Negative Staff Attitudes Research Articles

Does volunteering change attitudes towards people with disabilities? A qualitative study of the experience of orthodox Jewish nursing students

BackgroundPeople with disabilities identify negative staff attitudes and behaviors as barriers to accessing health services. Studies show that nursing education activities specific to people with disabilities improves nursing care. This study explores the experience of orthodox Jewish nursing students volunteering with people with disabilities, how their attitudes towards this population changed. DesignA qualitative design was used. This research is part of an extensive ongoing study of orthodox and ultra-orthodox (Haredi) students volunteering with people with disabilities. MethodsData from 13 semi-structured interviews, conducted between July and September 2017, with 14 male students (two students chose to be interviewed together) and four people with disabilities were analyzed using thematic analysis. ResultsVolunteering enhanced students' awareness of the needs of people with disabilities, changed their attitude towards this population and enhanced their confidence as nurses. The individuals with disabilities valued the help they received as well as the opportunity to change the students' prior notions and stigmas regarding disability. ConclusionsProjects such as ours could improve the attitude of nursing staff towards individuals with disabilities and improve nursing care. We recommend involving people with disabilities in designing such projects.

Gastronomy tourism through tea and coffee: travellers’ museum experience

PurposeThe main aim of the present research is to investigate the tea and coffee experience of travellers around the world and clutch the dimensions of tea and coffee museum experience.Design/methodology/approachTravellers who had experienced tea and coffee museums were purposefully selected as a sample group for the study. As tea and coffee museums that are benefiting from user-generated content (UGC) are limited, a qualitative multiple case study method has been chosen to enrich more comments and obtain more data. For the data gathering, as a UGC platform, TripAdvisor was benefited.FindingsAccording to an inductive content analysis of reviews, the model of dimensions of tea and coffee museum experience that consist of nine main categories revealed: educational experience, authentic experience, memorable experience, participatory experience, shopping experience, atmosphere, facilities, employees and tour guides and negative experiences (negative staff attitudes and skills, lack of foreign language explanations and cleanliness).Originality/valueTo the best of the authors’ knowledge, this study is the first to examine the tea and coffee museum experience of travellers around the world. It contributes to the gastronomy literature by providing the dimensions of the tea and coffee museum experience.

Nursing degree students’ clinical placement experiences in Australia: A survey design

AimThis study aimed to evaluate Australian nursing students’ views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET). BackgroundClinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences. DesignA survey design was used with a contemporary survey tool– the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed. MethodsA total of 1263 nursing students completed the Placement Evaluation Tool (PET) − 19 items (rated 1–5), one global rating (rated 1–10) − following placement in three Australian States (July 2019−February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall. ResultsThe total PET mean score was 78.3% with 29.8% being ‘extremely satisfied’ (10 out of 10 – Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle. ConclusionsWhilst students’ clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.

The Use of Digital Technology Platforms in the Context of Cybersecurity in the Industrial Sector

Abstract This study discusses the use of digital technology platforms (DTPs) in the context of cyber-security in the industrial sector, with a focus on digital industry (industrial) platforms (DIPs). A definition of DTPs is presented, including the author's interpretation, as well as the scope of DTP application in the industrial sector, which includes, in particular, European Digital Platforms (EDPs) and Polish Digital Platforms (PDPs), such as non-ferrous metals PDP or intelligent transport systems PDP. This is followed by a section covering the theoretical basis of the study that highlights the key challenges and risks associated with the use of DTPs as well as the methods for their neutralization in the form of specific concepts and systems that can be employed in the industrial sector. The subsequent section of the study is based on results of the author's own survey which collected information from a total of 120 companies operating in Poland, which were granted subsidies under the Operational Program Innovative Economy for investments involving the implementation and development of DTPs. The survey was carried out using a questionnaire developed by the author, which consisted of 23 questions. In this respect, as shown by the author's own studies, of greatest relevance are hardware failures and Internet outage events. Most importantly, concerns about such risks are some of the major factors underlying the negative attitudes of management staff of industrial companies toward DTPs, and therefore, it is so important to ensure that any such risks can be effectively addressed. They can be avoided through the use of certain concepts and systems such as STOE or CVSS. A typical company may know the model of DTPs in the context of challenges in the field of cybersecurity through this study; in particular, it can improve IT security.

Exploring women's experience of healthcare use during pregnancy and childbirth to understand factors contributing to perinatal deaths in Pakistan: A qualitative study.

Understanding key healthcare system challenges experienced by women during pregnancy and birth is crucial to scale up available interventions and reduce perinatal mortality. A community perspective about preferences and experience of care during this period can be used to improve community-based programs to reduce perinatal mortality. Using a qualitative exploratory approach, we examined women's experience of perinatal loss, aiming to understand the main factors, as perceived and experienced by women, leading to perinatal loss. Qualitative in-depth Interviews were conducted with 25 mothers with a recent perinatal loss, three family members, six healthcare officials, and two focus group discussions with 17 lady health workers. Data were analysed using inductive and deductive coding, by thematic analysis. Our findings revealed three distinct but interrelated themes, which include: 1) poor access to care during pregnancy and birth, 2) unavailability of appropriate healthcare services, and 3) poor quality of care during pregnancy and birth. Women frequently delayed seeking formal care around birth because of delays by themselves, their family members, or the local traditional birth attendants who frequently induced births at women's homes without recognising the dangers to the mothers or their babies. Preference for private care was common, however they often could not bear the cost of care when they needed caesarean section or in-patient care for their sick newborns because these services were absent in public health facilities of the district. Referral to the regional tertiary care hospital was often not officially arranged leading to risky births in small and crowded private clinics. Women's views about negative staff attitudes and the lack of attention given to them in public health facilities highlighted a lack of quality and respectful antenatal care. Improvement in women's access to essential care during pregnancy and around birth, availability of emergency obstetric and newborn care, improving the quality of maternal and newborn care in both public and private health facilities at the district level might reduce perinatal mortality in Pakistan.

Not ‘Just a Talking Head’: Experiences of Australian Public Mental Health Clinicians Implementing a Dialogical Family Therapy Approach for Young People with Severe Mental Health Concerns

The evidence for efficacy of family‐based approaches for psychological problems is extensive, although model‐specific effects have not been established. However, implementation of family therapy approaches in tertiary mental health settings has been challenging due to factors such as negative staff attitudes and difficulties engaging families. Open Dialogue is an emerging network‐based therapy that has a focus on genuine collaboration, flexibility, authenticity, and openness. This study describes the experiences and perspectives of clinicians, service users and families, following training in Open Dialogue, within a child and adolescent mental health service, and an adolescent inpatient unit in public mental health services. A total of 16 participants (11 clinicians and five service users and family members) took part in semi‐structured interviews regarding their experiences with Open Dialogue. Interpretative phenomenological analysis was used to analyse interview transcripts. Four major themes were identified from interviews with clinicians: valuing responses from families, learning from families and privileging their expertise, hesitation about doing family therapy, and engaging with authenticity and flexibility. Three themes emerged from family interviews: hesitation about doing family therapy, valuing collaboration and openness, and opening space for more talk. These themes are relevant to challenges of family therapy in public mental health settings and future directions for implementation.

How Do Economically Active People with Disabilities Access Microfinance?

Abstract:Many economically activepeople with disabilities do not haveaccess to affordable financialproducts and services. The consequence is that not only do people with disabilities experience social exclusion, but they also struggle to secure their financial lives. Althoughmicrofinance has been widely used in Bangladesh formore than three decades as a tool for reducing poverty and empowering poor people, few Microfinance Institutions (MFIs) recently started providing microfinance to some selected economically active people with disabilities. However, very little evidence exists to show how people with disabilitiesaccess microfinance. Therefore, the aim of this research is to identify the barriers or challenges that people with disabilities face to access microfinance. This study uses a qualitative case study approachbased on interviews with thirty-five economically active people with disabilities and ten stakeholdersalong with document analysis and observation as a tool for research data collection. Data analysis was conducted usingthematic analysis, with findings showingthat people with disabilities face substantial barriers to access microfinance. These barriers includeharder credit conditions, lack of social capital, negative staff attitudes,no or insufficient training,andabsence of an integrated approach. Theresearch suggests that the government should formulate an integrated policy framework aiming to help people with disabilities for financial inclusion. Moreover, Non-GovernmentalOrganizations (NGOs), Disabled People Organizations (DPOs), MFIsandpeople with disabilities couldcome together todevelop an effective partnership for designing social and economic development programs that canempower people with disabilities. Finally, this research suggestssome of the key strategies such as to develop MFI’s anti-discrimination policiesand theirimplementation, convenient credit designfor people with disabilities, improve skills, enhance capacitiesand, build self-confidence of people with disabilities. Furthermore, this research recommendsthat MFIs couldprovide financial literacy to people with disabilities, trainingto MFIs staffon disability issues, raise awareness among credit group membersabout disability, and more importantly identify people with disabilitiesespecially in the rural areas to enhance financial inclusionof people with disabilities.

Why don't health care frontline professionals do more for segregated Roma? Exploring mechanisms supporting unequal care practices

RationaleUnequal provision of health care contributes to the poor health status of segregated Roma in Central and Eastern Europe. Studies on the drivers and mechanisms behind this are lacking. ObjectiveWe explored what kinds of substandard practices health care frontline professionals engage in regarding segregated Roma and what mechanisms support such practices during the professionals' careers in care services. MethodsOver a three-month period at five different locations in Slovakia we interviewed and observed 43 frontline professionals serving segregated Roma. Next, through qualitative content analysis we identified in the data three themes regarding kinds of substandard practices and 22 themes regarding supporting mechanisms. We organized these themes into an explanatory framework, drawing on psychological models of discrimination and intergroup contact. ResultsThe frontline staff's substandard practices mostly involved substandard communication and commitment to care, but also some overt ethnic discrimination. These practices were supported by five mechanisms: the staff's negative experiences with people labelled “problematic Roma patients”; the staff's negative attitudes regarding segregated Roma; adverse organizational aspects; adverse residential-segregation aspects; and poor state governance regarding racism. In the course of their careers, many professionals first felt obliged and diligent regarding segregated Roma patients, then failing, unequipped and abandoned, and ultimately frustrated and resigned regarding the equal standard of care towards the group. ConclusionsHealth care frontline staff's practices towards segregated Roma are frequently substandard. The psychological processes underlying this substandard care are supported by specific personal, organizational and governance features. These mechanisms cause many frontline professionals gradually to become cynical regarding segregated Roma over the course of their careers. Health care staff should be supported with skills and tools for effectively handling their own and others' racism, the culturebound and structural vulnerabilities of patients as well as related professional expectations regarding equity.

Self-harm presentations in emergency departments: staff attitudes and triage.

Addressing the rising incidence of self-harm and the demand this places on emergency departments (EDs) are UK Government healthcare priorities. A history of self-harm is linked with suicide risk, so self-harm is a public health issue. The ED is the first point of contact for many people who self-harm so it plays a pivotal role in access to services. Research has highlighted difficulties around triage and assessment in EDs of patients who self-harm, especially frequent attenders. The evidence base on patient experience related to addressing negative staff attitudes is lacking, despite their potent nature and impact on care. Limited knowledge of self-harm aetiology and clinical inexperience have been found to be fundamental to nurses' negative attitudes when dealing with patients who self-harm. This has been linked to negative patient outcomes, including a reluctance to engage with services. This article acknowledges positive changes that have been made and highlights the importance of the triage stage, which is a potential service improvement area, where it would be possible to start and drive positive change in the care of people who self-harm. To address knowledge gaps in education and management, clinical understanding of the aetiology of self-harm should be improved with the aid of education on self-harm cycles. Nurses should also be made aware of common myths surrounding self-harm, as these are barriers to care. Recommendations for practice include partnership working and the urgent need for formal education on this topic for all health professionals working in EDs.

Barriers and facilitators to linkage to care and ART initiation in the setting of high ART coverage in Botswana

ABSTRACTWe conducted a qualitative study using focus groups and in-depth interviews to explore barriers to and facilitators of linkage-to-care and antiretroviral treatment (ART) initiation in Botswana. Participants were selected from communities receiving interventions through the Ya Tsie Study. Fifteen healthcare providers and 49 HIV-positive individuals participated. HIV-positive participants identified barriers including stigma, discrimination and overcrowded clinics, and negative staff attitudes; personal factors, such as a lack of acceptance of one’s HIV status, non-disclosure, and gender differences; along with lack of social/family support, and certain religious beliefs. Healthcare providers cited delayed test results, poverty, and transport difficulties as additional barriers. Major facilitators were support from healthcare providers, including home visits, social support, and knowing the benefits of ART. Participants were highly supportive of universal ART as a personal health measure. Our results highlighted a persistent structural health facility barrier: HIV-positive patients expressed strong discontent with HIV care/treatment being delivered differently than routine healthcare, feeling inconvenienced and stigmatized by separately designated locations and days of service. This barrier was particularly problematic for highly mobile persons. Addressing this structural barrier, which persists even in the context of high ART uptake, could bring gains in willingness to initiate ART and improved adherence in Botswana and elsewhere.

Investigation into attitudes towards older people with dementia in acute hospital using the Approaches to Dementia Questionnaire.

Health care professionals have poor recognition of cognitive impairment among older patients and often have difficulties in providing care for people with dementia in acute hospitals. There are also reported high levels of stigma and negative staff attitudes towards people with dementia. A one-time survey of staff working on acute medical and orthopaedic wards of five District Health Boards in New Zealand using the 'Approaches to Dementia Questionnaire'; a 19-item Questionnaire that aims to capture two attitudinal domains (Hope and Person-Centredness), towards people with dementia. A total of 563 questionnaires were distributed. Data were analysed using R. Three hundred and four (53.99%) respondents completed the survey. Ninety-four of the respondents (31.1%) were aged 51 years or older, and nearly all (88.4%) were women. One hundred and sixty-four of the respondents (53.9%) were registered nurses, 10 were student nurses (3.3%), 24 (7.9%) were healthcare assistants, 70 (23.0%) were allied health professionals, 27 (8.9%) were doctors and 9 (3%) were pharmacists. The mean total score of 72.7 reflected positive attitudes overall on the part of the respondents. Allied health professionals, student nurses and pharmacists had high scores on both scales whilst healthcare assistants scored lowest on both scales. Overall, the Approaches to Dementia Questionnaire is a useful measure, but it can be difficult to differentiate between genuine attitudinal differences and confounding influences such as level of knowledge and education amongst such a diverse group of participants. Differences between staff may be considered as a reflection of the high level of direct care that is expected of some staff and not of others. Further, the Approaches to Dementia Questionnaire may not be the most appropriate measure to accurately understand attitudes to dementia care in acute environments; and that it more usefully reveals knowledge about dementia rather than attitudes related to real-time practice.

Attitudes of hemodialysis patients, medical and nursing staff towards patients' physical activity.

Patients with end-stage renal disease (ESRD) seem to have a negative attitude towards physical activity, which is mainly favored by the lack of counseling provided by the medical and nursing staff. The aim of this study was to investigate the attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity and identify the obstacles that discourage patients' involvement in intervention programs. Subjective assessment questionnaires and the International Physical Activity Questionnaire were administrated to hemodialysis patients and medical staff, to investigate the association between patient's barriers to physical activity, the total intensity level of physical activity, and attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity. A total of 103 ESRD patients (61 men, 59.2%), 20 nephrologists (12 men, 60.0%), and 72 nurses (61 women, 84.7%) participated in the study. Most commonly reported patient's barriers were fatigue on dialysis (97.4%) and non-dialysis days (55.1%). Healthcare staff showed positive attitude towards renal rehabilitation exercise programs. However, most of physicians (85.0%) and nurses (83.3%) did not have previous experience with interventional exercise rehabilitation programs. Binary logistic regression revealed significant association between patients' inactivity, demographic data, and barriers towards physical activity, such as fatigue and pain in dialysis and non-dialysis days (p < 0.05), family's and physician's concern (p < 0.05), too many medical problems (p < 0.05), the fear of getting hurt (p = 0.01), and unwillingness for exercise (p < 0.05). Interestingly, healthcare staff's negative attitudes toward patient's physical activity seem to be strongly associated with patient's inactivity status. Healthcare staff negative attitudes and multiple related barriers especially fatigue on dialysis and non-dialysis days, towards ESRD patient's physical activity, suppress desire for exercise and active patients' status, leading them to abstain from it.

Exploring maternal and health professional beliefs about the factors that affect whether women in Saudi Arabia attend antenatal care clinic appointments

ObjectiveEffective antenatal care is important for the health and wellbeing of pregnant women and infants. However, in Saudi Arabia, attendance rates are low, increasing the risk of negative birth outcomes. The aim of this research is to understand the beliefs of pregnant women and health professionals about the factors leading to these low attendance rates. MethodologyA qualitative exploratory study-using semi structured face-to-face interviews. Interviews were conducted exploring (a) attitudes to the use of antenatal care by pregnant Saudi women, (b) beliefs of women regarding the value of antenatal care and (c) perceived barriers to attendance. SettingData were collected from three hospitals in two regions of Saudi Arabia. ParticipantsWomen at any stage of their pregnancy attending for antenatal care or ultrasound, women attending postnatal clinic, and health professionals (obstetricians) who support women during pregnancy and birth. FindingsAlthough mothers viewed antenatal care as important for maternal and infant health, several barriers to attending care were identified by mothers and professionals. These factors were classified into three themes: physical barriers (e.g., lack of transport), low maternal education, and inadequate healthcare facilities (including negative staff attitudes and poor communication). These factors were exacerbated by the beliefs of partners and family. Notably, the theme of low maternal education was raised only by health professionals, whilst the theme of staff attitudes and communication was raised only by mothers. Key conclusionsBarriers to antenatal care exist at the personal, social, socioeconomic and health services level. Some health professionals may be unaware of the importance of their communication style. Interventions to improve attendance must be multifaceted rather than focussing on individual women alone. Implications for practiceBarriers for women attending antenatal healthcare must be addressed in order to increase attendance rates. Specific practice-based interventions may involve changing the time or location of services and exploring changes to staff communication with women.

Delirium Stigma Among Healthcare Staff.

Older people with delirium occupy more than one third of acute medical beds and require increased medical attention, as care at present is suboptimal. In addition, since delirium is undetected, it should form a target for teaching in wards. Moreover, as people with delirium are largely dependent on daily interactions and care by inpatients professional staff, it is important to address stigmatisation of these vulnerable patients. This is especially important as previous studies have shown that negative staff attitudes towards these patients undermine good care. This single center cross-sectional study was designed to determine the extent of institutional stigma among health professionals involved in the care of people with delirium. For this, professional staff working on medical wards and in communities were approached to fill in a questionnaire containing the adapted Delirium Stigma Scale and the EuroQol five dimensions (EQ-5D-5L) questionnaire. Additional demographic information concerning their education and professional and personal experience with delirium was also collected. The characteristics associated with stigma were determined from the sample. The findings of our study provide an insight into the high level of stigmatisation of delirium patients among professionals (mean 11.66/18 points). This was not related to professionals’ own experiences of delirium, their educational and professional backgrounds, or them having received formal delirium education. However, working closely with people with delirium seems to have a positive impact on the de-stigmatisation of this population among health professionals. Our findings that attitudes are not influenced by formal delirium teaching need to be incorporated into the design of interprofessional educational interventions. Accordingly, we advocate more direct patient-oriented and care delivered teaching interventions.

\u201cIn the hospital, there will be nobody to pamper me\u201d: a qualitative assessment on barriers to facility-based delivery in post-Ebola Sierra Leone

BackgroundSierra Leone has one of the highest maternal mortality rates in the world. Encouraging the use of skilled birth attendance in health facilities is an important step in the endeavor to increase the number of safe deliveries. However, public trust in health facilities has been greatly damaged during the Ebola epidemic outbreak in Sierra Leone in 2014/2015, and little is known about external and intrinsic barriers to facility-based delivery (FBD) in the country since the end of the Ebola epidemic.MethodsWe conducted a qualitative study on FBD in Princess Christian Maternity Hospital, Freetown, which is the national referral maternity hospital in Sierra Leone. We performed six focus group discussions with providers, pregnant women and recent mothers surrounding experiences, attitudes and behaviors regarding FBD and potential barriers. Discussions were tape recorded, transcribed and evaluated through content analysis.ResultsWomen in our study were overall technically aware of the higher safety linked with FBD, but this often diverged from their individual desire to deliver in a supportive and trusted social and traditional environment. Close relatives and community members seemed to be highly influencial regarding birth practices. Many women associated FBD with negative staff attitudes and an undefined fear. Logistic issues regarding transportation problems or late referral from smaller health centers were identified as frequent barriers to FBD.ConclusionsMore supportive staff attitudes and acceptance of an accompanying person throughout delivery could be promising approaches to increase women’s confidence in FBDs. However, these approaches also imply revising health systems structures, like staff working conditions that are conducive for a friendly atmosphere, sufficient space in delivery wards allowing the women to bring a birth companion, or like the establishment of a reliable peripheral ambulance system to ensure transportation and fast referral.

Maternity experiences of mothers with multiple disadvantages in England: A qualitative study

BackgroundDisadvantaged mothers and their babies are at increased risk of poor perinatal outcomes and have less positive experiences of maternity care. AimTo explore the maternity care experiences of mothers with multiple disadvantages. MethodsA qualitative descriptive study based on semi-structured interviews with 40 mothers with multiple disadvantages, using thematic analysis. FindingsFour themes emerged: ‘A confusing and frightening time’, ‘Longing to be respected as an individual’, ‘The importance of choice and control’, and ‘Needing trust to feel safe’. Mothers brought feelings of powerlessness and low self-esteem to their encounters with maternity professionals, which could be significantly worsened by disrespectful care. They needed support to navigate the complex maternity system. Positive experiences were much more likely where the mother had received continuity of care from a specialist midwife or small team. Discussion and conclusionMothers with multiple disadvantages value being treated as an individual, making informed choices, and feeling safe, but they may lack the confidence to ask questions or challenge disrespectful treatment. Training and supervision should enable maternity professionals to understand how confusing maternity care can be to very disadvantaged mothers. It should emphasise the need to provide accessible and empowering information and guidance to enable all mothers to make choices and understand the system. Leaders of maternity services need to do more to challenge negative staff attitudes and ensure that that all mothers are treated at all times with kindness, respect and dignity. Specialist midwives can deliver a high quality service to mothers experiencing multiple disadvantages.

Health and health care access for Syrian refugees living in İstanbul.

The study was conducted to assess the health needs of urban refugees living in İstanbul. A mixed methods approach was adopted to interview Syrian women from households, doctors, decision makers and NGO representatives. The data were collected between June and October 2015. The main challenges were the cost of living in İstanbul, increased rent and language barrier. Almost half (49.6%) of the interviewed women did not know about free health care rights for Syrians. In the last 30days preceding the interview, 58.6% of the participants sought health care primarily through state hospitals, primary health care centres and pharmacies. The participants had difficulty in accessing health care due to the language barrier and a lack of knowledge of the Turkish health care system. Waiting time at hospitals and negative attitudes of health care staff reduced satisfaction in these services. In relation to life in Turkey, the main issues for Syrian refugees were not directly related to health. They have been given the right to access health care, although had many difficulties in understanding and accessing services in a crowded city.

An introduction to nursing surveillance in the tele-ICU

An introduction to nursing surveillance in the tele-ICU

The efficacy of infection prevention and control committees in Lesotho: A qualitative study

The implementation of the core components of infection prevention and control (IPC) recommended by the World Health Organization faces severe challenges, particularly in developing countries. Given that hospital IPC committees in these countries are the key implementers of IPC, there is a need to evaluate their effectiveness. This study qualitatively evaluated the effectiveness of IPC committees in the southern African country of Lesotho with the aim of identifying themes for policy discourse on improving IPC practice in the country. Data gathering was conducted through open interviews with purposefully selected key informant IPC committee members and relevant officials at the Ministry of Health, whereas data analysis was based on grounded theory. Despite their commitment, IPC committees were largely ineffective because of 5 major barriers, namely poor sense of competence, administrative constraints, inadequate financial support, role uncertainty, and negative staff attitudes. Poor IPC governance was found to be a central barrier to the effectiveness of IPC committees in Lesotho. The import of this study is that effective IPC governance is key to improving the IPC program in Lesotho. Effective leadership with the necessary competencies is needed to steer the IPC program in the country.

Perceptions of learning disability nurses and support staff towards people with a diagnosis of schizophrenia.

Background and purpose of study The prevalence of schizophrenia in people with learning disability is 3-4%. This is the first study to investigate the illness perceptions of learning disability (LD) practitioners towards people with schizophrenia. Methods Learning disability practitioners (n=210) that work with people with LD and schizophrenia completed a modified version of the Illness Perception Questionnaire Schizophrenia Carers Version (IPQ-SCV). Descriptive and correlational analyses were conducted for all of the IPQ-SCV subscales. Results A significant positive correlation was found between consequences relative and consequences patient (0.495, P<0.001), and a negative correlation was found between timeline episodic and timeline chronic (-0.243, P<0.001) subscales. Discussion Consistent with previous evidence found regarding negative staff attitudes to schizophrenia recovery outcomes, course and chronicity, the current investigation has extended and confirmed these observations to staff working with individuals with comorbid schizophrenia and learning disability. Implications for practice This study identifies the nature of LD practitioner perceptions about schizophrenia and contributes to the development of the recovery philosophy in relation to the management of LD and schizophrenia. The findings inform the design of training modules in bio-psycho-social models of schizophrenia, recovery approaches, family intervention, clinical supervision and reflection. These can help LD practitioners to reframe their schizophrenia/LD illness beliefs.