Providing Quality Health Care Research Articles

Exploring Therapeutic Relational Connection in Virtual Healthcare: Insights From Nurse Practitioner Practice With Young Adults Living With Chronic Illness.

To identify the essential characteristics of therapeutic relational connection (TRC) as viewed by nurse practitioners (NPs) in the practice of their virtual visits caring for young adults living with chronic illness. This is a qualitative descriptive study of data obtained from open-ended items on an online questionnaire. The sample was recruited through an electronic listserv sent by the National Association of Pediatric Nurse Practitioners (NAPNAP) to access a national sample. Study data were collected and managed using REDCap electronic data capture tools. Data analysis was conducted through open and axial coding towards grounded theory. The 'towards grounded theory' approach adapts and evolves grounded theory principles to incorporate broader perspectives, enhancing flexibility and contextual sensitivity in the co-construction of knowledge between researcher and participants. TRC was the central phenomenon. Four themes emerged from the data including Characteristics of TRC, Behavioural Manifestations, Potential Outcomes and Environment. The transfer of skills from in-person clinic visits to the virtual setting is not synonymous. As virtual visits continue to be implemented as a mode to provide quality healthcare, identification of best practises for establishing an intentional use of TRC during virtual visits may be an essential component in the patient-provider relationship. Educational interventions can be designed to train providers to identify their current practices and ways in which they might adapt their in-person approach to the virtual visit. Identifying essential elements of TRC in virtual visits may achieve improved outcomes as an emergent healthcare delivery model for young adults with chronic illness. No patient or public contribution. Patient or public contribution was not indicated in this study as the aim was to identify the characteristics of TRC from NPs.

Using Social Robots and AI to Perform Genetic Risk Assessment for Cancer

Genetic risk assessment (GRA) and genetic counseling have become integral to optimal patient care for patients with cancer. At present, there is a limited number of qualified healthcare providers who provide this service. To assist professionals in the GRA process, we have combined social robotics and retrieval-augmented generative artificial intelligence (RAG AI) to provide education related to hereditary cancer to be included in GRA sessions for individuals at risk. This GRA application pushes the boundary on previously available chatbots and AI systems by creating a novel and interactive experience enhanced by professionally verified information. In the future, we seek to improve the app as it is and obtain feedback from both GRA professionals and potential end-users that will be used to enhance the system and provide customized risk assessment. Overall, our GRA system takes the next step towards informing patients of their hereditary cancer risk and pertinent care options.

Intraorbital Trauma with Wooden Foreign Body: Report of An Atypical Surgical Case

Among the various types of injuries that affect the maxillofacial region, perforating objects can result in doubtful prognosis due to the possibility of reaching vessels, nerves, and other key structures, causing hemorrhages, airway obstruction, brain damage and even death. Foreign bodies in the orbital cavity are usually divided into two categories: inorganic and organic. This report intends to present an atypical case of wooden foreign body remotion from the intraorbital area which was performed surgically in a Public Hospital Center in Sergipe, Brazil. Facial injuries should be evaluated with a rigid protocol to provide quality healthcare, thus minimizing problems during the management of the cases. Imaging examinations should not be neglected, so that careful evaluation of the extent of the lesions and presence of foreign objects can be performed. Although CT is regarded as the gold standard, MRI scans are superior to CT in the diagnosis of small pieces of wood. Surgery is the preferred treatment, in which the surgeons should carefully remove all foreign bodies and residual fragments will result in orbital infection. Postoperative sinus drainage and systemic antibiotic treatments are necessary.

Expat patient's satisfaction of healthcare services in the UAE’s Private Hospitals

Patient satisfaction is the chief parameter for health care services. The UAE receives millions of visitors, tourist every year in addition to its expat resident’s population of around 88%. The increasing trend of multinational residents makes the necessity of a large number of private hospitals in the UAE. The Private hospitals face challenges in business perspective, economy and customer service. Providing quality healthcare services are mandatory by law and to sustain the healthcare business in the UAE. The patient experience in the hospital needs to be converted into patient satisfaction through providing quality of healthcare services. This study takes an insight of expat patients’ satisfaction to assess the characteristics of quality healthcare services in the UAE’s private hospitals.

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (B)

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (B)

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (C)

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (C)

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (A, B & C)

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (A, B & C)

Medication Adherence and Practices in Pediatric Patients

Background: Improper medication practices and non-adherence are the biggest challenges faced by pediatricians in outpatient practice. Hence this study was aimed at determining the medication practices and factors affecting adherence. Methods: A cross sectional descriptive study was conducted at a tertiary care hospital in Southern India over a period of 3 months (January to March 2023), to study medication adherence and parental medication practices in pediatric patients. A pre structured questionnaire was administered to parents of 320 children. Results: Majority of the parents (55%) had children aged 1-5 years of age. It was noted that most of the families (89%) were above poverty line (APL). About 34% parents were educated till graduate level and 17% were educated beyond post graduate level. Frequency of medication adherence in our study was found to be 78%. It was noted that parents with education of graduate level and above, those belonging to APL families and the ones with no fear of adverse drug reactions showed higher medication adherence as compared to other parents and this association was found to be statistically significant (p <0.001). Majority of the parents (80%) reported that their children preferred liquid formulations, of which 57% preferred fruit flavoured ones. Around 51% parents preferred twice daily dosing of medications. While 47% parents used previous prescriptions, 39% bought over the counter medicines, especially paracetamol. Conclusion: Knowledge about medication practices and factors affecting adherence is important in order to provide quality health care. Actively involving children and parents while prescribing medications with health education goes a long way in improving adherence.

Chemical Poisoning: Prevalence, Knowledge, and Management of Commonly Encountered Types among Selected Adult Population

Chemical poisoning is a threat to the health of both children and adults in the Niger Delta region. Nevertheless, the study of the prevalence of poisoning has been undermined in Bayelsa state. Chemical poisoning remains an important health concern in Nigeria, especially in the south-south Niger Delta states which are rich in natural fuel. Information on the prevalence in the Niger Delta region is quite scarce, especially in Bayelsa state. The study investigated the risk factors, awareness, and perception of chemical poisoning, and the prevalence among residents of Amassoma and Yenagoa. A descriptive research employed systematic random sampling of 400 residents from Amassoma and Yenagoa from ages 15 years and above, by administering questionnaires and, collecting data. Data were analyzed using SPSS software utilizing ANOVA. The percentage of awareness of chemical poisoning is 28.4% and the majority of the respondents are educated at the tertiary level with a percentage of 51.5%. The female gender was more with a percentage of 51.0%. Among the signs and symptoms of chemical poisoning, nausea or stomach upset has a percentage of 74.6% being the highest percentage, and stomach cramps have a percentage of 72.9% while having a percentage of 56.7%. About 95.5% of respondents concurred to contacting qualified healthcare providers when poisoning is suspected and 93.8% agreed to keep all chemicals out of reach of children as a preventive measure. It can be concluded that the overall prevalence of chemical poisoning is quite low though used intentionally in young adults for suicide. It can also be said that there is proper awareness of the preventive measures for unintentional poisoning.

Public–Private Partnership Model in Delivering Quality Health Care and Medical Education - An Enduring Success Story for the Past Seven Decades

Public–private partnerships (PPPs) are integral to the National Health Mission (NHM). Kasturba Medical College (KMC), Mangalore, was the first private institution in India to embrace the PPP model way back in 1953. The then Government of Madras permitted KMC Mangalore to partner with the 2 district hospitals – the Government Wenlock and the Lady Goschen Hospitals. For almost seven decades, KMC Mangalore has been using the clinical facilities at District Wenlock and Lady Goschen hospitals to provide quality health care and also train the Undergraduate and Postgraduate students of KMC. The Manipal experiment is a shining example of public–private collaboration to provide quality accessible health care to everyone, which is in line with the Sustainable Development Goal (SDG) 3 and its targets.

Trustworthiness, Value, Danger, and Readability of ChatGPT-Generated Responses to Health Questions Related to Pulmonary Arterial Hypertension.

To enhance outcomes for patients with pulmonary arterial hypertension (PAH), comprehensive and individualized therapy is needed. A large language model called Generative Pre-trained Transformer (ChatGPT) has the ability to provide expert yet patient-friendly care. We wanted to determine how well ChatGPT could accurately and consistently respond to inquiries on knowledge and management for PAH. When 20 PAH patients were diagnosed, they were asked what concerns they had about PAH and what they had researched online.In the evaluation, it was determined that patients frequently searched the Internet for answers to eight queries. These eight queries were posed to ChatGPT, and their responses were recorded. Ten experts in the field of PAH assessed the trustworthiness, value, and hazard of the answers generated by the ChatGPT. According to evaluations conducted by experts, the ChatGPT-generated responses were deemed trustworthy with an average score of 8.4 (7.7-9.2) and valuable with an average score of 7.9 (7.4-8.2). Based on the statistical analysis, it can be inferred that most professionals believed that the utilization of prompts provided by ChatGPT did not present a substantial risk, with a mean of 2.1 (1.7-2.5).The answers were assessed for readability using two different indicators, namely the Flesch-Kincaid Grade Level (FKGL) and the Simple Measure of Gobbledygook (SMOG). The average FKGL value was determined to be 13.52 ± 2.40, indicating a "difficult" level of readability. ChatGPT provides reliable PAH-related information, but it is important to seek professional medical advice before making any decisions regarding PAH. ChatGPT can only provide general information and support, but a qualified healthcare provider can offer tailored recommendations.

Exploring cultural competence barriers in the primary care sexual and reproductive health centres in Catalonia, Spain: perspectives from immigrant women and healthcare providers

BackgroundImmigrant populations, especially women, continue facing challenges in accessing quality healthcare, particularly sexual and reproductive health services (SRH). Poor cultural competent health systems contribute to communication challenges between immigrant women and healthcare providers perpetuating health disparities. This exploratory study describes these communication barriers from the perspective of Moroccan and Pakistani immigrant women and healthcare providers within the Catalan health system and its implications to ensure an equitable provision of SRH services.MethodsAn exploratory-descriptive qualitative study was conducted in various municipalities of Barcelona with high concentration of immigrants. Eight focus groups (N = 51) and semi-structured interviews (N = 22) with Moroccan and Pakistani immigrant women were combined with key informant interviews (N = 13) with healthcare professionals. Thematic analysis and data triangulation were performed primarily using an inductive approach.ResultsLanguage barriers and cultural differences in health needs, expectations, care-seeking behaviours and understanding of quality healthcare provision hindered the ability of immigrant women and providers to interact effectively. Limited availability of intercultural mediators and inadequate cultural competence training opportunities for health staff were also identified. Findings suggest a lack of minority representation in the Catalan health workforce and leadership roles.ConclusionThis study reinforces the evidence of persistent inequities in accessing healthcare among immigrant populations by focusing on the cultural competence barriers of the Catalan health system in the provision and access to SRH services. The regularization of adequately trained intercultural mediators, quality training in cultural competence for health staff and a commitment to increase workforce diversity would contribute to improve intercultural communication between immigrant patients and providers. An urgent call to action in this direction is needed to ensure an equitable access to SRH services among immigrant women.

Digital Education on Hospital Nutrition Diets: What Do Patients Want to Know?

Therapeutic nutrition plays an imperative role during a patient's hospital course. There is a tremendous body of literature that emphasizes the systematic delivery of information regarding hospital nutrition diets. A major component of delivering healthcare information is the principle of providing quality healthcare information, but this has not yet been investigated on hospital nutrition diets. This study aimed to evaluate the comprehension and readability of patient education materials regarding therapeutic hospital diets. The methodology employed the use of publicly available questions regarding hospital nutrition diets and categorized them per Rothwell's Classification of Questions. Additionally, the questions were extracted online and have an associated digital article linked to the question. These articles underwent analysis for readability scores. This study's findings reveal that most hospital diets do not meet the recommended grade-reading levels. This underscores the need for healthcare providers to enhance patient education regarding hospital diets. The prevalence of "Fact" questions showcases the importance of clearly explaining diets and dietary restrictions to patients.

Healthcare sectors in EU countries: Their impact on employment and infrastructure development

This scientific study aims to thoroughly assess the current status and evaluate key indicators influencing healthcare and the workforce in selected European Union (EU) member states. Building upon this ambitious research agenda, we focused on a comprehensive descriptive analysis of selected indicators within the healthcare sector, including healthcare financing schemes, overall employment in healthcare and social care, the number of graduates in healthcare (including physicians and general practitioners), as well as migration patterns within the healthcare sector. The data forming the basis of this analysis were systematically gathered from Organization for Economic Co-operation and Development (OECD) and Eurostat databases. Subsequently, we conducted a robust correlation analysis to explore the intricate relationships among these indicators. Our research endeavour aimed to identify and quantify the impact of these indicators on each other, with a focus on their implications for overall healthcare and the workforce in the respective countries. Based on the findings obtained, we derived several significant conclusions and recommendations. For instance, we identified that increasing employment in the healthcare sector may be associated with the overall quality of healthcare provision in a given country. These findings have important implications for policymaking and decision-making at the EU level. Therefore, we recommend that policymakers in these countries consider implementing measures to further develop the healthcare sector while also helping to retain and attract qualified professionals in the healthcare industry. Such recommendations could include improving healthcare infrastructure, incentivizing professional education and further training in the healthcare sector, and implementing policies to support healthcare provision more broadly.

The effect of health facility ownership on perceived healthcare quality: evidence from Ghana

Whether private healthcare providers should be encouraged over public providers remains unclear. On the one hand, because private providers are profit-driven, they are more motivated to compete for demand by enhancing quality if demand is elastic. However, because they are more motivated to maximize revenue, they may sacrifice quality to maximize profit. A crucial factor in determining whether private providers should be encouraged is the extent to which their quality exceeds or falls short of that of the public provider. This study, therefore, investigates whether the public and private differ in providing quality healthcare services using the 2014 Ghana Demographic and Health Survey. Our measure of healthcare quality is based on patient satisfaction level with nine healthcare services (cleanliness, waiting time, comfort and safety, consultation time, privacy, listening, explanation, treatment advice and confidentiality) provided by public and private healthcare facilities. We applied an instrumental variable approach to account for endogeneity issues related to the patient’s choice of healthcare provider. We find that private facility users have a higher probability of being very satisfied with “waiting time”, “consultation time”, “listening”, “cleanliness”, “comfort and safety”, “confidentiality”, and “privacy” than public users, thus suggesting that private facilities provide better service than public. We thus recommend encouraging the private sector to enter the healthcare market. We also find that failing to account for endogeneity in provider choice when estimating the effect of healthcare facility ownership on healthcare service quality underestimates the effects.

Impact of COVID-19 lockdown on sleep patterns and the related problems among nursing students.

To evaluate the impact of the COVID-19 lockdown on sleep patterns and quality among nursing students in our college. A cross-sectional study was carried out. A total of 302 nursing students aged 18-25 years, representing both genders and various academic levels, participated in this study. A pre-validated, self-administered questionnaire was used to assess sleep quality during COVID-19 and it was distributed through various social media platforms for data collection. Female students comprised the majority (92.1%) of participants. Of 332 nursing students, 302 completed the questionnaire, yielding a 91% response rate. Statistically significant differences were observed before and during the COVID-19 lockdown regarding the need to sleep after waking, feeling refreshed upon waking, satisfaction with individual sleep patterns and experiencing restless and troubled sleep (p = 0.001). Additionally, approximately one-third of nursing students (32.9%) reported poor sleep quality during the COVID-19 pandemic, with minimal impact on the total sleep hours among the studied cohorts. The COVID-19 pandemic has statistically significant impacted nursing students' sleep quality and levels. Acknowledging these challenges and planning for providing supporting measurements is essential to ensuring that nursing students can maintain their physical and mental health, which is critical for their ability to provide quality healthcare.

High Responsibility, limited authority, and endless expectations: a policy critique of the Community Health Officer’s role in the government healthcare delivery systems in India

BackgroundThe shortage of qualified healthcare providers in rural areas of India has led to a emergence informal and unqualified practitioners and poses significant risks to population health. Community Health Officers (CHOs) were introduced as mid-level health providers (MLHP) at Sub-health Centres (SHC) to bridge the healthcare resource gap and serve as the primary point of contact for rural communities.MethodsThis qualitative cross-sectional study aimed to explore the CHOs experiences and performance at sub-health centre Health and Wellness Centres (SHC-HWCs) in India. CHOs and Medical Officers (MOs) from randomly selected SHC-HWCs and Primary Health Centre-Health and Wellness Centres (PHC-HWCs) across different geographic zones were interviewed. Semi-structured interviews were conducted with CHOs, MOs, and State Nodal Officers (SNOs) to gather information on drug provisioning, prescription practices, and perspectives on the roles and capacities of CHOs. The study is based on 40 in-depth interviews of health providers sampled at different levels of healthcare system in India.ResultsThe study revealed barriers and challenges faced by CHOs in meeting the expectations outlined in the Comprehensive Primary Health Care (CPHC) guidelines. These included a lack of agency, difficulties in team dynamics with existing healthcare professionals, and inadequate availability of medicines at sub-health centres. Due to the existing contradictions and prescription restrictions, CHOs found themselves failing to meet community expectations and foster trust.ConclusionCHOs encounter significant challenges in fulfilling their roles as mid-level health providers. Addressing these challenges is crucial for optimizing their effectiveness and strengthening the delivery of primary healthcare in rural areas. Clear protocols, supportive policies, and capacity-building initiatives are necessary to enhance the role and impact of CHOs in the healthcare system.

Doctors' understanding of their learning and learning needs in Kwazulu-Natal district hospitals.

Medicine is a self-regulating profession. Doctors must learn how to self-regulate to keep up-to-date with evolving health care needs. This is challenging for those working at District Hospitals (DHs) in rural settings, where limited resources and understaffing may compound a poor approach and understanding of how to become a self-directed learner. To explore perspectives of doctors working in rural DHs, regarding their understanding of learning and learning needs. This study was conducted in Bethesda and Mseleni DHs, in rural KwaZulu-Natal. This was a qualitative study. Data was collected through 16 semi-structured interviews and non-participatory observations. Four major themes emerged: "Why I learn," "What I need to learn," "How I learn," and our learning environment." This paper focussed on the first three themes. Doctors' learning is influenced by various factors, including their engagement with clinical practice, personal motivation, and their learning process. Deliberate practice and engagement in reflective practice as key principles for workplace learning became evident. In rural DHs, doctors need to take a proactive self-regulated approach to their learning due to difficulties they encounter. They must build competence, autonomy, a sense of connection in their learning process, thus recognizing the need for continuous learning, motivating themselves, and understanding where they lack knowledge, all essential for achieving success.Contribution:This article contributes towards strengthening medical education in African rural context, by empowering medical educators and facility managers to meet the learning needs of doctors, thus contributing to the provision of quality health care.

The transition of patient care: Exploring the outcomes of prehospital to hospital patient handover practices and healthcare provider education

IntroductionInadequate patient handover is linked to numerous medical errors and lapses in communication between hospital healthcare providers and prehospital healthcare providers. Undergraduate healthcare curricula may limit programme-specific education on patient handover and shift learning to informal learning opportunities. This study aimed to investigate the outcomes of qualified healthcare provider (HCPs) educational programmes to determine the adequacy of handover practices, the source of their training, and their interprofessional acceptance of these practices. MethodsA multi-method study design was used – a document analysis of HCP programme outcomes and a two-section questionnaire. The questionnaire was sent to HCPs to determine the impact of patient handover practices on current healthcare systems and their opinion on whether the training on handovers is sufficient. ResultsHCPs indicated little educational interaction regarding patient handover. Most participants felt handover education relied predominantly on informal training. With their existing knowledge, many HCPs revealed that they were comfortable in handing over a patient. Little interprofessional confidence regarding patient handover information indicates minimal interprofessional collaboration toward standardised approaches for patient handover. ConclusionThis study indicates a lack of standardised handover procedures, which leads to HCP self-interpretations. There is low trust between HCPs regarding information received. The study highlights the need for standardised handover training in healthcare curricula to improve patient safety and interprofessional collaboration.

Intercultural competence development: A qualitative case study

AimThe aim of this study was to explore Bachelor of Science in Nursing (BSN) students' perceptions of the effectiveness of a unique teaching-learning strategy using their results from the Intercultural Development Inventory (IDI), an instrument for the assessment of intercultural competence, with their customized Intercultural Development Plan (IDP) in enhancing their cultural competence development in a nursing senior practicum. The study also examined student insights about how having a plan to develop their intercultural competence will have an impact on their future nursing practice. BackgroundIntercultural competence is vital for providing quality healthcare, yet there is a gap in understanding how educational interventions are designed and implemented to enhance cultural competence among nursing students. This paper describes a strategy for developing intercultural competence. The IDI was administered to Bachelor of Science in Nursing (BSN) students in the fourth semester of a five-semester BSN program. Based on their IDI results, each student received a customized IDP that suggested specific activities and encouraged guided self-reflection to enhance intercultural competence development. In the fifth-semester senior practicum course, the students developed personal intercultural competence development goals based on their IDP. They also kept weekly journals on their intercultural competence development during their practicum. DesignThis study used a Qualitative Case Study design. MethodsThis study was conducted from January to July 2021 with 47 senior practicum students in a large BSN program in the Southeastern United States. Data consisted of student written responses to prompts on how the IDI/IDP influenced their intercultural development and its potential effect on their future practice. The data were analyzed through inductive content analysis. ResultsThree key themes emerged: self-awareness, recognition of cultural influences and growth goals. Student reflections suggested that they desired to develop intercultural competence so they could provide the best possible nursing care for their patients. Still, most students did not have a plan for how to grow in this area. Many students reported that their IDI/IDP heightened cultural awareness throughout their practicum, guiding their development of intercultural competence and leading to a deeper and broader understanding of culture. Students suggested that this enhanced cultural understanding, along with their IDP, will facilitate their continued development of intercultural competence in their future professional practice. ConclusionThis study contributes to existing knowledge about intercultural competence development and effective teaching methods by providing empirical evidence of the positive impact of the IDI/IDP on nursing students' perceived intercultural development. These findings can inform the development and implementation of pedagogical strategies to enhance intercultural competence, which will ultimately improve patient care outcomes in all healthcare settings.