Previous Care Experience Research Articles

The effect of environmental stressors perceived by surgical intensive care unit patients on hopelessness level

The aim of the research was to determine the effects of environmental stressors perceived by patients hospitalized in the surgical intensive care unit on hopelessness level. This descriptive research was performed between September 2023 and February 2024. The population of the study included all adult patients hospitalized in the Surgical Intensive Care Clinic of a City Hospital in Eastern Türkiye. The sample of the study includes 230 patients selected by random sampling method from this population. We used Personal Information Form, Intensive Care Unit Environmental Stressors Scale (ICUESS) and Beck Hopelessness Scale (BHS) to collect the data. Descriptive statistics, t-test, ANOVA, and correlation analysis tests were used to evaluate the data. The ICUESS mean score of the patients participated in the study was found to be at a high level with 102.13±15.95. Beck hopelessness scale score mean was found to be at a mild level with 6.36±5.78. It was found that the patients' gender, age, educational status, chronic disease status and previous intensive care experience affected the level of hopelessness. The relationship between ICUESS and BHS scores of the patients included in the study was examined and it was found that there was a low level of positive significant relationship between them (r: 0.162, p: 0.014). The hopelessness level of patients in surgical intensive care units was found to increase as the level of exposure to environmental stressors increased. It may be recommended to identify environmental stressors affecting the hopelessness level of patients and to implement interventions to reduce them.

The perceived quality of maternal care during childhood shapes attentional bias to infant faces in parents and nonparents.

While research has shown that the attentional bias to infant faces predicts the quality of infant care, the antecedents of this cognitive process have been less established. In particular, it remains unknown whether the attentional bias to infant faces might be affected by the interplay between different factors, including memories of past experiences of care, adults' sex, and the experience of parenthood. To extend previous results, we examined the attentional bias to infant faces in a mixed sample of parents (n = 99) and nonparents (n = 102), and whether it varied in relation to parental status, sex, the quality of past experiences of care, and the interactions between these factors. A modified go/no-go task was used to compare the effect of adult and infant faces in retaining adults' attention. Memories of past experiences of paternal and maternal care were collected using the short form of the Italian version of the Parental Acceptance-Rejection scale. Results confirmed that infant faces induced greater attentional interference compared to adult faces. A heightened attention to all types of faces was found in parents versus nonparent. Women, as compared to men, were slower in the task performance, and allocated more attention to infant versus adult faces. Consistent with previous evidence, the attentional prioritization of infant faces varied in relation to previous experiences of care with one's own mother; individuals who remembered a more accepting maternal care allocated more attention to infant versus adult faces. Parental status did not modulate this effect, but sex of participants did. Grounded in the interpersonal acceptance-rejection theory (IPARTheory), this study provides new insights for discerning processes that might regulate global adult caregiving. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Time to initiation of antenatal care and its predictors among pregnant women who delivered in Arba Minch town public health facilities, Gamo Zone, southern Ethiopia, 2023: a retrospective follow-up study

BackgroundEarly antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities.MethodsAn institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance.ResultsThe median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors.ConclusionHalf of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed.

Preferences for Postacute Care at Home vs Facilities

Two in 5 US hospital stays result in rehabilitative postacute care, typically through skilled nursing facilities (SNFs) or home health agencies (HHAs). However, a lack of clear guidelines and understanding of patient and caregiver preferences make it challenging to promote high-value patient-centered care. To assess preferences and willingness to pay for facility-based vs home-based postacute care among patients and caregivers, considering demographic variations. In September 2022, a nationally representative survey was conducted with participants 45 years or older. Using a discrete choice experiment, participants acting as patients or caregivers chose between facility-based and home-based postacute care that best met their preferences, needs, and family conditions. Survey weights were applied to generate nationally representative estimates. Preferences and willingness to pay for various attributes of postacute care settings were assessed, examining variation based on demographic factors, socioeconomic status, job security, and previous care experiences. A total of 2077 adults were invited to participate in the survey; 1555 (74.9%) completed the survey. In the weighted sample, 52.9% of participants were women, 6.5% were Asian or Pacific Islander, 1.7% were American Indian or Alaska Native, 11.2% were Black or African American, 78.4% were White; the mean (SD) age was 62.6 (9.6) years; and there was a survey completion rate of 74.9%. Patients and caregivers showed a substantial willingness to pay for home-based and high-quality care. Patients and caregivers were willing to pay an additional $58.08 per day (95% CI, 45.32-70.83) and $45.54 per day (95% CI, 31.09-59.99) for HHA care compared with a shared SNF room, respectively. However, increased demands on caregiver time within an HHA scenario and socioeconomic challenges, such as insecure employment, shifted caregivers' preferences toward facility-based care. There was a strong aversion to below average quality. To avoid below average SNF care, patients and caregivers were willing to pay $75.21 per day (95% CI, 61.68-88.75) and $79.10 per day (95% CI, 63.29-94.91) compared with average-quality care, respectively. Additionally, prior awareness and experience with postacute care was associated with willingness to pay for home-based care. No differences in preferences among patients and caregivers based on race, educational background, urban or rural residence, general health status, or housing type were observed. The findings of this survey study underscore a prevailing preference for home-based postacute care, aligning with current policy trends. However, attention is warranted for disadvantaged groups who are potentially overlooked during the shift toward home-based care, particularly those facing caregiver constraints and socioeconomic hardships. Ensuring equitable support and improved quality measure tools are crucial for promoting patient-centric postacute care, with emphasis on addressing the needs of marginalized groups.

The effect of combining an e-learning module with s Virtual Dementia Tour® on knowledge and attitudes toward person-centered dementia care in prelicensure nursing education

BackgroundDue to the global prevalence of dementia the U. S. Department of Health and Human Services’ National Plan to Address Alzheimer’s Disease recommended that healthcare professionals prepare to address the complex needs of people with dementia. To address this gap, nursing programs adopted experiential learning methods. While such methodologies are increasingly used, limited evidence exists to inform best teaching practices. PurposeThis study evaluated the combined effect of an e-learning module with a virtual simulation on nursing students’ knowledge and attitudes of dementia. MethodsThe study followed quasi-experimental design with a cross-over and pretest/posttest design. A convenience sample of nursing students was recruited from three public universities in the Southeast United States. ResultsSignificant improvements in attitudes toward people with dementia were found in students with previous dementia care experience or those employed to provide services to people with dementia. Experience was a stronger predictor of attitudes than education. However, the reliability of the Dementia Knowledge Assessment Scale was not sufficient in this study. SignificanceThe findings may inform best practices in nursing education to prepare graduates to provide quality care for people with dementia.

Previous mental health care and help-seeking experiences: Perspectives from sexual and gender minority survivors of near-fatal suicide attempts.

Sexual and gender minority (SGM) populations face heightened risk of suicide compared to their heterosexual and cisgender counterparts, and a previous suicide attempt is among the strongest predictors of suicide mortality. Despite this increased risk, limited research has explored mental health help-seeking behavior and previous mental health care experiences of SGM individuals among the highest risk for suicide-individuals with a recent, near-fatal suicide attempt. This study presents thematic analysis results of interviews with 22 SGM individuals who reported at least one near-fatal suicide attempt in the past 18 months. Identified themes were (a) factors that affect help-seeking for SGM individuals with a recent, near-fatal suicide attempt, including previous mental health care experiences, support systems, and structural barriers and facilitators; (b) hospitalization is not a one-size fits all solution; and (c) recommendations for improving care for this population. Findings demonstrate that anti-SGM stigma may magnify existing barriers to mental health care across all socioecological levels. Notably, participants cited a fear of loss of autonomy from inpatient hospitalization and previous discriminatory experiences when seeking mental health care as hampering help-seeking. Given increased risk for suicide mortality, this patient population is a necessary stakeholder in suicide prevention and intervention development and policy discussions affecting mental health care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

P693 Care needs and reasons for (not) seeking care among fatigued patients with Inflammatory Bowel Disease: A qualitative study

Abstract Background Fatigue is one of the most prevalent and burdensome symptoms experienced by patients with inflammatory bowel disease (IBD), even when the disease is in remission. Many patients report dissatisfaction towards fatigue-related care and uptake of available interventions is often low. This study aims to explore reasons why IBD patients do or do not engage in professional fatigue-related care and their needs regarding type of care and how to offer care. Methods We conducted a qualitative study, taking a phenomenological methodological approach. Sixteen adult IBD patients with disease in remission and severe fatigue (i.e., Checklist Individual Strength – subjective fatigue ≥ 35) were recruited from an academic hospital. We performed semi-structured interviews. Data were analysed using template analyses. Results We identified six themes regarding reasons why to (not) seek care for fatigue: 1) cognitions about fatigue and coping (e.g., a need to deal with fatigue alone), 2) perceptions of fatigue-related care and previous care experiences (e.g., perceiving that nothing can be done about fatigue), 3) knowledge and behaviour of the healthcare provider (e.g., fatigue complaints are not taken seriously), 4) somatic factors (e.g., physical symptoms of IBD), 5) social factors (e.g., feeling misunderstood by others) and 6) practical factors (e.g., time and money). Furthermore, we identified needs regarding how to offer care, i.e., proactive screening and active offer of care by healthcare providers, a holistic and person-centred approach and practical needs taken into account. Finally, regarding what care to offer, patients suggested a broad range of options, including information provision on fatigue management, eliminating physical causes of fatigue, discussing medication options, lifestyle support, psychological support, peer support and practical support. Conclusion IBD patients’ perceptions, coping and knowledge, as well as healthcare professionals’ behaviours play a major role in seeking fatigue-related care. Findings emphasize the importance of discussing IBD-related fatigue actively and taking a holistic and patient-centred approach to treat fatigue, targeting a broad range of physical- and psychological factors. These findings yield a better understanding of factors that hinder and facilitate care seeking in fatigued IBD patients and hereby provide ways to optimize the uptake of care.

Patients’ Perceptions of Quality in Healthcare: A review

An individual’s perception is their reality. Due to individual expectations two patients can provide different satisfactionscores after receiving the same care. It reflects how that care is supposed to be delivered as perceived by the patient.The individualized perception of a patient is influenced by patient’s individual values, personal beliefs, culturalbackground, age, education level, socioeconomic status, health literacy, and previous health care experiences. Patientsperceived low quality of physical care are extremely complicated to explain. Patients socio-demographic variables,especially age, sex, level of education, income, family background, ethnicity all can influence perceived satisfaction.The overall quality measure is either satisfying or dissatisfying. The health care administrators, health educatorsand other stakeholders and the community at large are in constant pressure to improve the patient perception ofquality health care. The increase in perceived care quality from the patients’ perspective are associated with improvedenvironmental conditions, care quality related to the health care personnel, information-communication andtechnological development. The high-tech environment may not improve patients’ perceptions towards quality careprovided by health care personnel if there is no empathy. Patient-centered service is recognized as a core componentof quality care. Patient-centered care is cost-effective and improves outcomes and patients are genuinely involved inhealthcare decisions and their preferences are considered, the result is better health, more involved patients and lowercosts.

Nurse-Led, Telephone-Based Primary Palliative Care Intervention for Patients With Lung Cancer: Domains of Quality Care.

Palliative care is traditionally delivered by specialty-trained palliative care teams. Because of a national workforce shortage of palliative care specialists, there is an urgent need to explore alternative models of palliative care delivery to meet the needs of patients living with serious illness. As part of a multisite randomized controlled trial, 2 registered nurses without previous palliative care experience were trained to deliver a primary palliative care intervention to patients with newly diagnosed lung cancer. The intervention focused on assessing and managing symptoms, psychosocial needs, education, and initiating goals-of-care discussions. The primary outcome, improved symptom burden and quality of life, was not statistically significant. Despite this finding, nurses addressed 5 of the 8 National Consensus Project Guidelines domains of quality palliative care: structure and processes of care; physical, psychological, and social aspects of care; and ethical and legal aspects. Patients' engagement in goals-of-care discussions, a measure of high-quality palliative care, increased. Clinical recommendations offered by the nurses to the patients' clinicians were addressed and accepted on a timely basis. Most patients rated satisfaction with the intervention as "very or extremely" satisfied. These findings may inform future nurse-led palliative care interventions on the specific quality domains of palliative care.

The use of non-invasive ventilation by emergency doctors in Johannesburg Academic Hospitals, South Africa – assessing knowledge, attitudes and practices

IntroductionNon-invasive ventilation (NIV) is an alternative ventilatory method to endotracheal intubation and invasive ventilation in patients presenting in acute respiratory failure. Appropriate and timely application of NIV has shown benefits over invasive ventilation. In recent years, there has been an increase in the use of NIV for varying pathologies in response to limited resources.Emergency department doctors’ knowledge of NIV, as well as their attitude towards its use can have significant effects on the success of NIV. The aim of this study was to assess emergency doctors’ use of NIV in the South African setting. MethodsThis was a multi-centre prospective cross-sectional study that was conducted across three academic emergency departments in Johannesburg, South Africa. Doctors of various grades were included in the study and their responses were analysed according to their level of experience and their job description. ResultsThe mean knowledge score of the participants was shown to increase with an increase in job designation (p < 0.001). The doctors’ attitude towards NIV was more positive in those with higher knowledge scores (p < 0.001). Participants with previous critical care experience versus those without was associated with a higher average knowledge score (77% vs. 69 %, p = 0.009) as was formal NIV training versus those without (77% vs. 69 %, p = 0.01). The COVID-19 pandemic increased confidence in the use of NIV in 61 % of participants. The majority (69 %) of participants did not use a checklist when administering NIV. Only 53 % used a guideline when initiating a patient on NIV and just 26 % used a locally produced protocol. ConclusionIncreased clinical experience, critical care exposure and formal NIV training corresponded with higher knowledge scores. Formal NIV training programs, the implementation of a checklist and the development of locally produced protocols are recommended to improve knowledge, attitudes and NIV practice that is in-keeping with international standards.

Attentional bias to infant faces might be associated with previous care experiences and involvement in childcare in same-sex mothers

BackgroundAttentional bias toward infant faces is associated with parental sensitivity and supports the infant-caregiver attachment relationship, ultimately fostering child health outcomes. However, experience-related determinants of parents' attentional bias to infant faces have been poorly investigated. We examined attentional bias to infant versus adult faces in a sample of same-sex mothers (N = 76), and whether it varied depending on maternal involvement in childcare and the perceived quality of past experiences of care. MethodA Go/no-Go attentional task was used to compare the effects of infant and adult faces in retaining attention. Maternal involvement in childcare was measured using items addressing nurturing behaviors. Memories of past experiences of care were collected using the short-form version of the Parental Acceptance-Rejection scale. ResultsResults confirmed that infant faces induced greater attentional bias compared to adult faces. More involved mothers were more biased, in terms of attention, to infant versus adult faces. Attentional bias to infant versus adult faces increased as mothers felt more rejected by their own fathers during childhood. DiscussionOur findings suggested that attentional bias to infant faces might be associated with past experiences of care and direct commitment in childcare in same-sex mothers. Robust and accurate empirical findings on same-sex parent families are essential to inform social policies supporting these families’ well being.

Patient perceptions of microaggressions and discrimination toward patients during emergency department care.

Disparities in emergency department (ED) care based on race and ethnicity have been demonstrated. Patient perceptions of emergency care can have broad impacts, including poor health outcomes. Our objective was to measure and explore patient experiences of microaggressions and discrimination during ED care. This mixed-methods study of adult patients from two urban academic EDs integrates quantitative discrimination measures and semistructured interviews of discrimination experiences during ED care. Participants completed demographic questionnaires and the Discrimination in Medical Settings (DMS) scale and were invited for a follow-up interview. Transcripts of recorded interviews were analyzed leveraging conventional content analysis with line-by-line coding for thematic descriptions. The cohort included 52 participants, with 30 completing the interview. Nearly half the participants were Black (n = 24, 46.1%) and half were male (n = 26, 50%). "No" or "rare" experiences of discrimination during the ED visit were reported by 22/48 (46%), some/moderate discrimination by 19/48 (39%), and significant discrimination in 7/48 (15%). Five main themes were found: (1) clinician behaviors-communication and empathy, (2) emotional response to health care team actions, (3) perceived reasons for discrimination, (4) environmental pressures in the ED, and (5) patients are hesitant to complain. We found an emergent concept where persons with moderate/high DMS scores, in discussing instances of discrimination, frequently reflected on previous health care experiences rather than on their current ED visit. Patients attributed microaggressions to many factors beyond race and gender, including age, socioeconomic status, and environmental pressures in the ED. Of those who endorsed moderate to significant discrimination via survey response during their recent ED visit, most described historical experiences of discrimination during their interview. Previous experiences of discrimination may have lasting effects on patient perceptions of current health care. System and clinician investment in patient rapport and satisfaction is important to prevent negative expectations for future encounters and counteract those already in place.

Freebirth, the only option for women who do not fit into common practice– A Swedish national interview study

ObjectiveTo explore women’s experience of freebirth, as giving birth without the presence of a skilled healthcare professional such as a midwife. MethodsOnline semi-structured interviews with nine multiparous women in Sweden. A qualitative experiential approach, as described by Burnard, was followed for data analysis. ResultsThe five main categories explored were: (i) previous negative experiences of hospital care as a reason for freebirth; (ii) receiving support for the decision of freebirth was crucial; (iii) longing for individual midwifery-assisted home-birthing support; (iv) to give birth in peace and in self-control, in the safe home environment; and (v) helpful support during labor and birth was appreciated. ConclusionsThe women in the study had a powerful and positive experience of freebirth, but individual midwifery birthing support was also requested. Easily available and respectful midwifery support should be offered to all childbearing women.

Knowledge, attitude and practice of caregiver of the elderly with Alzheimer's regarding this disease in Yazd city, 1400

Introduction: Along with the increase in the elderly population, caring for the elderly with Alzheimer's disease has become a challenge in the field of their health and well-being. Also, the need for caregivers is increasing due to the lengthening of the care period. Considering that the nurses of Alzheimer's patients play the main role in providing services to the elderly, the present study was conducted with the aim of determining the state of knowledge, attitude and practice of the caregiver of elderly Alzheimer's patients in Yazd city.&#x0D; Methods: This study was descriptive. The sample size was 60 caregiver of elderly people with Alzheimer's disease in Yazd city. The sampling method in this study was based on the vailability of statistical research and consulting facilities. The data collection tool in this study was a four-part questionnaire (demographic, knowledge, attitude and practice) that was used in a similar study. Data were analyzed with spss24 software and using descriptive statistics as well as t-test and Anova.&#x0D; Results: The average age score of nurses was 62.73 ± 11.78. The average score of knowledge, attitude and practice of elderly caregiver were 21.58 ± 1.87, 35.65 ± 2.84 and 12.57 ± 1.28, respectively. The data showed that there is a significant relationship between the knowledge score and family ratio and previous experience of care. Also, there is a significant relationship between attitude score and previous care experience (P≤0.05).&#x0D; Conclusion: Considering the importance of caregivers' knowledge of the phenomenon of aging and Alzheimer's disease, it is suggested to provide appropriate training to improve the knowledge and change the attitude of caregivers of the elderly in order to improve the quality and provide better and more suitable services for the elderly.

Cortical activation and oxygen perfusion in preterm newborns during kangaroo mother care: A pilot study.

This study aimed to assess the functional activation of preterm newborns' cerebral cortex during kangaroo mother care. Possible effects of gestational age and previous kangaroo mother care experience were also considered. Fifteen preterm newborns were recruited (gestational age: 24-32 weeks). Cortical activation was assessed in frontal, motor and primary somatosensory cortices after 15 and 30min of kangaroo mother care by multichannel near-infrared spectroscopy (gestational age at assessment: 30-36 weeks). Both oxy- and deoxy-haemoglobin variations were analysed by t-test. Possible effects of gestational age and previous kangaroo mother care experience on cortical activation were studied by regression analysis. After 15min, bilateral activations (oxy-haemoglobin increase) were observed in frontal, somatosensory and motor cortices. After 30min, the right motor and primary somatosensory cortices were found activated. Deoxy-haemoglobin increased after 15min, returning to baseline at 30min. After 15min, there was a positive effect of gestational age at the assessment on both haemoglobin concentrations and a negative effect of previous kangaroo mother care on deoxy-haemoglobin increase. Motor and somatosensory cortices, particularly on the right side, showed significant activation during kangaroo mother care. Kangaroo mother care seems to benefit activated cortical areas by improving oxygen supply.

Readiness for Telemedical Services in Patients With Cardiovascular Diseases: Cross-sectional Study.

Telemedicine solutions, especially in the face of epidemiological emergencies such as the COVID-19 pandemic, played an important role in the remote communication between patients and medical providers. However, the implementation of modern technologies should rely on patients' readiness toward new services to enable effective cooperation with the physician. Thus, successful application of patient-centric telehealth services requires an in-depth analysis of users' expectations. This study aimed to evaluate factors determining readiness for using telehealth solutions among patients with cardiovascular diseases. We conducted a cross-sectional study based on an investigator-designed, validated questionnaire that included 19 items (demographics, health status, medical history, previous health care experience, expected telehealth functionalities, and preferred remote communication methods). Multivariate logistic regression was applied to assess the relationship between readiness and their determinants. Of the 249 respondents, 83.9% (n=209) consented to the use of telemedicine to contact a cardiologist. The nonacceptance of using telemedicine was 2 times more frequent in rural dwellers (odds ratio [OR] 2.411, 95% CI 1.003-5.796) and patients without access to the internet (OR 2.432, 95% CI 1.022-5.786). In comparison to participants living in rural areas, city dwellers demonstrated a higher willingness to use telemedicine, including following solutions: issuing e-prescriptions (19/31, 61.3% vs 141/177, 79.7%; P=.02); alarming at the deterioration of health (18/31, 58.1% vs 135/177, 76.3%; P=.03); and arranging or canceling medical visits (16/31, 51.6% vs 126/176, 71.6%; P=.03). Contact by mobile phone was preferred by younger patients (OR 2.256, 95% CI 1.058-4.814), whereas older patients and individuals who had no previous difficulties in accessing physicians preferred landline phone communication. During a nonpandemic state, 83.9% of patients with cardiovascular diseases declared readiness to use telemedicine solutions.

Transitions from intensive eating disorder treatment settings: qualitative investigation of the experiences and needs of adults with anorexia nervosa and their carers.

Relapse rates for individuals with anorexia nervosa after intensive hospital treatment (in-patient or full-time day care) are high. Better knowledge about the difficulties and opportunities that arise during this transition is needed to identify factors that support or hinder continued recovery upon discharge. The aim of this study was to explore the experiences of adult patients and their chosen carers on the process of transitioning from intensive eating disorder treatment settings to the community. Semi-structured interviews were conducted with patients with anorexia nervosa (n = 11) discharged from day or in-patient care from specialised eating disorder units across the UK, and their chosen carers (n = 20). Data were analysed with inductive thematic analysis. Four interrelated themes were identified for both groups. For patients, themes were continuity of care, ambivalence about continued recovery, the value of social support and a call for enhanced transition support. For carers, themes were the impact of the eating disorder on themselves and the family, perceptions of recovery and support post-discharge, the impact of previous treatment and care experiences, and desire to create a supportive transition process. The study provides an insight into the unique challenges that individuals with anorexia nervosa face upon leaving intensive treatment. A lack of post-discharge planning, support system and identity formation outside of anorexia nervosa were perceived as barriers to continued recovery. Patients and carers advocated for transition support that incorporates a phased, inclusive approach with accessible professional and social support in the community.

Exploring the impact of suicide care experiences and post-intervention supports sought among community pharmacists: a cross-sectional survey

BackgroundThere is a need to appropriately train, support and remunerate pharmacists for their expanding roles in mental healthcare. Pharmacists often care for people experiencing mental health crises, including suicidal thoughts and behaviours, but little is known about pharmacists’ suicide care experiences.AimThis cross-sectional study aimed to explore the impact of professional experiences with people at risk of suicide and support accessed, among community pharmacists.MethodA survey exploring pharmacists’ experiences with people at risk of suicide and post-intervention support-seeking was disseminated through Australian and Canadian professional associations, conferences and social media (June 2016-May 2017). Quantitative data were analysed using Chi-squared, Fisher’s exact and independent t-tests, where appropriate. Qualitative data exploring the impact of these experiences were thematically analysed, and reasons for not seeking help post-intervention were identified.ResultsAmong 378 respondents, 84% had encountered patients at risk of suicide and 28% had lost patients to suicide. Some were negatively affected personally and/or professionally (11%), of which 88% did not seek professional support, mainly due to uncertainty about available services. Pharmacists were significantly more negatively affected if they had a personal mental health diagnosis (p = 0.017) and previous suicide care experiences (p = 0.001). Qualitative themes included: expanding knowledge and skills, role limitation and emotional impact and response.ConclusionA large proportion of pharmacists have interacted with suicidal patients and are impacted by these experiences, yet few seek help due to lack of awareness and access. There is a need to recognize pharmacists’ roles in suicide care, and develop pharmacist-specific post-intervention support.

A lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical needs—a qualitative study among multiparous women in Somaliland

ABSTRACT Background Around 20% of births in Somaliland take place at health facilities staffed by trained healthcare professionals; 80% take place at home assisted by Traditional Birth Attendants (TBAs) with no formal training. There has been no research into women’s choice of place of birth. Objective In this study, we explore multipara women’s needs and preferences when choosing the place of birth. Method An explorative qualitative study using individual in-depth interviews analysed inductively using content analysis. The interviews were conducted in Somaliland with 25 multiparous women who had experience of giving birth both at home and at a health facility within the past three years. Results The results provide a description of how, for women in Somaliland, a lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical need. The women in this study desired intentionality in their role as mothers and sought some measure of control over the environment where they planned to give birth, depending on the circumstances of that particular birth. The results describe what quality care means for multipara women in Somaliland and how women choose birthplace based on previous experiences of care. The expectation of respectful care was a vital part for women when choosing a place of birth. Conclusion To meet women’s needs and preferences in Somaliland, further investments are needed to strengthen the midwifery profession and to define and test a context specific midwife-led continuity of care model to be scaled up. A dialogue to create new roles and responsibilities for the TBAs who attend most home births is further needed to link them to the formal healthcare system and assure timely healthcare seeking during pregnancy and birth.

Factors associated with hospital admission and severe outcomes for older patients with COVID-19.

BackgroundMorbidity and death due to coronavirus disease 2019 (COVID‐19) experienced by older adults in nursing homes have been well described, but COVID‐19's impact on community‐living older adults is less studied. Similarly, the previous ambulatory care experience of such patients has rarely been considered in studies of COVID‐19 risks and outcomes.MethodsTo investigate the relationship of advanced age (65+), on risk factors associated with COVID‐19 outcomes in community‐living elders, we identified an electronic health records cohort of older patients aged 65+ with laboratory‐confirmed COVID‐19 with and without an ambulatory care visit in the past 24 months (n = 47,219) in the New York City (NYC) academic medical institutions and the NYC public hospital system from January 2020 to February 2021. The main outcomes are COVID‐19 hospitalization; severe outcomes/Intensive care unit (ICU), intubation, dialysis, stroke, in‐hospital death), and in‐hospital death. The exposures include demographic characteristics, and those with ambulatory records, comorbidities, frailty, and laboratory results.ResultsThe 31,770 patients with an ambulatory history had a median age of 74 years; were 47.4% male, 24.3% non‐Hispanic white, 23.3% non‐Hispanic black, and 18.4% Hispanic. With increasing age, the odds ratios and attributable fractions of sex, race–ethnicity, comorbidities, and biomarkers decreased except for dementia and frailty (Hospital Frailty Risk Score). Patients without ambulatory care histories, compared to those with, had significantly higher adjusted rates of COVID‐19 hospitalization and severe outcomes, with strongest effect in the oldest group.ConclusionsIn this cohort of community‐dwelling older adults, we provided evidence of age‐specific risk factors for COVID‐19 hospitalization and severe outcomes. Future research should explore the impact of frailty and dementia in severe COVID‐19 outcomes in community‐living older adults, and the role of engagement in ambulatory care in mitigating severe disease.