intensive Care Unit Through Infant and Family Needs-Based Care.

Provision of compassionate care to infants and their families in the neonatal intensive care unit (NICU) is a key component of competent critical care. Although recognized as an essential aspect of NICU care, compassionate care for infants and families in a NICU setting has been underexplored. This study defined and described compassionate care according to NICU staff. Voice-recorded, face-to-face individual interviews occurred with NICU nurses (n = 45), NICU nurse practitioners (n = 15), and neonatologists (n = 9) from two NICUs in the midwestern United States. Semantic content analysis was used. Consolidated criteria for Reporting Qualitative research guidelines were followed. Three dynamic and interactive qualitative themes emerged: excellent standard of intensive care, commitment, and engaged family communication. A conceptual framework entitled patient and family needs-based care was developed from the qualitative interviews. The framework developed from this study supports the therapeutic journey of NICU infants and families by integrating a focus on compassionate personalized care within the context of keen clinical and communication skillsets that staff have gained throughout their NICU careers. · While clinical competence is emphasized as a practice standard, compassion remains a core care value.. · A working definition of compassionate care and the description of its defining pillars has been underexplored.. · This study describes the perspectives of NICU staff on the actionable components of compassionate care for ill infant and their families..

Socio-demographic, behavioural and clinical factors influencing control of diabetes and hypertension in urban Mysore, South India: a mixed-method study conducted in 2018

BackgroundInadequate control of diabetes and hypertension is a major concern in India because of rising mortality and morbidity. Few studies in India have explored factors that influence control of diabetes and hypertension. The current study aimed to improve the understanding of multifactorial influence on the control of diabetes and hypertension among patients in Primary Health Care Settings(PHC) of urban Karnataka.MethodsWe used a mixed-method study design, within a project aiming to improve non-communicable disease (NCD) continuum of care across PHC in Mysore city, India, conducted in 2018. The quantitative study was conducted among 399 patients with diabetes and/or hypertension and a logistic regression model was used to assess the factors responsible for biological control levels of diabetes and hypertension measured through Glycated Haemoglobin(HbA1c) and blood pressure. Further, in-depth interviews(IDI) were conducted among these patients and the counsellors at PHCs to understand the barriers and enablers for better control.ResultThe quantitative assessment found odds of poor control amongst diabetics’ increased with older age, longer duration of disease, additional chronic conditions, and tobacco consumption. For hypertensives, odds of poor control increased with higher body mass index(BMI), alcohol consumption, and belongingness to lower social groups. These findings were elaborated through qualitative assessment which found that the control status was affected by stress as a result of family or financial worries. Stress, poor lifestyle, and poor health-seeking behaviour interplay with other factors like diet and exercise leading to poor control of diabetes and hypertension.ConclusionA better understanding of determinants associated with disease control can assist in designing focused patient outreach plans, customized communication strategies, need-based care delivery plans, and specific competency-based capacity-building models for health care workers. Patient-centric care focusing on biological, social and behavioural determinants is pivotal for appropriate management of NCDs at community level in low-middle income countries.