Health Service Practice Research Articles

Assessment of Knowledge, Attitude, and Practice of Skilled Assistance Seeking Maternal Healthcare Services and Associated Factors among Women in West Shoa Zone, Oromia Region, Ethiopia.

Background This study aimed to assess women's knowledge, attitude, and practice towards skilled assistance seeking maternal healthcare services in West Shoa Zone, Oromia Region, Ethiopia. Methods Cross-sectional survey design was conducted from 1 February to 23 March 2018 in West Shoa Zone, Oromia, Ethiopia. A simple random sampling technique was used to select the participants. The data were collected using a pretested and structured questionnaire. Data were entered using EpiData version 3.1, and descriptive analysis and bivariate and multivariate logistic regression analyses were carried out using SPSS version 20 statistical software package. Results The study revealed that the knowledge, attitude, and practice towards skilled maternal health services were found such that 473.3 (72.4%) of the study participants had good knowledge, 180.7 (27.6%) had poor knowledge, and 400 (61.3%) had positive attitude, 254 (38.84%) had negative attitude, 460.3 (70.4%) had good practice, and 193.7 (29.6%) had poor practice towards skilled maternal health services. Factors that had a significant association with antenatal care utilization were planned pregnancy (AOR = 8.2, 95% CI = 3.39-19.78-0.87) and access to transport (AOR = 3.1, 95% CI = 1.46–6.61). Attending ANC at least once (AOR = 3.1, 95% CI = 1.13–8.41), women's education (AOR = 3.0, 95% CI = 1.18–7.84), and unplanned pregnancy (AOR = 0.3, 95% CI = 0.21–0.75) were factors associated with skilled delivery service utilization. Attending ANC at least once (AOR = 2.1, 95% CI = 1.1–4.2), birth complications (AOR = 2.2, 95% CI = 1.35–3.66), unplanned pregnancies (AOR = 0.3, 95% CI = 0.22–0.68), and awareness about skilled obstetric care (AOR = 3.7, 95% CI = 1.68–12.79) were factors associated with postnatal care utilization. Conclusions This study found that the knowledge, attitude, and practice of skilled maternal health services among the study participants are low, showing less than three-quarters of the total sample size. Therefore, this study implied that interventions are required to improve women's knowledge, attitude, and practice of skilled maternal health services in the study area. Furthermore, women's education is significantly associated with skilled delivery service utilization. Accordingly, this study recommends that improving equity among the marginalized population is needed to increase maternal health service coverage.

Community's experience and perceptions of maternal health services across the continuum of care in Ethiopia: A qualitative study.

Continuum of care is an effective strategy to ensure that every woman receives a series of maternal health services continuously from early pregnancy to postpartum stages. The community perceptions regarding the use of maternal services across the continuum of care are essential for utilization of care in low-income settings but information in that regard is scanty. This study explored the community perceptions on the continuum of care for maternal health services in Ethiopia. This study employed a phenomenological qualitative research approach. Four focus group discussions involving 26 participants and eight in-depth interviews were conducted with women who recently delivered, community health workers, and community leaders that were purposively selected for the study in West Gojjam zone, Amhara region. All the interviews and discussions were audio-taped; the records were transcribed verbatim. Data were coded and analyzed thematically using ATLAS.ti software. We identified three primary themes: practice of maternal health services; factors influencing the decision to use maternal health services; and reasons for discontinuation across the continuum of maternal health services. The study showed that women faced multiple challenges to continuously uptake maternal health services. Late antenatal care booking was the main reasons for discontinuation of maternal health services across the continuum at the antepartum stage. Women's negative experiences during care including poor quality of care, incompetent and unfriendly health providers, disrespectful care, high opportunity costs, difficulties in getting transportation, and timely referrals at healthcare facilities, particularly at health centers affect utilization of maternal health services across the continuum of care. In addition to the reverberation effect of the intrapartum care factors, the major reasons mentioned for discontinuation at the postpartum stage were lack of awareness about postnatal care and service delivery modality where women are not scheduled for postpartum consultations. This study showed that rural mothers still face multiple challenges to utilize maternal health services as recommended by the national guidelines. Negative experiences women encountered in health facilities, community perceptions about postnatal care services as well as challenges related to service access and opportunity costs remained fundamental to be reasons for discontinuation across the continuum pathways.

Effects of Cognitive Remediation on Cognition, Metacognition, and Social Cognition in Patients With Schizophrenia.

We aimed to evaluate in a sample of outpatients with schizophrenia (SCZ) the effectiveness of a cognitive remediation (CR) program (through the use of the Cogpack software) [computer-assisted CR (CACR)] in addition to standard therapy on cognitive outcomes as compared with that in a control active group (CAG) and to highlight a possible effect on social cognition (SC), metacognition, symptomatology, and real-world functioning. Of the 66 subjects enrolled, 33 were allocated to CACR and 33 to the CAG. Twenty-three patients in the CACR group and 25 subjects in the CAG completed at least 80% of the 48 prescribed CACR sessions, performed twice a week, for a total of 24 weeks of treatment. A significant time × group interaction was evident, suggesting that patients undergoing CACR intervention improved in specific metacognitive sub-functions (understanding others' mind and mastery), some cognitive domains (verbal learning processing speed, visual learning, reasoning, and problem solving) (h2 = 0.126), depressive symptoms, SC, awareness of symptoms, and real-world functioning domains (community activities and interpersonal relationships) more significantly than did patients undergoing CAG. The most noticeable differential improvement between the two groups was detected in two metacognitive sub-functions (understanding others' mind and mastery), in verbal learning, in interpersonal relationship, and in depressive symptomatology, achieving large effect sizes. These are encouraging findings in support of the possible integration of CACR in rehabilitation practice in the Italian mental health services.

The Application Study on Accurately Search&Rescue of the Wounded on the land battlefield base on “Beidou + Armored ambulance”

The accurately program of search&rescue of the wounded is designed and an initial design idea of various subsystems is proposed in order to provide theoretical explorations and solutions for making the search & rescue of the wounded on a land battlefield immediate, intelligent and accurate and for lowering the death and disability rates of the wounded. A full combination of skill features and functional advantages is made between BDS and Armored ambulance, which is systematically applied to the search & rescue on the land battlefield. The rationality and feasibility of the program of search&rescue are guaranteed by functional combinations, comprehensive integration and experimental verification. The verification of the program of search&rescue is made in the form of war-game exercises. The result finds that the “BDS + Armored ambulance” pattern of search & rescue can accurately acquire real-time locations of the wounded, immediately provide on-site first-aid services and emergency aid & treatment for the wounded and rapidly receive and transfer the wounded, which demonstrate a better practice and application prospect of health services. As the BDS-3 is to be put into service in 2020, the informationized upgrading and transformation of Armored ambulance will be gradually completed and the “BDS + Armored ambulance” program of search &rescue will exert a more obvious influence on the search & rescue of the wounded on the land battlefield, which provide a capability support for realizing the idea of “Medical Treatment be with Soldiers”.

Making every drop count: reducing wastage of a novel blood component for transfusion of trauma patients

Recent research demonstrates that transfusing whole blood (WB=red blood cells (RBC)+plasma+platelets) rather than just RBC (which is current National Health Service (NHS) practice) may improve outcomes for major trauma patients....

Unique knowledge, unique skills, unique role: Aboriginal and Torres Strait Islander Health Workers in Queensland, Australia

Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are a professional cadre of Australian health workers typically located in primary care clinics. The role is one of only two that...

Legal Protection for Doctors in Health Service Practices

The advanced developments in technology, information, and knowledge, especially in the fields of health and law, will have a negative impact on the mindset of society, especially in health services. This is proven by the wide variety of demands on medical personnel, the doctors who practice medicine. Cases of suspected malpractice are often over-reported by the mass media and social media. Doctors are seen to have no responsibility or making mistakes in their profession. In fact, all the news that is delivered or written does not necessarily reflect reality. The actions were taken by the doctor corresponds with professional standards and standard for operating procedures. This study aims to explore the analysis of legal protection implementation and its weaknesses in a medical dispute between doctors and patients. This study employed a normative juridical approach by library research. The primary and secondary legal material sources were taken from laws, books, and scientific journals. The findings revealed that in doing medical practice, doctors must fulfill informed consent and medical records. This is to serve as evidence that can exempt the doctors from all lawsuits if malpractice allegations arise. There are many reasons for the repeal of the doctors’ sentences to free them from lawsuits. This includes the risk of medication and medical accidents. In conclusion, a doctor who has carried out his duties based on professional standards, service standards, and standard operating procedures is entitled to proper legal protection based on the value of justice

Baccalaureate occupational therapy students' development of social and emotional competencies

BackgroundAcademic life requiring students to meet academic and professional practice expectations can be stressful. Effective emotional and social competence can assist students in managing feelings, stressful situations and fostering relationships with educators, peers, and clients. Hence this is a helpful professional competence for health students to possess. ObjectiveTo compare the emotional and social competence among the baccalaureate occupational therapy students across four academic year levels. MethodA quantitative cross-sectional design was used. A total of 360 baccalaureate occupational therapy students completed the Emotional and Social Competency Inventory– University Edition. Regression analysis followed by contrast analysis examined the differences among first-, second-, third- and fourth-year levels. ResultsStudents demonstrated “satisfactory” or above social and emotional competencies. For all students, the average Emotional and Social Competency Inventory subscale scores on teamwork, empathy and achievement orientation were the highest three competencies. The lowest average scores were systems thinking, inspirational leadership and coach and monitor skills. Fourth year students' emotional self-control (p = 0.03), positive outlook (p = 0.02), and influence (p = 0.02) were significantly lower than first-year students. No other significant differences were found between year levels on the other subscales. ConclusionOverall, students demonstrated good social and emotional competencies, with strengths in teamwork, empathy and achievement orientation competencies, which are fundamental in health service practice. However, fourth-year students demonstrated lower scores in emotional self-control, positive outlook, and influence competencies compared to their first-year peers. This indicates that fourth-year students have developed better self-awareness, can be more reflective and have a better perception of reality. It is recommended that targeted learning opportunities to develop students' emotional and social competencies to nurture final-year students' abilities and confidence be incorporated into the curriculum. Academic and practice education staff working with final year occupational therapy students need to consider the associated stress during this time when providing learning opportunities.

Inner and Outer Voices in Research: How Dialogical Approaches Can Enhance Knowledge Development in Mental Healthcare

This article contributes methodological reflections on how dialogical and reflective approaches can enhance many voices in research. An epistemological assumption in research with a participatory design is that knowledge can be developed by collaborative processes between researchers and individuals with lived experiences. The study was conducted by arranging a reflective process meeting with different participants: researchers and mental health service providers and users. Using reflective thematic analysis and an analytical perspective, it describes the reflective process as the tailoring of different voices, which is a way of facilitating research that enables different participants to contribute their experiences in a dialogical process. The findings show that reflective processes can encourage people to both listen and talk and, in that sense, have both inner and outer dialogues that endorse the use of different types of knowledge, including research and lived experiences, to create new understandings together. This can have an impact on both collaborative research and practice in mental health services.

Nursing Students' and Preceptors' Experiences with Using an Assessment Tool for Feedback and Reflection in Supervision of Clinical Skills: A Qualitative Pilot Study.

Background There is a need to improve students' learning in clinical practice. Undergraduate students need guidance when it comes to transferring knowledge from the classroom to clinical practice in community health services. Competence Development of Practical Procedures (COPPs), a simulation assessment tool, was used to explore students' and preceptors' experiences with feedback and reflection during the supervision of clinical skills in real practice. Method This was a pilot study with a qualitative exploratory and descriptive research design. Four students in their first year of a bachelor's programme in nursing and four preceptors participated. Data were collected from eight clinical skills performance assessments, audio recordings of supervision, and open-ended questionnaires. Data were systematized, categorized, and analysed using qualitative content analysis. Findings. Participants' experiences were divided into five categories: “learning environment, an atmosphere of respect, acceptance, and encouragement,” “students' reflections on their own personal learning,” “students' reflections on various care situations,” and “students' and preceptors' assessment and feedback.” Participants found COPPs easy to use and providing structure for assessment, feedback, and reflection during supervision. Concepts related to learning clinical skills became visible for both students and preceptors and helped students assess their performance of clinical skills. Through verbalization and reflection in supervision, participants established a consensus around what students knew and what they needed to learn. Conclusions The students and preceptors experienced the tool as a supportive structure to enhance feedback and reflection for the learning of clinical skills in municipal healthcare services. COPPs filled a gap in practice by providing a language for students and preceptors to articulate their knowledge and increasing students' awareness of what constitutes a good performance. The tool supported the coherence of concepts, enhanced clinical reasoning, and promoted deeper thinking and reflection, and the students gained insight into their own needs related to learning clinical skills.

Out of time: adolescents and those who wait for them

ABSTRACT This paper draws on the scholarship of an inter-disciplinary project about time and waiting in healthcare to explore questions of urgency and risk in clinical work with depressed and suicidal young people, and how the feeling of being compelled to act can be meaningfully explored from a psychoanalytic perspective. The paper examines adolescence as both a time of inherent crisis and one in which self-harm and suicidal ideation represent particular challenges. It then considers Child and Adolescent Mental Health Service practice in relation to acute mental health crisis, and in the context of the chronic crisis affecting the UK National Health Service. Considering both formal psychoanalytic psychotherapy and the contribution of psychoanalytic thinking to multidisciplinary discussions and emergency work in CAMHS, the author then considers the anticipatory anxieties that affect such work, and the particular role of psychoanalytic thinking for young people burdened by suicidal ideation and the professionals caring for them.

Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers

BackgroundThis paper presents the results of the first UK-wide survey of National Health Service (NHS) general practitioners (GPs) and practice managers (PMs) designed to explore the service improvement activities being...

The implementation of family-focused practice in adult mental health services: A systematic review exploring the influence of practitioner and workplace factors.

There is increased recognition of the need for greater and more appropriate support to be offered to families in which a parent experiences mental illness and has dependent children. One way of meeting this need is for adult mental health services to take a more family-focused approach. However, there are recognized difficulties in facilitating family-focused practice (FFP). The current review systematically synthesized quantitative and qualitative literature of practitioner perspectives and experiences of FFP in adult mental health settings to identify modifiable factors associated with its successful implementation. Five databases were searched systematically leading to the inclusion and quality assessment of 19 papers, ten of which were quantitative and nine qualitative. Analysis was guided by a narrative synthesis approach. Factors shown to influence FFP functioned at both practitioner and workplace levels and included personal attitudes, beliefs about job role, and perceptions of workplace support. Practitioners who felt that a family-focussed approach was inappropriate or detrimental to service users or outside of their remit as mental health professionals were less likely to adopt this approach. For those who saw the potential benefits of FFP, lack of confidence in their ability to deliver such an approach and lack of training can be barriers, as can lack of support and resources within services. This review highlights the need for actions to boost the awareness of adult mental health practitioners working with parents and to increase their confidence. It also makes the case for broader organizational support if family-focussed practice is to be implemented successfully.

Who is Responsible for Compassion Satisfaction? Shifting Ethical Responsibility for Compassion Fatigue from the Individual to the Ecological

ABSTRACT Compassion fatigue, a secondary traumatic stress [STS] disorder with similar symptoms as post-traumatic stress disorder, is a recognised workplace hazard, particularly for those working in trauma exposed occupations. Here, and by drawing on Australian codes of ethical practice for nurses, social workers and youth workers, we explore how these codes might inform the practice of these Australian health and human services practitioners with respect to compassion fatigue. Drawing on Nikolas Rose’s ideas about responsibilisation and the death of the social, we argue that these codes tacitly reflect a broader research and organisational impetus to responsibilise individuals to prevent compassion fatigue and maintain compassion satisfaction, and we situate this in a broader neoliberal socio-political context also framed by ‘responsibilisation’ in the context of a ‘decaying social’ and by a health and human service sector shaped by new public management. Finally, we begin to explore a preliminary conceptual case for an ecological lens through which to understand ethical responsibility for self-care, maintaining practitioner health and mitigating compassion fatigue. We argue that this lens brings into focus the need for codes to more clearly articulate broader and collective responsibilities for these elements.

A Co-Design Process to Elaborate Educational Materials to Promote Appropriate Use of Antibiotics for Acute Lower Respiratory Tract Infections in Primary Healthcare in Catalonia (Spain).

PurposeCo-design processes with patients allow developing health education materials, that are adapted to the population’s knowledge and use of language, to reduce inappropriate antibiotic use.Patients and MethodsThis study presents a co-design process of educational material with patients (over 18 years old) with a previous diagnosis of acute lower respiratory tract infection. The co-design was framed within a qualitative study (Phase I, interviews; Phase II, focus group) conducted in Barcelona between April and September 2019.ResultsTwenty-nine semi-structured interviews were conducted. Six people participated in the focus group. Based on participants’ narratives, educational materials can be useful to support healthcare consultations. Materials should be designed to be accessible in terms of the content and language used.ConclusionThe co-design of educational materials is essential for health promotion. This study presents an example of how materials can be co-developed with patients. The material elaborated in this study is being used for the ISAAC-CAT project and may be useful for future research, practice in health services and health policy.

A dynamic systems view of clinical genomics: a rich picture of the landscape in Australia using a complexity science lens

BackgroundClinical genomics represents a paradigm shifting change to health service delivery and practice across many conditions and life-stages. Introducing this complex technology into an already complex health system is a significant challenge that cannot be managed in a reductionist way. To build robust and sustainable, high quality delivery systems we need to step back and view the interconnected landscape of policymakers, funders, managers, multidisciplinary teams of clinicians, patients and their families, and health care, research, education, and philanthropic institutions as a dynamic whole. This study holistically mapped the landscape of clinical genomics within Australia by developing a complex graphic: a rich picture. Using complex systems theory, we then identified key features, challenges and leverage points of implementing clinical genomics.MethodsWe used a multi-stage, exploratory, qualitative approach. We extracted data from grey literature, empirical literature, and data collected by the Australian Genomic Health Alliance. Nine key informants working in clinical genomics critiqued early drafts of the picture, and validated the final version.ResultsThe final graphic depicts 24 stakeholder groups relevant to implementation of genomics into Australia. Clinical genomics lies at the intersection of four nested systems, with interplay between government, professional bodies and patient advocacy groups. Barriers and uncertainties are also shown. Analysis using complexity theory showed far-reaching interdependencies around funding, and identified unintended consequences.ConclusionThe rich picture of the clinical genomic landscape in Australia is the first to show key stakeholders, agencies and processes and their interdependencies. Participants who critiqued our results were instantly intrigued and engaged by the graphics, searching for their place in the whole and often commenting on insights they gained from seeing the influences and impacts of other stakeholder groups on their own work. Funding patterns showed unintended consequences of increased burdens for clinicians and inequity of access for patients. Showing the system as a dynamic whole is the only way to understand key drivers and barriers to largescale interventions. Trial Registration: Not applicable

BronchUK: protocol for an observational cohort study and biobank in bronchiectasis.

Bronchiectasis has been a largely overlooked disease area in respiratory medicine. This is reflected by a shortage of large-scale studies and lack of approved therapies, in turn leading to a variation of treatment across centres. BronchUK (Bronchiectasis Observational Cohort and Biobank UK) is a multicentre, prospective, observational cohort study working collaboratively with the European Multicentre Bronchiectasis Audit and Research Collaboration project. The inclusion criteria for patients entering the study are a clinical history consistent with bronchiectasis and computed tomography demonstrating bronchiectasis. Main exclusion criteria are 1) patients unable to provide informed consent, 2) bronchiectasis due to known cystic fibrosis or where bronchiectasis is not the main or co-dominant respiratory disease, 3) age <18 years, and 4) prior lung transplantation for bronchiectasis. The study is aligned to standard UK National Health Service (NHS) practice with an aim to recruit a minimum of 1500 patients from across at least nine secondary care centres. Patient data collected at baseline includes demographics, aetiology testing, comorbidities, lung function, radiology, treatments, microbiology and quality of life. Patients are followed up annually for a maximum of 5 years and, where able, blood and/or sputa samples are collected and stored in a central biobank. BronchUK aims to collect robust longitudinal data that can be used for analysis into current NHS practice and patient outcomes, and to become an integral resource to better inform future interventional studies in bronchiectasis.

Examination of health services for citizens

The aim of the study is to reveal the health services for disabled citizens upon accessibility and automation. The study relies on qualitative research which documentary analysis and self-report reflection of authorities form upon themes were employed. Automation and accessibility models and practice of social and health services from literature and workshop results revealed and compared with the results. System and welfare for the developing country needs automation and accessible services for disabled citizens. Physical and web accessibility create a big dilemma to reach services that needs to be considered urgently by governmental and institutional authorities.

Attending a Blended In-Service Management Training in a Public Health System: Constraints and Opportunities for Pharmacists and Health Services.

Management and public health are important domains of competency for pharmacists. In about 90% of Brazilian health departments, pharmacists manage the selection and purchase of medicines. The Pharmaceutical Services and Access to Medicines Management Course (PSAMM) was offered to pharmacists working in the public health system. The aim of this study is to analyze the impacts of the course as perceived by the students (pharmacists). Two thousand five hundred pharmacists completed the course. It is a mixed-methods study, including subscribing forms (n = 2500), evaluation questionnaire (n = 1500), focus groups (n = 10), and semi-structured interviews (n = 31). Participants reported a high level of satisfaction with the course; they considered to have developed competencies related to leadership and management, competencies needed to enhance and sustain their practices in health services. Data analyses showed important barriers to complete the course: high course workload, poor quality of Internet access, lack of support from the health services. Participants highlighted crucial features of the course that helped them develop key competencies: practical in-service activities, useful and realistic contents, tutoring. These features helped participants overcome some important constraints described by them. The educational model described in this study was perceived as having a long-term impact on their behaviors and management practices in health services.

Coverage of EBT practices in routine clinical supervision for youth: how much overlap with the evidence base?

ABSTRACT Clinical supervision is a common practice in youth mental health services; however, research that characterizes the extent to which routine supervision aligns with gold standard supervision described in research trials is largely unknown. Community supervisors and supervisees reported on 100 supervision sessions; a subset (n = 57) were analyzed using observational coding. Results indicated that coverage of evidence-based practice elements was brief and some elements were rarely discussed (e.g., exposure for anxiety). Participants also reported discussion of practice elements outside of research-supported protocols (e.g., therapeutic alliance). Findings highlight differences between supervision in controlled research and supervision in routine settings.