Previous Healthcare Experience Research Articles

Expanding access to healthcare for people who use drugs and sex workers: hepatitis C elimination implications from a qualitative study of healthcare experiences in British Columbia, Canada

BackgroundHepatitis C virus (HCV) is a major health threat in Canada. In British Columbia (BC) province, 1.6% of the population had been exposed to HCV by 2012. Prevalence and incidence of HCV are very high in populations of people who use drugs (PWUD) and sex workers (SW), who may experience unique barriers to healthcare. Consequently, they are less likely to be treated for HCV. Overcoming these barriers is critical for HCV elimination. This research sought to explore the healthcare experiences of PWUD and SW and how these experiences impact their willingness to engage in healthcare in the future, including HCV care.MethodsInterpretive Description guided this qualitative study of healthcare experiences in BC, underpinned by the Health Stigma and Discrimination framework. The study team included people with living/lived experience of drug use, sex work, and HCV. Twenty-five participants completed in-depth semi-structured interviews on their previous healthcare and HCV-related experiences. Thematic analysis was used to identify common themes.ResultsThree major themes were identified in our analysis. First, participants reported common experiences of delay and refusal of care by healthcare providers, with many negative healthcare encounters perceived as rooted in institutional culture reflecting societal stigma. Second, participants discussed their choice to engage in or avoid healthcare. Many avoided all but emergency care following negative experiences in any kind of healthcare. Third, participants described the roles of respect, stigma, dignity, fear, and trust in communication in healthcare relationships.ConclusionsHealthcare experiences shared by participants pointed to ways that better understanding and communication by healthcare providers could support positive change in healthcare encounters of PWUD and SW, who are at high risk of HCV infection. More positive healthcare encounters could lead to increased healthcare engagement which is essential for HCV elimination.

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).

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.

Any Questions? Understanding the Functional Health Literacy in Patients Who Underwent Ureteroscopy

To correlate health literacy of patients undergoing ureteroscopy and identify gaps within current patient education practices in order to better tailor the preoperative experience. Eighteen patients were retrospectively recruited to complete an in-depth semistructured interview and the Test of Functional Health Literacy for Adults (TOFHLA). All interviews were recorded, transcribed, and then coded and analyzed using the grounded theory of analysis. The average participant age was 56.2±12.8years, and 10 (55.6%) identified as female. Education level ranged from some high school to a professional degree. The average TOFHLA score was 88.1±11.7. Irrespective of score, all participants felt they understood the purpose and basic elements of a ureteroscopy. The use of nontechnical language, repetition, and previous healthcare experiences were identified as positive aspects of the education experience. However, 72.2% (n=13) identified the primary gap in understanding revolved around the use, purpose, and pain associated with stents. Functional health literacy is an essential element, but not the only factor informing patient education and comprehension. Current practices are effective in explaining the basics of a ureteroscopy, but even when identified health literacy is higher than expected, a gap remains in stent education. Efforts should be made to better understand how stents can be effectively explained to patients in addition to continuing to refine education practices to elicit true comprehension.

Implementation of a structured revision program and the impact on final-year undergraduate nursing students’ preparedness for clinical placement: Mixed methods study

ProblemThe effects of a revision program on undergraduate nursing students’ preparedness for their final clinical placement leading to their graduate year are unknown. AimTo explore students’ perceptions of confidence, anxiety, self-doubt, and preparedness for a high-acuity clinical placement following a three-day structured revision program. MethodThis was a mixed methods study conducted in the final year of the undergraduate nursing degree. Data were collected by survey using a self-developed 10-item instrument with three components of confidence, inhibitors (self-doubt/anxiety), and preparedness (n = 75) and by semi-structured individual interviews and focus group (7 students in total). Independent sample t-tests were used to compare data between components’ scores and demographic characteristics. Interview data were analysed using thematic analysis. ResultsStudents who attended the revision program had significantly higher scores for confidence, inhibitors, and preparation. Higher scores in one or more components were associated with enrolment in the Bachelor of Nursing (BN) versus the Bachelor of Nursing/Bachelor of Midwifery, enrolment in the accelerated pathway of the BN, older age, and previous healthcare experience. Four themes emerged from the qualitative data: anticipatory concerns, confidence, preparedness, and striving to belong. ConclusionThe findings have potential implications for adverse learning outcomes and poor student performance because of negative behaviours, lack of preparedness, and belongingness. There is a need to structure curricula, implement instructional support for students with anxiety and self-doubt, and faculty to align pedagogy to best educational practices with student attendance at structured revision sessions before each clinical placement.

Previous Health Care Experiences' Influence on Health Care Perceptions Among Residents of Six Homeless Shelters in Seattle, Washington, July-October 2021.

The study purpose was to learn and describe 1) where homeless shelter residents receive health care, 2) what contributes to positive or negative health care experiences among shelter residents, and 3) shelter resident perceptions toward health care. Semi-structured interviews (SSIs) utilizing purposive sampling and focus group discussions (FGDs) utilizing convenience sampling were conducted at 6 homeless shelters in Seattle-King County, Washington, during July-October 2021. All residents (age ≥18) were eligible to participate. SSIs were conducted with 25 residents, and 8 FGDs were held. Thematic analysis was conducted using Dedoose. Participants received health care in settings ranging from no regular care to primary care providers. Four elements emerged as contributing positively and negatively to health care experiences: 1) ability to access health care financially, physically, and technologically; 2) clarity of communication from providers and staff about appointment logistics, diagnoses, and treatment options; 3) ease of securing timely follow-up services; and 4) respect versus stigma and discrimination from providers and staff. Participants who felt positively toward health care found low- or no-cost care to be widely available and encouraged others to seek care. However, some participants described health care in the United States as greedy, classist, discriminatory, and untrustworthy. Participants reported delaying care and self-medicating in anticipation of discrimination. Findings demonstrate that while people experiencing homelessness can have positive experiences with health care, many have faced negative interactions with health systems. Improving the patient experience for those experiencing homelessness can increase engagement and improve health outcomes.

Effects of the Virtual Simulation Prebriefing-Debriefing Educational Strategy on Nursing Students’ Self-Efficacy and Virtual Simulation Performance: A Quasi-Experimental Study

BackgroundThrough the use of virtual simulations nursing students are exposed to a variety of clinical scenarios that may potentially improve their learning of competencies, increase their self-efficacy (confidence), and enhance their future clinical performance. MethodsGuided by the National League for Nursing Jeffries Simulation Theory, Bandura's self-efficacy theory, and the Healthcare Simulation Standards of Best PracticeTM, this quasi-experimental, two-group, pretest/post-test educational intervention study examined the effects of the synchronous Virtual Simulation Prebriefing-Debriefing strategy on Associate Degree Nursing students’ self-efficacy perceptions and virtual simulation performance scores in the care of patients experiencing a myocardial infarction. ResultsStudy results revealed statistically significant findings concerning the effectiveness of the Virtual Simulation Prebriefing-Debriefing strategy on students’ self-efficacy perceptions (in the cognitive, psychomotor, and affective domains) and virtual simulation performance scores. Results also support that there is a small positive correlation between students' self-efficacy perceptions and virtual simulation performance scores. This study also provided evidence that the study's educational strategy caused positive changes in students’ self-efficacy perceptions and virtual simulation performance scores regardless of students’ age, previous experience with video or computer gaming, or previous healthcare work experience. ConclusionFindings suggest that a high-quality virtual simulation experience that integrates the Healthcare Simulation Standards of Best PracticeTM, including structured prebriefing and debriefing strategies, can positively influence students’ self-efficacy perceptions and virtual simulation performance scores.

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.

Nursing students' interprofessional socialisation and readiness for interprofessional learning: A cross-sectional research study

BackgroundInterprofessional education programs in university settings have facilitated the development of student attributes needed to become a team-player, understand roles and responsibilities of other health disciplines, and acquire knowledge to deliver patient-centred care. Although the benefits of interprofessional education are widely acknowledged, there is limited research on interprofessional socialisation within university contexts. ObjectivesTo examine readiness of undergraduate nursing students for interprofessional learning and interprofessional socialisation. DesignA cross-sectional design was used to examine the correlation between interprofessional learning and socialisation, and group differences between mode of study, year level, and prior healthcare experience. SettingA large Australian regional university, across two campuses. ParticipantsA total of 103 undergraduate nursing students across year levels, including 58 enrolled on-campus, and 45 studying externally. MethodStudents completed an online survey using the Readiness for Interprofessional Learning Scale and the Interprofessional Socialisation and Valuing Scale. Data analyses included independent t-tests, and a one-way between subjects ANOVA. ResultsNo significant differences in student readiness for interprofessional learning or interprofessional socialisation were found between on-campus and external modes of study and between healthcare experience and no prior healthcare experience. Participants with previous healthcare experience had significantly higher scores for interprofessional socialisation than those with no previous healthcare experience. ConclusionsReadiness for interprofessional learning and interprofessional socialisation and were not impacted by the students' mode of study; however, previous experience in the healthcare industry and duration of study significantly improved interprofessional socialisation skills. As nursing students advance through their study, they may experience interprofessional education opportunities that influence their perceived socialisation skills.

Type of Health Care Experience Impact on PA Education Association End of Rotation Exam Scores.

The physician assistant (PA) profession is based on previous healthcare experience (HCE), yet few studies have examined the influence of HCE on outcomes. This exploratory study examined possible differences between type of HCE and End of Rotation scores as a surrogate for clinical acumen and medical knowledge. Participants included consecutive classes of PA students (2017-2020) from a single public institution (N = 196). Self-reported HCE was used to classify students into HCE groups: group 1, lower decision-making professions; and group 2, higher decision-making professions. Group 1 (n = 124) and group 2 (n = 72) had no significant difference in the 7 individual End of Rotation exam scores and HCE ( p =.163 to .907). A correlation was found between average End of Rotation exam score and PANCE scores ( r =.80, p ≤ .001). The impact of HCE during the clinical year of education and its influence on noncognitive attributes, such as communication skills and professionalism, is not known. HCE might have a role in hard to measure noncognitive, nonquantifiable qualities.

How do people with chronic pain explain their use, or non-use, of pain-related healthcare services? A qualitative study of patient experiences

PurposeThis study aims to explore how people with chronic pain explain their use or non-use of pain-related healthcare services and their expectations of the healthcare provider, and explore how explanations and expectations vary between different levels of pain-related healthcare use.Materials and methodsWe conducted 20 individual semi-structured interviews with purposely sampled adults between 39 and 77 years of age with chronic pain. All interviews were audio-recorded, transcribed and analysed using a thematical template analysis approach.ResultsFour key drivers for pain-related healthcare use were identified: (1) the healthcare system facilitates clinical pathways, (2) appraisal of pain-related healthcare initiatives influences future use, (3) autonomy, beliefs and values determine healthcare behaviour, and (4) recommendations from others impact healthcare behaviour. Comparing explanations across different pain-related healthcare user groups (high, medium and low) showed that perceived needs, beliefs and values, and appraisal of previous healthcare experiences differed between these groups.ConclusionsBeliefs, pain characteristics, recommendations, and the search for a diagnostic label, often initiate pain-related healthcare use. Healthcare is modified by two interconnected systems: (1) perceived needs, beliefs and values and (2) previous healthcare experiences. Differences related to these systems could explain some of the variance in pain-related healthcare use.Implications for RehabilitationDifferent use of pain-related healthcare services for people with chronic pain could be related to differences in perceived needs, beliefs and values and appraisal of previous healthcare.It may be helpful to explore the perceived needs and beliefs of those seeking healthcare due to chronic pain.Previous healthcare experiences may impact and should be explored.

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.

Young adults’ expectations for healthcare following institutional betrayal

ABSTRACT Healthcare-related institutional betrayal has been used to examine how patients’ previous negative healthcare experiences influence their current provider-level trust and future interactions with the healthcare system. However, healthcare-related institutional betrayal has rarely been considered among emerging independent users of the healthcare system: college students. Moreover, it is unknown whether healthcare-related institutional betrayal is associated with future healthcare expectations among this population. Using a trauma-informed framework, this study examined the relations among self-reported experiences of healthcare-related institutional betrayal, trust in healthcare providers, and subsequent expectations for healthcare among college students (n = 967). Analyses considered whether greater past healthcare-related institutional betrayal during one’s worst healthcare experience predicts i) lower current trust in healthcare providers and ii) greater negative expectations for future healthcare above and beyond trauma symptoms and the perceived severity of participants’ worst healthcare experiences. Sixty-nine percent of participants endorsed having experienced at least one act of institutional betrayal, the most common being the institution not taking proactive steps to prevent unpleasant healthcare experiences (28.5%). As predicted theoretically, greater experiences of institutional betrayal accounted for 16% of the variance in current trust in healthcare providers, even after accounting for trauma symptoms and the severity of the worst healthcare experience. Greater endorsement of institutional betrayal experiences were also significantly associated with negative expectations for future healthcare. Given the youthfulness of the sample, it is noteworthy that 41.4% of participants endorsed at least one negative expectation for future healthcare. Future research should examine how negative expectations are related to healthcare avoidance behaviors.

Young adults' needs when seeking first-line healthcare: A grounded theory design.

BackgroundHealthcare outpatient visits have increased in recent years, and young adults are often given as an explanatory factor for many avoidable visits.ObjectiveThe objective of this study was to explore how young adults perceive seeking first-line healthcare.Design and settingThe study utilized a grounded theory design with data collection at primary healthcare centres and emergency departments in southeast Sweden.MethodData were collected during individual interviews and patient observations with subsequent interviews during the years 2017–2018. The analysis was performed using grounded theory.ResultsThe main concern when young adults are seeking healthcare is that their worries are taken seriously. It is a four-part process: becoming aware of, verifying, communicating, and receiving an opinion about one’s symptoms. The process includes external factors, clarity of symptoms, behavioural approaches, healthcare know-how, enabling self-management, and prior healthcare experience(s). When communicating symptoms, the clearer the symptoms, the less there needs to be communicated. When symptoms are unclear, the importance of different behavioural approaches and healthcare know-how increases. When receiving a medical opinion about symptoms, young adults want to learn how to self-manage their symptoms. Depending on previous healthcare experience, the healthcare visit can either harm or help the patient in their healthcare-seeking process.ConclusionThis study reflects several insights in the healthcare-seeking process from a young adult perspective. Based on the results, we suggest that healthcare providers focus on the final step in the healthcare-seeking process when giving their medical opinion about symptoms. Having extra minutes to give support for future self-care regardless of diagnosis could increase positive healthcare experiences and increase future self-care among young adults.

Emotional Intelligence: Changes Over the First Year of Physician Assistant Education.

To investigate emotional intelligence (EI) development in physician assistant (PA) students as they progress through their didactic education. Data were gathered through an online survey of EI distributed to a purposeful sample of 5 institutions with similar curriculum length and start dates. Program directors forwarded the survey to students at the start of their didactic education (pretest). Follow-up surveys were distributed via email to the students at the end of their didactic education (posttest). The survey consisted of 33 items related to 4 subscales of EI. Participants' age, gender, and previous healthcare experience were gathered. Five repeated measures ANOVAs were calculated for each EI summary score. Independent sample t-tests were conducted between pretest scores and a previously established EI mean. A total of 192 first-year students were solicited. A sample of 68 (16 males; 52 females) served as participants. No results were attained for gender or age due to unbalanced sample sizes. Significant results were realized for total EI and the Managing Others' Emotions subscale. Participants with more than one healthcare experience demonstrated significantly high emotional intelligence on the pretest. Participants with one healthcare experience demonstrated a significant increase in total EI and the Managing Others' Emotions subscale. The main limitation of the study was the attrition of participants between measures. Future research is needed to assess EI at the end of the clinical year, after a period of clinical experience, and to determine which educational activities are most likely to enhance EI.

The efficacy of virtual distance training of intensive therapy and anaesthesiology among fifth-year medical students during the COVID-19 pandemic: a cross-sectional study

BackgroundThe coronavirus disease (COVID-19) brought several challenges in medical education. The aim of our study was to investigate whether virtual distance trainings (VDT) organized during the COVID-19 pandemic at our university were effective in replacing in-person bed-side education in intensive therapy and anaesthesiology among fifth-year medical students, both from students’ and instructors’ perspectives.MethodsThis was a cross-sectional study consisting of three parts: a 20-item students’ questionnaire filled out by students participating in VDT, a 22-item instructors’ questionnaire filled out by instructors taking part in virtual distance education and a 20-item knowledge test completed by students participating in VDT, as well as by students visiting bed-side trainings (BT) during the same semester, before COVID-19 pandemic. The questionnaires focused on effectiveness, content, self-preparedness, technical background and interactivity of VDT. Instructors’ and students’ responses given to the common questions, as well as the knowledge test results were compared. Mann-Whitney U test was used for group comparisons and binary logistic regression was performed to analyze the influence of previous health-care experience on students’ feeling of self-preparedness.ResultsOne hundred thirthen students (response rate {RR}: 68%) and 29 instructors (RR: 97%) filled out the questionnaires. The majority of students found our VDT useful and effective; however, a considerable number of participants felt disadvantaged by taking VDT instead of BT sessions and would recommend keeping virtual distance education methods combined with BT. Instructors found VDT overall effective and deemed the transfer of their knowledge satisfactory; however, they described worse interactivity and contact with students during virtual sessions compared to in-person teaching. Instructors showed a clearer consensus that VDT should not replace BT in the future, while students’ answers were more divided in this regard. Previous health-care experience did not influence students’ feeling of self-preparedness.One hundred and twenty-seven students (56 after VDT {RR: 34%}; 71 after BT {RR: 67%}) completed the end-of-semester knowledge test. Students attending VDT performed better than students visiting BT (median score VDT:83.5 vs BT:77.3; p = 0.015).ConclusionsVirtual distance learning incorporating virtual practice sessions was effective in maintaining continuous education of intensive therapy and anaesthesiology among fifth-year medical students during the COVID-19 outbreak.

Why women choose to to seek facility-level obstetrical care in rural Guatemala: A qualitative study

ObjectiveThe majority of indigenous Guatemalan women give birth at home with traditional birth attendants (TBAs), and maternal mortality rates are high (Ministerio de Salud, 2017). Our objective was to better understand decision-making around whether to remain in the home or to seek facility-level care for obstetric complications. MethodsThis study was a qualitative analysis using semi-structured interviews in a Maya population in the Western Highlands of Guatemala who received prenatal care between April 2017 and December 2018. We used qualitative interviews with women who were identified as medically high-risk and needing facility-level care, offered assistance with acquiring such care, and yet declined this option. Women interviewed were connected to a primary care organization called Maya Health Alliance, through care with TBAs involved in a program utilizing a smartphone-based decision support application to identify maternal and neonatal complications of pregnancy. Interviews were analyzed using Dedoose (www.dedoose.com). Deductive and inductive analysis was performed. ResultsBarriers to care included a disagreement between the respondent and TBA about indications for facility care, fear of hospital care, concerns about the quality of hospital care, logistical obstacles, and lack of control; and they were more often described by respondents who had previous healthcare experiences. Therapeutic misalignment occurred more with conditions perceived to be less severe. Participants described a balancing of fears and apprehensions against concerns of low quality and disrespectful maternity care, and in the setting of emergent conditions, disregarded barriers that were often described as inhibiting non-urgent obstetric care. ConclusionsThe decision to engage in medical care in this population of Maya women involves a weighing of the perception of seriousness of the medical complication against fears of facility level care and concerns of a poor quality of care.

Ethnic minority and migrant underrepresentation in Covid-19 research: Causes and solutions.

Ethnic minority and migrant underrepresentation in Covid-19 research: Causes and solutions.

Serving Culturally and Linguistically Diverse Patients in Audiology-Part 2: Promoting Health Literacy

Serving Culturally and Linguistically Diverse Patients in Audiology-Part 2: Promoting Health Literacy

Does alarm fatigue start in nursing school?

Alarm fatigue among working nurses is a well-documented, high-priority safety issue. This article describes a study to learn whether alarm fatigue develops in undergraduate nursing student populations. This longitudinal quantitative study employed survey data from a single cohort of nursing students in the Southeastern US over a period of 18 months to assess nursing students' level of sensitivity to alarms, including the call bell, bathroom, fall and safety, I.V. infusion pumps, and telemetry alarms. These data were significant for I.V. infusion pump alarms and indicated a general decrease in sensitivity over an 18-month period. Nursing students with previous healthcare experience also noted decreased sensitivity to bathroom call bells and fall and safety alarms. Alarm fatigue was recognized among the surveyed nursing students. Nurse educators also identified a performance-based strategy to increase student awareness of alarm fatigue and evidence-based strategies to minimize desensitization to alarms in both education and practice.