Health Service Practice Research Articles

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.

Antimicrobial Resistance in Enterococcus faecalis and Enterococcus faecium Bacteria Isolated from Bloodstream Infections: A Single-Center Evaluation

Objective: Enterococci are an important cause of healthcare-related bloodstream infections. The present study aimed to contribute to form empirical treatment models that can be used in the treatment of Enterococcus faecalis and Enterococcus faecium bacteria isolated from bloodstream infections in our hospital by reviewing their resistance status against antibiotics, requently used in the treatment of these bacteria. Methods: In our study, the resistance status of E. faecalis and E. faecium bacteria isolated from bloodstream infections in Sivas Cumhuriyet University, Health Services Practice and Research Hospital between January 2015 and June 2020 against ampicillin, amoxicillin, clavulanic acid, high-level gentamicin, linezolid, teicoplanin, and vancomycin was examined retrospectively. The diagnosis of healthcare-related bloodstream infections was made using the diagnostic criteria of “Centers for Diseases Control and Prevention (CDC).” Results: A total of 227 enterococcal isolates were evaluated within the scope of our study between the specified dates. The percentage of patients with Enterococcus bacteria isolated in their blood cultures were 44.5% male, and 55.5% female. Of the isolates, 60.8% were identified as E. faecalis and 39.2%as E. faecium. High-level gentamicin resistance was found to be 25.3% in E. faecalis isolates, and no resistance was found against vancomycin, teicoplanin, and linezolid. In E. faecium isolates, while the highest resistance was observed against amoxicillin-clavulanic acid and ampicillin with 87.6%, vancomycin resistance was determined to be 3.3%. No resistance to linezolid was identified. Conclusions: Enterococci cause life-threatening infections and there are some difficulties in the treatment. Especially since E. faecium has higher resistance against antibiotics, the agents to be chosen in the treatment of infections caused by these bacteria are limited. Therefore, the current local resistance data will be useful in developing rapid and appropriate treatment models, especially in cases when empirical treatment is required. We think that our study will contribute to the literature in this regard.

Safety for women when accessing mental health services: a scoping review of the link between safety and recovery.

Objective A sense of safety and recovery from mental health issues seem to be interrelated concepts but, to date, there has been no review of studies exploring the links between safety and recovery for women accessing mental health programs. This review aimed to identify current knowledge and knowledge gaps regarding the experiences of women and their personal safety when accessing mixed-gender and women's mental health programs. Methods A scoping review methodology was used. Four electronic databases (Medline, PsycINFO, AMED, and CINAHL) were searched, covering the period from January 2000 to December 2019, to identify relevant peer-reviewed articles, which were screened for inclusion. Key search terms included ('women' or 'female' or 'gender') and ('recovery' and 'mental health programs') or ('community mental health' or 'community mental health centres/or community mental health centre') and 'safety'. Results Twelve studies were identified, 10 of which were from English-speaking countries (five from the UK, three from Australia, two from the US) and two from European countries, indicating there is limited literature directly relevant to women with mental health issues and their personal safety while using mental health services. Safety from assault and harassment and finding safe and supportive connections were commonly reported as crucial to the process of recovery for the women with mental health issues across these studies. Conclusions Based on the identified knowledge gaps, this paper advances the argument for more research to inform gender-specific service provision. What is known about the topic? Service guidelines identify the need for gender-sensitive practices in mental health services, yet women continue to report experiences of sexual or other forms of harassment while in acute and subacute mental health programs. What does this paper add? This study identified the current knowledge regarding the experiences of women when accessing mental health programs. In particular, a sense of feeling safe in services was crucial to the process of recovery for women with mental health issues. What are the implications for practitioners? This study contributes to the body of knowledge informing health professionals who work within these mental health programs and highlights the need to meet women's needs to feel safe when accessing services.

Implementing recovery-oriented practice in older people’s mental health services: the NSW experience.

Personal recovery is central to Australian mental health standards, but promoting recovery-oriented practice remains a wicked problem (ie complex, with definitions and appropriate interventions impacted upon by context and values), with limited evidence regarding effective implementation. This case study re-examines a statewide initiative to enhance recovery-oriented practice in older people's mental health services in New South Wales from the perspective of complex adaptive systems. The initiative consisted of three key strategies: (1) statewide collaborative leadership and practice resources; (2) locally determined and led improvement projects; and (3) evaluating, disseminating and sustaining initiative outcomes. Published outcomes of the initiative, related policy and benchmarking materials and author reflections are used to propose lessons for other services and policy makers. From a systems perspective, a relatively small investment from a state policy unit to enhance a facilitating environment resulted in the emergence of local leaders and voluntary participation of services within 80% of local health districts without funding incentives. Local leaders and activities informed statewide policies and models of care to sustain practice change. Limitations included variability in project scopes and the involvement of people with lived experience, as well as the level of refinement in change management approach. Self-audit and consumer-rated experience suggest resilience of practice and culture change. The outcomes are consistent with conceptualisations of mental health services being complex adaptive systems requiring distributive leadership. Established mechanisms encouraging statewide cooperation between clinicians, service managers and policy makers may have been significant facilitators of engagement in practice change. What is known about this topic? Recovery remains an important concept for older people with mental ill health, with implementation of recovery-oriented practice a wicked problem. What does this paper add? Central policy investment in a collaborative facilitatory environment can stimulate the emergence of local leadership and investment in actions to enhance recovery orientation. As predicted by complex adaptive systems theory, the impact of the leaders developed may be broader than the sum of individual project outcomes. What are the implications for practitioners? A start where you can message can engage and enable leaders in feasible and locally relevant changes consistent with a statewide strategy. This may be a feasible approach to improving recovery orientation in mental health care services for and beyond older people, with potential implications for addressing other wicked problems in health care.

Strategies Used by Middle Managers to Support Employees Carrying Out Emotionally Demanding Work: Which Strategies and Why Those Ones?

Many areas of practice in health and social services are emotionally demanding. This type of work can be associated with psychological health problems and middle managers play a key role in reducing such risks for their staff. Although the importance of providing this support is recognized, attaining such an objective is not necessarily straightforward because of the multiple demands that managers must juggle. Using an ergonomic perspective, this qualitative research study, which was conducted in a regional child protection service in Quebec (Canada), aimed to identify the strategies used by middle managers to support staff whose work is considered emotionally demanding. The results reveal that managers use a range of support strategies, which fall into seven categories. Although the strategies are distributed along two axes, proximity (direct, indirect) and time (short-term, long-term), they tend to be more direct and short-term (e.g., provide emotional support). The choice of strategies is influenced by various facilitating or constraining organizational, interpersonal and individual factors. A strong influence appears to be time availability. This study provides a detailed picture of the strategies used by middle man-agers and the complexity with which these individuals are confronted in providing their staff with support. Further research is required, for example, to better understand the impact of certain factors on the choice of support strategies and to evaluate the impact of support strategies from a staff perspective.

SOCIAL WORKERS’ACTIVITIES IN THE FIELD OF POPULATION’ MENTAL HEALTH PRESERVATION IN THE XXI CENTURY

The aim: Social work is focused on overcoming inequality and social isolation of individuals and communities due to health conditions. Therefore, substantiating the activities of social workers to preserve mental health of citizens is an important component of the new strategy for the development of the profession in the XXI century. Materials and methods: The methodological basis of the study is a holistic approach to the interpretation of individual health in the unity of physical, mental, social, and spiritual components; ecosystemic approach assumes the impact of the environment on the social functioning of the individual; interdisciplinary approach identifies ways of dealing withmental health challengein the global context; social inclusion approach provides a basis for the practice of experts of the social spherein the XXI century. Conclusions: The article substantiates the need for social workers to maintain the mental health of the population under the negative impact of global factors within their own countries and internationally. The evolution analysis of the international experience of transformations of social work practice in the area of mental health preservation is carried out. Preserving the mental health of citizens under the negative effects of globalization processes depends on the concerted actions of states, international organizations, civil society, communities, and individuals themselves. This encourages social workers to work at regional and international levels with institutions interested in fair policies and practices in social and health services.

Theory and Practice of Person-Centered Mental Health Services

Person-centered approaches have been demonstrated to be effective in a variety of mental healthcare contexts and across different service user populations. In this overview, the author explores fundamental notions of such person-centered approaches (PCAs) with examples from health (clinical) care, research, education, and leadership of successful person-centered applications in the mental health field. He then extends this conversation further by looking at related challenges, particularly where person-centered approaches are lacking and may be applied. He challenges various areas in mental health services by addressing commonplace examples in which person-centered approaches do not appear to occur. He concludes with a call to action for profound person-centered change at the level of self and with others, which may lead to fundamental transformation of the mental health system.

Role of Public Health Ethics for Responsible Use of Artificial Intelligence Technologies.

Recent advancements in artificial intelligence (AI) technologies have shown promising success in optimizing health-care processes and improvising health services research and practice leading to better health outcomes. However, the role of public health ethics in the era of AI is not widely evaluated. This article aims to describe the responsible approach to AI design, development, and use from a public health perspective. This responsible approach should focus on the collective well-being of humankind and incorporate ethical principles and societal values. Such approaches are important because AI concerns and impacts the health and well-being of all of us collectively. Rather than limiting such discourses at the individual level, ethical considerations regarding AI systems should be analyzed enlarge, considering the complex socio-technological reality around the world.

Training in community psychiatry

Training in community psychiatry is an essential aspect of psychiatric education in Europe. Community psychiatry is a branch of psychiatry that focuses on the prevention and treatment of mental illness in the community, with an emphasis on promoting recovery and social inclusion. Training in community psychiatry in Europe typically involves a combination of didactic and clinical experiences, including classroom lectures, group discussions, and supervised practice in community-based mental health services. The curriculum covers topics such as community mental health policy, community-based care, social determinants of mental health, and recovery-oriented approaches to care. The training also emphasizes the importance of inter professional collaboration and the need to work closely with other healthcare professionals, service users, and family members. Overall, training in community psychiatry in Europe is designed to equip psychiatrists with the knowledge, skills, and attitudes necessary to provide high-quality, person-centered care to individuals with mental illness in the community.

Augmented reality practices in health services: Literature review

Augmented reality (AR) is a version of virtual reality (VR) technology, and digital three-dimensional interfaces and virtual objects appear before us as a dynamic and innovative technology allowing simultaneous interaction with the real world. Today, we encounter wearable technologies as the widespread use of augmented reality technologies. Along with the rapid proliferation of mobile devices and wireless network technologies, innovative technologies such as augmented reality (AR) and virtual reality (VR) have also become useable in each domain. The development of health technologies also in the same pace brings along the opportunities for using such technologies in the domain of health. In the present study, literature review on AR practices used in the domain of health was made, and the data was analyzed.

How do staff in residential care transform Trauma-Informed principles into practice? A qualitative study from a Norwegian child welfare context

ABSTRACT Trauma-informed practices (TIP) in social welfare and mental health services have become widespread. TIP is considered to be a mindset rather than an operationalized methodology. TIP principles need to be transformed into practice in any given context. We interviewed staff at a Norwegian residential care institution on how they transformed TIP-principles into practice after receiving competence building based on Howard Bath’s ‘three-pillar’ approach. Informants emphasized the importance of self-awareness such as self-reflection, authenticity, and other-regulation, intended actions such as building strength, providing staff availability, setting safe limits, and collaborating with the youth, as well as organizational and cultural practices such as promoting a shared coherent mindset, stability, routines, and cultural safety. Using an adherence check model as a framework, we discuss if informants´ descriptions reflect a general humanist approach, rather than TIP as such. Most of their descriptions make sense in a TIP perspective, but few can be claimed to be unique to TIP, and their focus on authenticity may even conflict with theories of change embedded in TIP. Further, we reflect on the debate on whether TIP should be more standardized or not, and outline implications of findings for future implementations of TIP programmes.

Language Ideologies and Language Practices in Health Services: Patients’Experiences in Post-Colonial Zimbabwe

Language Ideologies and Language Practices in Health Services: Patients’Experiences in Post-Colonial Zimbabwe

Learning about user participation among nursing students: A qualitative study

BackgroundUser participation is an important aspect of nursing, especially within a rehabilitation setting where the emphasis is on the patient's ability to become as independent as possible. It is also decreed by law that students should learn about user participation. Furthermore, to achieve good nursing skills it is important for the students to understand “the what” and to reflect on “the how” regarding user participation. ObjectivesThe aim of the study was to explore how students learn to apply user participation in a context of rehabilitation. Design and methodThe design of the study is qualitative. Content analysis was adopted, and both inductive and deductive approaches were used. The informants were nursing students in the second and third years of the bachelor's degree at a university in Norway. Most of the students were in community health services, but some of them performed their internship at hospitals. Two focus groups with 11 students were conducted. In addition, the data also consist of 28 written reflections and 31 written work requirements in relation to rehabilitation. The students from the focus groups and the written work requirement were in practice in community health services. In the written reflections it was 14 students who had their internship at hospital and 14 students in community health services. ResultsThe main categories of the study are barriers to learning, dialogue as a tool and reflection as essential. The students learn to use check lists and focus on organizational planning, which might be a barrier to learning. Dialogue is important to improve the students' learning. Students need to reflect on user participation together with their supervisor to learn to be confident in encountering users, which indicates that reflection is essential. ConclusionThe major findings indicate that students lack competence og user participation and that their supervisors seldom talk about it with them. Also, it should be compulsory reflection notes about user participation in the student's internships. Teachers at universities must inform supervisors and develop courses about mentorship and user participation. This may be a step forward to overcome theory-practice gap.

Digital Platform for Evidence-Based Medicine in Hematology (non-malignant and malignant conditions) in a Developing Country

Introduction: The SARS-COV2 pandemic has transformed several aspects of our daily lives, we have already experienced profound changes in our society and behavior, and it was only possible to keep part of the gear of life functioning thanks to technology. But it is not possible to talk about technology without talking about digital transformation.The technology applied to medicine provides health professionals with greater access to information and tools that convey evidence-based medicine are essential. Among them we can mention databases such as Medline, PubMed, Embase, Cochrane and UpToDate platform. The COVID 19 pandemic has further accelerated this digital transformation process, instituting changes that are here to stay.Objectives: Today in Brazil, we have an average of 7,000 oncologists and 3,000 hematologists. We know that access to information in a foreign language, even English, is still a problem. The excess of information, and the difficulty of reading scientific publications critically, are another obstacle in medical education in a developing country. The objective of this project is to expand access to information, in continues medical education model, to improve public and private health in the area of hematology.Methods: The hematology team at Hospital Israelita Albert Einstein (HIAE), associated with the HIAE digital transformation laboratory, developed a healthtech platform, called hematolog.app, aiming to make available several updated technical content in different formats: podcasts, videos , discussion of clinical cases, analysis of scientific articles in the form of visual abstracts, reviews of relevant topics in text format. The initiative is supported by the most important national hematology Societies. Discussion: We know that healthtech platforms have transformed medical practice. An online survey of clinicians at the Massachusetts General Hospital and Brigham and Women's Hospital described the following effects among UpToDate users: 95% reported that UpToDate was integral for making decisions, 94% reported that they had changed diagnosis, 95% reported that UpToDate led to a change in patient management, 97% said UpToDate helps them provide the best care for their patients, 90% reported that UpToDate makes them a better doctor, 96% reported made them more comfortable with their decisions. PubMed makes it possible to identify references and summaries of articles from the Medline database, maintained by the National Library of Medicine. PubMed provides several tools to make the search more efficient, unknown to most doctors.Conclusion: The development of hematolog.app aims to create a digital platform that integrates specialists in the area, creating a continuous process of education, and integrating professionals in a developing country, seeking to standardize medical practice in different regions and health services in Brazil, creating an interconnected social network and practicing evidence-based medicine.DisclosuresNo relevant conflicts of interest to declare.

Comprehensive Women Health Services at Beverage-Producing Industries of Limpopo (South Africa): Women's Perspective.

(1) Background: Women remain highly vulnerable to numerous risks at work, including labor rights violations, violence and harassment, myriad general and reproductive health risks. The availability of the comprehensive services remains the only hope for these women, yet very little is known about their perspective. (2) Aim: To determine the experiences of women regarding the availability of comprehensive women’s health services in the industries of Limpopo (South Africa). (3) Methods: The project adopted the qualitative research method to determine the experiences of women related to the availability of comprehensive women’s health services. Non-probability purposive and convenience sampling was used to select 40 women employed in two beverage producing industries. A semi-structured interview with an interview guide was used to collect data that were analyzed using thematic analysis. (4) Results: Four themes emerged about the available health services in the two industries; diverse experiences related to available women’s health services, knowledge related to women’s health services, and diverse description of women’s health services practice and risks. The themes are interpreted into ten sub-themes. (5) Conclusions and Recommendations: There is a lack of available comprehensive women health services at the two beverage producing industries. Thus, women face challenges regarding accessing comprehensive women’s reproductive health care services as well as being exposed to health hazards such as burns, bumps, injuries and suffering from inhalation injuries and burns from moving machines, noise, slippery floors, and chemicals that are used for production in the industry. Women expressed dissatisfaction in the industries regarding the provided general health and primary healthcare services that have limited women’s health-specific services. We recommended that the industries should prioritize designing and developing the comprehensive women health services that to enable women at the industries to have access to good-quality reproductive health care and effective interventions.

The Early Impact of the Covid-19 Emergency on Mental Health Workers: A Survey in Lombardy, Italy.

Lombardy was the epicenter of the Covid-19 outbreak in Italy, and in March 2020 the rapid escalation in cases prompted the Italian Government to decree a mandatory lockdown and to introduce safety practices in mental health services. The general objective of the study is to evaluate the early impact of the Covid-19 emergency and quarantine on the well-being and work practices of mental health service personnel and professionals. Data were collected through an online survey of workers and professionals working with people with mental health problems in Lombardy in several outpatient and inpatient services. Their socio-demographic characteristics, professional background, description of working conditions during lockdown and psychological distress levels were collected. All analyses were performed on a sample of 241. Approximately, 31% of the participants obtained a severe score in at least one of the burnout dimensions, 11.6% showed moderate or severe levels of anxiety, and 6.6% had a moderate or severe level of depression. Different work conditions and patterns of distress were found for outpatient service workers and inpatient service workers. The overall impact of the Covid-19 emergency on mental health workers’ level of distress was mild, although a significant number of workers experienced severe levels of depersonalization and anxiety. More research is needed to assess specific predictive factors.

Payments Systems in the NHS

Finance within the NHS is poorly understood by clinicians and the limited engagement of clinical leaders in finance decisions is recognised as a common pitfall in recent inquiries such as the Francis report1 and recent King’s Fund report into financial failure2. The complexity and rapidly changing landscape of financing systems in place across the NHS on a background of complex and transient organisational structure makes it challenging for the patient focused clinician to achieve a working knowledge of finance. This article will discuss various payment mechanism and explore their advantages and disadvantages and then discuss how they have been used on their own or in combination to fund healthcare organisations. In order to provide context for clinicians, we will discuss how the payment contracts influence day to day health service practice.

Rehabilitation following proximal humeral fracture in the UK National Health Service: A survey of publicly facing information.

Proximal humeral fractures (PHF) are a common injury in the older population but there is limited research evaluating rehabilitation following PHF. The aim of this study was to understand current National Health Service (NHS) practice for rehabilitation following PHF as a platform for conducting future research. Two reviewers independently undertook electronic searches for publicly available information sheets (PIS) from websites of NHS Trusts that included detail about rehabilitation following PHF, for example, duration of immobilisation. One reviewer extracted data and a second reviewer verified this. Seventeen PIS from 17 different NHS trusts were identified. All provided some information on the method of immobilisation but only six provided guidance on duration of immobilisation with the median time being 2 weeks (range 0-6). The median time to commencement of passive exercise was 2 weeks (range 0-4) and 9 weeks (range 6-12) for active exercise. Only one PIS reported on the time for commencement of resisted exercises and this was reported as 6 weeks. The median time recommended return to work was 7.5 weeks (range 6-12). This study found limited publicly available information for rehabilitation following PHF in the NHS but offers some insight into current approaches. Our results will facilitate development of relevant information for patients and evaluation of rehabilitation strategies in future research.