Providing Patient Care Research Articles

Influence of process-focused patient care on clinical outcomes among hospitalized heart failure patients in the cardiology ward

Abstract Background The implementation of a process-oriented organizational structure in patient care allows for a comprehensive and optimized approach. In the context of heart failure (HF), it remains uncertain whether the establishment of a specialized hospitalisation team can contribute to improved major clinical outcomes. Purpose To analyse the rates of all-cause hospitalisation, cardiovascular hospitalization, HF hospitalization and overall mortality at 180 days among patients admitted to the Cardiology ward for HF, both prior to and after the implementation of a specialized HF hospitalisation team. Methods The study included all patients discharged from the Cardiology department with HF as the primary diagnosis and subsequent outpatient follow-up by the Community HF Unit in both 2019 and 2022. Clinical outcomes were compared between two distinct periods: the pre-implementation year of 2019 and the subsequent year of 2022, characterized by process-oriented HF care. Statistical analyses were performed using Kaplan-Meier and adjusted Cox proportional-hazards models. Results A total of 140 patients were enrolled in the study, comprising 55 individuals receiving care from a conventional ward team in 2019 and 85 under the specialized HF team in 2022. The mean age of the cohort was 69.4 years (+/-11.8), with a mean LVEF of 40.6%. The pre-implementation group showed a higher percentage of male patients (73% vs. 47%; p=0.003) and LVEF was lower in the HF team period (38.9% vs. 43.4%; p=0.045), with no statistically significant differences in other baseline variables. As shown in figure 1, over 180 days of follow-up, 15 patients (27.6%) were admitted to hospital in the conventional ward team period and 13 (15.3%) in the HF team period (hazard ratio [HR] 0.44; 95% confidence interval [CI] 0.19 to 0.99; P=0.047). Of these hospitalisations, 13 patients (23.6%) in pre-implementation period and 10 (11.8%) in post-implementation period were attributed to cardiovascular events (HR 0.40; 95% CI 0.16 to 0.99; P=0.049). Additionally, there was a reduction in the rate of heart failure admissions in the post-implementation period compared to the pre-implementation time (HR 0.30; 95% CI 0.09 to 0.94; P=0.039). Furthermore, a significant decline in all-cause of death was observed in patients treated by HF-team in 2022 compared to patients receiving care from the conventional ward team (log-rank test, p=0.015). Conclusions The implementation of a process-oriented organizational model within the Cardiology unit consisting in the provision of patient care by a team specialized in HF management, is associated with a statistically significant reduction in major clinical outcomes such as all-cause hospitalization, cardiovascular hospitalization and HF readmission, alongside a reduction in overall mortality rates at 180 days.

3D Remote Monitoring and Diagnosis during a Pandemic: Holoportation and Digital Twin Requirements

COVID-19 regulations presented clinicians with a new set of challenges that affected their ability to efficiently provide patient care and, as a result, telemedicine was rapidly adopted to deliver care remotely. However, these telemedicine platforms undermine patient care due to clinicians' inability to acquire all the relevant patient information required to diagnose and treat the patient. To explore this gap, we conducted a requirements analysis for the development of a 3D remote patient monitoring and diagnosis platform, by using a user-centric design methodology. In this requirements analysis, we elicited information about the clinical domain, identified clinicians’ requirements, elicited clinicians’ insights, and documented the clinicians' requirements. The outcome was the emergence of refined clinicians' requirements to guide the implementation of the Digital Twin concept paired with holoportation for remote 3D monitoring and diagnosis of patients. We anticipate that the application of a 3D telemedicine platform with these requirements for patient care during a pandemic could potentially enhance clinicians' efficiency and the effectiveness of remote patient care.

A survey of healthcare workers on the acceptance and value of personal protective equipment for patient care.

Assess healthcare workers' (HCW) attitudes toward universal masking, and gowns and gloves used as part of transmission-based precautions. Cross-sectional survey. Academic, tertiary care medical center in Baltimore, Maryland. HCW who work in patient care areas and have contact with patients. In May 2023, a 15-question web-based survey was distributed by the hospital's communications team via email. The survey contained questions to assess HCW perceptions of universal masking policies prior to the availability of COVID-19 vaccines and at the time of the survey, and the use of gowns and gloves for transmission-based precautions. Descriptive statistics were used to summarize data. Differences in agreement with universal masking over time, level of agreement with gown and glove policies, and with all PPE types across respondent characteristics were assessed. 257 eligible respondents completed the survey. Nurses and patient care technicians (43%) and providers (17%) were the most commonly reported roles. Agreement with universal mask use decreased from 84% early in the pandemic to 55% at the time of the survey. 70% and 72% of HCW agreed masks protect themselves and others, respectively. 63% expressed any level of annoyance with mask wearing, the most often due to communication challenges or physical discomfort. 75% agreed with gown use for antibiotic-resistant bacteria compared with 90% for glove use. The majority of HCW agree with the use of PPE to prevent pathogen transmission in the healthcare setting. Agreement with universal mask use for patient care shifted during the COVID-19 pandemic.

02 Youth perspectives on virtual healthcare appointments in Nova Scotia – a qualitative study

Abstract Background With the onset of the COVID-19 pandemic, public safety measures required healthcare providers to look for alternative ways of delivering care in a safe and timely fashion. This led to an escalated use of virtual appointments to continue to provide patient care. For future decision-making regarding virtual care in our community, we must consider the youth perspective to ensure our healthcare delivery meets the needs of this patient population. Objectives Our study aims to determine the perspectives of local youth patients on their experience with virtual and in-person paediatric clinic appointments. Design/Methods Participants were recruited from general and subspecialty paediatrics clinics at the IWK Health Centre, in Nova Scotia, Canada. Eligibility criteria included attending both a virtual and in-person appointment from 2019-2022. Participants completed a semi-structured interview and provided their perspective on comfort level, accessibility, participation, and general preferences between virtual and in-person clinics. Transcribed data was analyzed using thematic analysis with both inductive and deductive approaches to identify themes. Results 12 participants aged 14-18 provided interviews. Participants represented clinical areas of general paediatrics, rheumatology, diabetes clinic and gender clinic. Virtual appointments were preferred for convenience, flexibility, and efficiency during shorter conversations. In-person appointments were preferred for physical concerns, communication and relationship building. Some youth appreciated talking face-to-face for the ease of communication, feeling able to “get the point across” in this setting. The value of the in-person connection with their healthcare team was expressed by some youth, and building this relationship held importance. When appointments provided education, youth preferred for that information to be delivered in-person. Participants overall felt more comfortable during virtual appointments, and participation levels varied based on the individual and not based on an appointment being virtual versus in-person. Accessibility issues were predominantly associated with in-person appointments, with barriers including access to transportation, time spent attending appointment, and the cost of travelling to a tertiary care centre. Conclusion Youth patients have unique and individual preferences for virtual versus in-person appointments. This study provided insight into situations when each appointment type should be considered and emphasizes the importance of including the youth in the decision-making process around appointment scheduling when possible.

Coordination in Dynamic Teams: Investigating a Learning–Productivity Trade-Off

The rapid growth in the use of teams and multiple team membership has led more organizations to structure work around dynamic teams, characterized by short lifespans and fluid membership boundaries. This approach to organizing work makes it difficult for teams to work efficiently or to support the learning and growth of members. Given the importance of productivity and learning, we ask how these processes can be supported in dynamic teams. We do so in a randomized controlled field experiment conducted with 91 teams in a teaching hospital, a context in which physician trainees must learn while providing patient care in dynamic teams of care providers. We randomly assigned physician teams, or “core” teams, to launch their work with an intervention focused either on internal coordination among the core team members or on external coordination with a changing cast of external contributors such as nurses and specialists. We measured resulting levels of internal and external coordination over teams’ week-long lifespans and observed that external coordination was associated with improved team efficiency, whereas internal coordination was associated with improved individual learning. Post hoc exploratory analysis suggested that individual learning was highest when teams achieved high levels of both internal and external coordination, and it was positively correlated with improvement in the team’s patients’ average length of hospital stay. We discuss the implications of the demonstrated causal effects of team launches, along with our exploratory findings, for the management of dynamic teams and the opportunities to mitigate potential trade-offs between learning and productivity. Supplemental Material: The online appendix is available at https://doi.org/10.1287/orsc.2022.16729 .

Bereavement coping strategies among healthcare professionals: A qualitative systematic review and meta-synthesis.

Coping with a patient's death is one of the most challenging events faced by healthcare professionals in clinical practice. A broad understanding of the coping strategies used by healthcare professionals is fundamental to the development of effective interventions and the provision of good bereavement care. This review aims to systematically synthesize the coping experience of healthcare professionals in the course of their work when they are confronted with patient deaths. PubMed, Embase, ScienceDirect, CINAHL, PsycINFO, Web of Science, Cochrane Library, Scopus, and Wiley online library were searched in April 2023 with no restriction on publication date. A 3-stage thematic synthesis method was applied for data integration and analysis. Thirty studies involving 545 participants met the inclusion criteria and scored a high level on quality assessment ranging from 9.0 to 10.0. Six themes were identified: emotional coping, cognitive coping, behavioral coping, relational coping, spiritual coping, and occupational coping. Overall, the coping strategies used by healthcare professionals in response to bereavement were found to be unique and multidimensional. Understanding how healthcare practitioners use emotional, cognitive, behavioral, relational, spiritual, and professional strategies to cope with bereavement will prove extremely beneficial in helping them to manage their grief, and can furthermore promote their professional growth and ensure the provision of excellent bereavement care for patients.

Digital supervision in the clinical learning environment: Characterizing teamwork in the electronic health record.

Attending physicians in academic hospitals work in supervisory team structures with medical residents to provide patient care. How attendings utilize the electronic health record (EHR) to support learning through supervision is not well understood. To compare EHR behavior on teaching versus direct care, including evidence of supervisory calibration to learners. Cross-sectional study analysis of EHR metadata from 1721 shifts of hospital medicine faculty at a large, urban academic medical center, January to June 2022. Measures included total EHR time per shift, EHR time outside shift, and time spent on: note-writing, note review/attestation, order entry, and other clinical review. We assessed within physician differences across these service types and used multilevel modeling to determine whether these behaviors varied with resident physicians' experience, accounting for physician-specific signature behavior patterns. Attendings spent substantially less time in the EHR while on teaching service than on direct service (129 vs. 240 min; p < .001) and apportioned their work differently throughout the day. Physicians were less behaviorally consistent and varied more than their peers when on teaching service. Attendings calibrated their supervision to learners. Attendings logged 12.7% less EHR time when paired with more senior residents than postgraduate year 2 (PGY2) residents (137 vs. 120 min, p = .002). PGY1 presence was also associated with reduced EHR time, suggesting some delegation of supervision to senior trainees. EHR behaviors on teaching service are highly variable and differ substantially from direct care; a lack of consistency suggests important opportunities to establish best practices for EHR-based supervision and create an effective clinical learning environment.

Organizational Climate Related to Patient-Perpetrated Sexual Harassment: VA Primary Care Provider Perceptions.

Patient-perpetrated sexual harassment toward health care providers is common and adversely affects provider well-being, workforce outcomes, and patient care. Organizational climate for sexual harassment-shared perceptions about an organization's practices, policies, and procedures-is one of the strongest predictors of harassment prevalence. We conducted a pilot survey assessing provider perceptions of the Veterans Health Administration (VA)'s climate related to patient-perpetrated sexual harassment. Responding providers completed a survey assessing: (1) experiences with patient-perpetrated sexual harassment, (2) beliefs about VA's responses to patient-perpetrated sexual harassment of staff, and (3) perceptions of VA's organizational climate related to sexual harassment for each of 4 perpetrator-target pairings (patient-perpetrated harassment of staff, patient-perpetrated harassment of patients, staff-perpetrated harassment of staff, and staff-perpetrated harassment of patients). Respondents included 105 primary care providers (staff physicians, nurse practitioners, and physician assistants) at 15 facilities in the VA Women's Health Practice-Based Research Network. Seventy-one percent of responding providers reported experiencing patient-perpetrated sexual harassment in the past 6 months. Respondent perceptions of VA's responses to patient-perpetrated harassment of staff were mixed (eg, indicating that VA creates an environment where harassment is safe to discuss but that it fails to offer adequate guidance for responding to harassment). Respondents rated organizational climate related to patient-perpetrated harassment of staff as significantly more negative compared with climate related to other perpetrator-target pairings. Future work with representative samples is needed to corroborate these findings, which have potential ramifications for VA's ongoing efforts to create a safe, inclusive environment of care.

The positive impact of daily well-being practices on individual veterinary professionals' professional quality of life self-assessment scores within an emergency and specialty hospital.

Our study set out to identify the benefits for veterinary workers of structured daily well-being practices on compassion satisfaction, burnout, and secondary traumatic stress. Suggested origins of high rates of psychological stress and burnout are significant occupational concerns for veterinary workers. Many professional helpers experience an extreme state of tension and preoccupation from exposure to the suffering of those being helped. Veterinary workers are further impacted by negative associations and moral distress experienced due to limitations in the provision of quality medical care for veterinary patients. These negative experiences exist despite veterinary professionals' work being worthwhile and highly valued. A randomized controlled study was performed over 6 months. Volunteer participants were members of a team of veterinary workers at a 24-h emergency and specialty hospital. Study participants were asked to incorporate daily well-being practice(s) into existing routines whereas control participants were not. Measures of well-being and the negative impacts of serving as veterinary helpers were assessed by having participants complete the Professional Quality of Life (ProQOL) self-assessment at baseline and at 1, 3 and 6 months. Composite scores for compassion satisfaction, burnout and secondary traumatic stress were calculated. Baseline ProQOL scores were similar between study participants and controls. Baseline compassion satisfaction (CS), burnout scores (BS), and secondary traumatic stress (STS) scores for those instituting well-being practices were 37.6 (+/- 3.6), 26 (+/- 5.3), and 26.6 (+/- 5.2). Study participants had higher compassion satisfaction scores at 6 months with mean CS scores (n = 15) of 40.1 (+/- 6.8) and adjusted scores that were on average 3.0 (95% CI 0-6.1) higher than the control group (p = 0.048). Significant differences in BS or STS scores were not seen. Improvements were seen in CS but not BO/STS for those caregivers who implemented well-being practices into their daily routines. Factors that likely contributed to successful implementation of well-being practices include educational resources, supportive leadership, accessibility, and consistent acknowledgement and positive rewards. Proposed supportive elements and resources for maintenance of well-being practices within a team of veterinary workers include provision of a psychologically safe community and team support (including formal or informal "buddy systems").

European Nurses’ Burnout before and during the COVID-19 Pandemic and Its Impact on Patient Safety: A Scoping Review

Health systems around the world continue to experience healthcare workforce shortages, including shortages of nurses. This results in staff experiencing prolonged shifts and other stressors, which are linked to burnout, yet burned-out staff are then entrusted with the provision of patient care, despite healthcare facilities being regarded as safety-critical areas. It is assumed that the situation may have been worsened by the COVID-19 pandemic. This scoping review aims to identify the prevalence of burnout among nurses in Europe before and during the pandemic, the factors associated with this burnout, and its impact on patient safety. A literature search was conducted in the MEDLINE database; search terms included Nurse and Burnout and Patient Safety and their synonyms. The search limits used were English language, 2013 to 2023 publication years, original published research only (excluding review papers, dissertations, and unpublished reports), and studies conducted in European countries. A total of 16 papers were included for analysis: four indicated burnout levels of study participants, while 11 gave scores for individual burnout symptoms. Almost all studies indicated factors that were linked to burnout or individual dimensions of burnout. A few papers touched on the implications of these factors on patient safety. The review findings concluded that the few studies providing burnout levels on study participants could not give a clear picture of the burnout prevalence among nurses across Europe, either in general, before, or during the pandemic; therefore, this objective was not achieved and more research is required to establish this. Several factors thematically classified as sociodemographic, personal, organizational, and patient/client-related were linked to burnout. However, there were some contradictions in sociodemographic factors. Low personal accomplishment was the most common symptom of burnout before the pandemic, followed by emotional exhaustion and lastly depersonalization. Emotional exhaustion took the lead during the COVID-19 pandemic, followed by low personal accomplishment, and depersonalization remained the least common. More research is needed to establish the relationship between burnout and these factors.

Assessing traditional medicine in the treatment of neurological disorders in Mali: prelude to efficient collaboration

IntroductionNeurological disorders (ND) have a high incidence in sub-Saharan Africa (SSA). In this region, systemic challenges of conventional medicine (CM) and cultural beliefs have contributed to a large utilization of traditional medicine (TM). Yet, data on TM and those who use it in the treatment of ND in SSA are scarce. Here, we systematically analyze its role as a therapy modality for ND in Mali, the socio-demographic characteristics of its users, and propose next steps to optimize the dual usages of TM and CM for patients with ND.MethodsWe conducted a questionnaire study in two phases. In phase one, patients with ND answered questions on their usage of and attitudes towards TM. In phase two, the TM therapists who provided care to the patients in phase one answered questions regarding their own practices for treating ND. Patients were recruited from the country's two university neurology departments.Results3,534 of the 4,532 patients seen in the Departments of Neurology in 2019 met the inclusion criteria. Among these 3,534 patients, 2,430 (68.8%) had previously consulted TM for their present ND. Patients over 60 years of age most often used TM (83.1%). By education, illiterate patients utilized TM the most (85.5%) while those with more than a secondary education used TM the least (48.6%). An income greater than the minimum guaranteed salary was associated with decreased use of traditional medicine (OR 0.29, CI 0.25–0.35, p < 0.001). Among those using TM, it was overwhelmingly thought to be more effective than CM (84.6%). Linking illness to supernatural causes and believing TM therapists had a better understanding of illnesses were the most common reasons patients used traditional medicine (82.3% and 80.5%, respectively).We then interviewed 171 TM therapists who had provided care to the patients in phase one. These providers most commonly “sometimes” (62.6%) referred patients to CM and 4.1% never had. A majority of TM providers (62.6%) believed collaboration with CM could be improved by having doctor “take into account” our existence.ConclusionOur work shows that TM plays a central role in the provision of care for patients with ND in SSA with certain cohorts using it at higher rates. Future development of treatment of ND in SSA will require optimizing TM with CM and needs buy-in from all stakeholders including conventional medicine clinicians, traditional medicine therapists, researchers, politicians, and most importantly, patients.

Experiences of nurses working in novel virtual care centres in the Netherlands: a qualitative study

BackgroundVirtual care centres (VCCs) are novel wards of hospitals and facilitate the provision of remote monitoring and home-based patient care. Whereas since the COVID-19 pandemic VCCs have rapidly emerged, there is no standardised framework for the development and implementation of VCCs. To develop such a framework, insight in current experiences of employment in VCCs is needed. Therefore, the aim of this study was to explore nurses' perceptions and experiences of working in VCCs.ResultsBetween February and July 2023, semi-structured online interviews were conducted with thirteen nurses (age 45 ± 8 years) from four VCCs in the Netherlands. Interviews were thematically analysed using a six-stage approach, yielding six themes of nurses’ perceptions and experiences of working in VCCs: 1)' Changing role of nurses', especially in the patient-professional relationship, transformation of care and communication; 2)’Clinical perspective of nurses’, need for general medical knowledge and use of data in relation to nurses’ clinical perspective, 3)‘Education and training’, need to keep nurses’ knowledge up-to-date and create time for education; 4)'Organisation of care', nurses’ role in the development of protocols and need for sufficient technological preconditions; 5)‘Cooperation with other healthcare professionals’, consisted of the collaboration with and needed support by other healthcare professionals to organize and provide care to VCC patients; 6)'Experienced effects of VCCs' included advantages and disadvantages of VCCs for the nurses, patients and the hospital. Themes were mapped onto the Capability, Opportunity and Motivation of Behaviour (COM-B) model where all themes included components of capability, opportunity and motivation.ConclusionsOur findings highlight the importance of considering COM-B components of nurses' work in VCCs. Due to the changing roles of nurses in VCCs, there are evolving educational needs in to communicate with patients and colleagues, and the use of data to support their clinical view, as well as providing technological optimisations to further support nurses' work and the VCCs.

Experiences of people with unexplained hearing concerns seeking hearing healthcare in the United States.

Up to 10% of adults seeking hearing healthcare for significant hearing concerns have diagnostic test results that indicate normal hearing. Knowledge of the interactions between patients with unexplained hearing concerns and hearing healthcare providers is minimal. In this study, we explored what themes emerged when individuals with unexplained hearing concerns discuss their experiences seeking hearing healthcare. We employed a prospective, cross-sectional qualitative design with semi-structured interviews. Fifteen adults who had sought professional hearing evaluations in the United States due to hearing concerns but had audiological testing that indicated hearing within normal limits, and no other medical explanation for their hearing concerns participated in the study. Saturation of themes was reached by Interview #2, suggesting sufficient sampling. Thematic analysis revealed 3 themes from the interviews: (1) dismissive healthcare providers, (2) misalignment of patient concerns and assessment protocols, and (3) doctor shopping. These findings highlight the need for improved care for patients with unexplained hearing concerns. Clinicians could help improve care provision for patients with unexplained hearing concerns, despite a lack of professional guidance on diagnostic tests or treatment recommendations, by soliciting, listening to, and trusting patient experiences as they seek support for their hearing concerns.

Experiences of genetic counselors practicing in multiple languages: Progress and places for improvement.

As awareness of the value of genetic counseling services increases, there has been greater recognition of the need to diversify service delivery into different languages. Studies within genetic counseling and related fields have identified complications that can arise from language nonconcordance between provider and patient. A strategy to mitigate language barriers is prioritizing the development of a multilingual workforce of genetic counselors (GCs) who can communicate with patients in their preferred language. This exploratory study assessed the experiences of multilingual GCs who have practiced in a clinical role with the aim to identify relevant challenges and differences when counseling in their nondominant language. Statistical analysis was performed to identify differences in session tasks and emotions experienced when counseling in one's nondominant language versus their dominant language. Data analysis identified an increase in reported difficulty level for most clinical tasks while using a nondominant language, most notably for difficulty with psychosocial counseling, disclosing results, and administrative tasks. Participants were also surveyed on employer support and resources provided. Overall, results suggest that multilingual GCs may benefit from greater support in certain areas within clinical roles to enhance their ability to provide patient care in their nondominant language.

Effect of acupressure on anxiety among cancer patients undergoing chemotherapy: A systematic review

This systematic review was conducted to investigate the impact of acupressure on anxiety levels among cancer patients undergoing chemotherapy. Comprehensive searches were performed in international electronic databases including Scopus, PubMed, and Web of Science, as well as Iranian databases such as Iranmedex, from inception to February 1, 2024, utilizing keywords derived from Medical Subject Headings such as "acupressure", "anxiety", and "chemotherapy". The methodological quality of randomized controlled trials (RCTs) and quasi-experimental studies was assessed using the Joanna Briggs Institute's critical appraisal checklist. A total of five studies, encompassing 401 cancer patients undergoing chemotherapy, were included in the review. Among these patients, 83.26% were female, with 54.36% assigned to the intervention group. The mean age of participants was 51.01 (SD=8.52) years. Of the included studies, three were RCTs and two were quasi-experimental studies. The average study duration and follow-up period were approximately 31 weeks and 35 days, respectively. Moreover, the average duration of the intervention was 18 minutes. Across all studies, acupressure interventions demonstrated efficacy in reducing anxiety levels among cancer patients undergoing chemotherapy. The findings suggest that healthcare professionals, particularly nurses, can effectively utilize acupressure techniques to alleviate anxiety in this patient population. It is recommended that healthcare managers and policymakers facilitate the integration of acupressure interventions into hospital settings, thereby enhancing the provision of care and support for cancer patients undergoing chemotherapy.

Moderating role of relationships between workloads, job burnout, turnover intention, and healthcare quality among nurses

BackgroundIn Jordan, nurses consider a primary providers of direct patient care, and play a multifaceted role in ensuring healthcare quality. The study aimed to examines the moderating effect of job satisfaction in the relationship between workload and healthcare quality, job burnout and healthcare quality, and turnover intention and healthcare quality.MethodsA cross-sectional research approach was adopted among 311 from Registered Nurses (RN) across Jordanian hospitals. Job satisfaction, workload scale and job burnout scale were shared between March and April 2023.ResultsThe overall findings indicate that workload, job burnout, and turnover intention are negatively and significantly related to healthcare quality, and that job satisfaction moderates the relationship between workload and healthcare quality, job burnout and healthcare quality, and turnover intention and healthcare quality. These findings have broad implications for healthcare organizations, emphasizing the pivotal role of job satisfaction in mitigating the negative effects of workload, burnout, and turnover intentions among nurses.ConsulsionStrategies to enhance job satisfaction, such as reducing work-related stress and fostering supportive work environments, should be prioritized by healthcare policymakers and institutions to ensure the delivery of high-quality patient care.

Understanding patient and health care provider perceptions of barriers and facilitators to diabetes care in immigrant and refugee populations

BackgroundThere is a lack of literature which assesses both patient and health care provider (HCP) perceptions of barriers and facilitators to diabetes health care in immigrant and refugee populations within the United States. This study uniquely incorporates both cohorts’ perceptions on the same topic to assess for congruency and discrepancies in perspectives.MethodsSurveys were deployed to patients with diabetes and HCPs to solicit perceptions of barriers and facilitators to diabetes care, with the intention to determine similarities and differences between cohorts. A literature review was conducted to explore barriers and facilitators to diabetes care in immigrant/refugee populations in the US to aid in development of the survey used in this study, as no validated survey existed. Broad recruitment strategies were used, including snowball sampling. Descriptive statistics were calculated and reported p-values were derived from a chi-squared or Fisher’s exact test and used for categorical data and a Wilcoxon rank sum or Kruskal–Wallis rank sum test was used for continuous data. Qualitive analysis was completed using the inductive analysis method.ResultsAmong 19 immigrant and refugee patients and 35 HCPs, almost all facilitators to diabetes care were endorsed by patients and HCPs as helpful. The highest ranked facilitator among patients and HCPs was having access to health insurance. Patients rated stress, while HCPs rated lack of health insurance as the biggest barriers to diabetes care for immigrants and refugees. Patients and HCPs differed in perspective on who held primary responsibility for diabetes management. Patients wanted more diabetes education and nutrition support, while HCPs thought understanding patients’ cultural context/sensitivity, providing more education, and having language/translation services were the most important things HCPs can do to care for patients’ diabetes.ConclusionsImmigrant/refugee patients and HCPs largely agree about what factors are most helpful in managing diabetes, with access to health insurance as the greatest facilitator. However, while HCPs identified lack of health insurance as the greatest barrier to care, immigrant and refugee patients cited the role of stress as the greatest challenge in managing their diabetes. There was a striking difference in perception of responsibility for diabetes management, with 89% of patient participants responding that the patient is responsible, while only 17% of HCPs responded that the patient was responsible. Future work should include surveys translated into languages other than English to further elicit the perspective of diabetes care in immigrant/refugee populations. Clinical recommendations based on this study include assessing and supporting patient stressors, assuring patients understand that diabetes management is a partnership, providing culturally tailored diabetes education, and increasing access to health insurance.

Presenteeism and missed nursing care: a descriptive, correlational and observational study

BackgroundMissed nursing care poses a significant challenge for healthcare staff in terms of patient safety and care quality.ObjectiveTo evaluate presenteeism and missed care attitudes of nurses and to determine the correlation between presenteeism and missed care.MethodsThis descriptive, correlational, and observational study was conducted between February and August 2023. The Stanford Presenteeism Scale-Short Form and the MISSCARE Survey were used to collect the data among nurses at two public hospitals in a city in Turkey. The study was completed with 229 nurses representing 27.4% of the total number of nurses who met the inclusion criteria. The data was analyzed using a comprehensive analytical approach, including Cronbach’s alpha analysis, frequency and percentage distribution, the Shapiro–Wilk test of normality, correlation coefficient analysis, Pearson correlation coefficient, and the Bonferroni test.ResultsThe participants’ mean age was 30.22 ± 7.14 years, and 74.2% of them were female. 53.3% of the participants reported difficulty providing patient care due to material shortages, and 62.9% experienced challenges delivering care due to the intensity of paperwork in the clinic. Nurses who felt that paperwork intensity affected patient care and were not confident in their care provision had higher levels of presenteeism (p = 0.041) and a significantly higher frequency of missed care instances (p < 0.001).ConclusionsMaterial shortages and high paperwork intensity are contributing factors to the difficulties experienced by nurses in their practice. These difficulties may lead to an increase in presenteeism and instances of missed nursing care. It is important to address these challenges to ensure adequate care provision and reduce the likelihood of presenteeism among nurses. The correlation between presenteeism and instances of missed nursing care highlights the impact of presenteeism behaviors on the quality of patient care.

Perceived Needs, Barriers, and Challenges to Continuing Professional Development (CPD): A Qualitative Exploration among Hospital Pharmacists.

Continuing professional development (CPD) is an essential tool for healthcare professionals to remain up-to-date with the latest advancements in their field. In Saudi Arabia, pharmacists are officially registered healthcare professionals by the Saudi Commission for Health Specialties (SCFHS). To uphold their licensure, they must complete 40 h of CPD every two years. This qualitative study aimed to explore hospital pharmacists' perceptions, barriers, and challenges of CPD, as well as their recommendations for improving CPD activities. A qualitative descriptive approach with semi-structured face-to-face interviews was employed. Using purposive sampling, 12 hospital pharmacists were interviewed. The recorded data were transcribed and analyzed using thematic analysis. Pharmacists generally showed positive perceptions of CPD, recognizing its importance for their professional development and the provision of high-quality patient care. However, some pharmacists expressed dissatisfaction with the current system. Several barriers to participation such as heavy workloads, lack of time, and limited financial support were highlighted. The primary motivations for engaging in CPD included fulfilling regulatory requirements. Workshops were the most beneficial CPD activities among others. Additionally, importance of more specialized, practice-oriented programs was highlighted. The study provides valuable insights into the needs and challenges faced by hospital pharmacists in Saudi Arabia regarding CPD. The insights gained can inform theory, policy, and practice relating to pharmacists' CPD at both professional and governmental levels.

Information behaviours of people with type 2 diabetes in Kuwait: a grounded theory study

BackgroundRelative to country-specific epidemiological trends, Kuwait experiences a far greater burden of type 2 diabetes among its population. Information behaviours form a significant component of self-care management for patients diagnosed with type 2 diabetes, however this remains an understudied aspect of disease management. This study aims to investigate the information behaviours of patients with type 2 diabetes in Kuwait, and characterise the methods employed to manage their disease.MethodsThis qualitative study employed a grounded theory method. Semi-structured interviews were conducted with twenty-seven participants over three phases of data collection in primary, secondary and tertiary healthcare settings across Kuwait. These were complemented by in-depth interviews to detail the information behaviours of these participants. The interviews were translated where appropriate, transcripts, and analysed through qualitative coding to synthesise the information behaviour patterns.ResultsThe findings demonstrated that living with type 2 diabetes involved a range of developmental and transformative stages, including changes to the patients’ emotional state, reconstruction of their lifestyle and identity, and changes in the ways they find and use information. Living with the chronic condition was viewed as a dynamic and transitional process, where patients’ information behaviours continually changed throughout the process across various identifiable stages. This dynamic pattern was reflected most prominently across the participants’ behavioural needs, sources and information-seeking patterns.ConclusionPatients with type 2 diabetes continuously adapted their information behaviours to optimise the self-management of their condition across a relatively predictable pattern. Greater understanding of these behaviours across a wider population would improve the provision of clinical care for patients with diabetes.