Overall Quality Of Care Research Articles

AI’s pivotal impact on redefining stakeholder roles and their interactions in medical education and health care

Artificial Intelligence (AI) has the potential to revolutionize medical training, diagnostics, treatment planning, and healthcare delivery while also bringing challenges such as data privacy, the risk of technological overreliance, and the preservation of critical thinking. This manuscript explores the impact of AI and Machine Learning (ML) on healthcare interactions, focusing on faculty, students, clinicians, and patients. AI and ML's early inclusion in the medical curriculum will support student-centered learning; however, all stakeholders will require specialized training to bridge the gap between medical practice and technological innovation. This underscores the importance of education in the ethical and responsible use of AI and emphasizing collaboration to maximize its benefits. This manuscript calls for a re-evaluation of interpersonal relationships within healthcare to improve the overall quality of care and safeguard the welfare of all stakeholders by leveraging AI's strengths and managing its risks.

Patient Safety Culture Among Nurses: Comparison Between Public and Private Hospital in Indonesia

Aims: This study aimed to describe the patient safety culture among nurses working in both public and private hospitals in Karawang, Indonesia. By examining the perceptions and practices of nurses regarding patient safety, the research sought to identify strengths and areas for improvement within the healthcare system. The findings are intended to inform strategies for enhancing patient safety practices, thereby contributing to better healthcare outcomes for patients in the region. Methods This study employed a cross-sectional methodology to investigate the patient safety culture in the intensive care units of two private and two public hospitals in Karawang, Indonesia. The researchers utilized the Hospital Survey on Patient Safety Culture (HSPSC) to gather data on nurses' perceptions and practices regarding patient safety. To analyze the data and identify any significant differences in patient safety cultural practices between the various hospital groups, both chi-square tests and independent t-tests were conducted. This approach allowed for a comprehensive assessment of the patient safety culture within the selected hospitals, facilitating comparisons between public and private healthcare settings. Results The study included a total of 118 nurses, with 52 working in a public hospital and 66 in a private hospital. The average age of nurses in the public hospital was 36.11 years (SD: 4.78), while those in the private hospital had a lower average age of 32.45 years (SD: 3.67). The results indicated a significant difference in the scores related to patient safety culture between the two groups of nurses. Specifically, nurses in the private hospital reported a higher patient safety culture compared to their counterparts in the public hospital, highlighting the disparities in perceptions and practices regarding patient safety in these different healthcare settings. Conclusion Nurses employed in private hospitals reported a higher level of patient safety culture compared to those working in public hospitals. This finding underscores the importance of creating a comfortable work environment in healthcare settings, as it is essential for minimizing the risk of patient safety incidents. By fostering a supportive and safe atmosphere, healthcare facilities can enhance the overall quality of care provided to patients and promote better outcomes in both private and public hospitals.

Report of cardiac electronic device implant complications over a 7-year study period

Abstract Background The global placement of cardiac implantable electronic devices (CIEDs) is on the rise. Complications linked to device implantation present a substantial burden on healthcare systems and patients alike. It is imperative to comprehend the complication rates associated with CIED procedures, enabling informed decision-making and strategic planning for patients, thereby enhancing the overall quality of care. Purpose We sought to determine post CIED implantation complication rates and provide operator specific complication data for quality assurance at our institution. Methods A comprehensive audit of all procedures completed between April 2016 to March 2023 by 14 high volume operators at a single academic center was completed. Complications and device data were extracted using electronic medical records. Complications evaluated include pneumothorax, infections, hematomas, venous thrombosis, lead perforation, and dislodgement using standardized definitions. Results During the 7-year period, a total of 9,467 procedures were completed. Among the cohort, 62% were male, with an average age of 74.6 ± 15.2 years. The procedural breakdown comprised 60% pacemakers, 19% ICDs, 16% CRTs and 3% ILRs. A total of 11,616 leads were implanted (3,644 RA leads and 1,110 LV leads). The overall complication rate was 3.1% (n=316): device pocket infection 0.68%, superficial infection 0.19%, lead dislodgement 0.53%, lead perforation 0.24%, pericardial effusion 0.1%, pneumothorax 0.15%, pocket hematoma 0.83%, DVT 0.36%, and hemothorax 0.02%. Complication rates per operator are shown in Figure-1. Conclusion Our findings indicate that the overall complication rates for CIED implants are lower than previously reported rates, and there is no significant difference between operators in overall rates of complication. This observation can be attributed to operator experience, advancements in peri-operative care and guideline-directed post-operative protocols. However, notable variations exist among operators in rates of pocket infection. The ongoing monitoring of CIED complications as a quality indicator remains a crucial benchmark, meriting annual assessments for ongoing evaluation.

Current Status of Nursing Home Distribution in China: ANational Cross-Sectional Study.

Population aging is a challenge that the whole world is facing, especially in China. This study aims to investigate the current distribution status of nursing homes in China using spatial epidemiology methods. Cross-sectional study in China. The data were obtained from the Integrated Civil Affairs Government Service Platform 'China County Statistical Yearbook' for 2020 and the 'China City Statistical Yearbook' for 2020. Using global Moran's index to test the clustering of nursing homes, inter-group and intra-group Theil index was utilised to differentiate the sources of differences. The coupling coordination analysis was conducted to explore the coordination. Geographically weighted regression was utilised to investigate the impact of economic development and aging on nursing home resources. All analyses were conducted by Arcgis 10.8 and R Studio 4.3.2. Global Moran's index indicated that the distribution of nursing homes in China exhibited clustering. The Theil index values for institutions and beds at the national county were 0.32450 and 0.30675. However, upon comparing provinces and regions, it was found that the differences across the country mainly stem from within provinces (contribution rate: institutions 65.0%; beds 73.0%) and within regions (contribution rate: institutions 99.0%; beds 91.0%). The majority of districts and counties had a coupling coordination index of institutions and bed numbers, both of which were < 0.5. The development of nursing home resources in China has been rapid, generally presenting a balanced state, but further optimisation is needed. This study established a foundation for the targeted distribution of essential public services, focusing on nursing home healthcare resources tailored to the needs of older persons. The study underscored the urgent need for targeted elderly care policies, emphasising the optimisation of resource distribution to enhance the overall quality of care provided to the aging population. The study did not involve humans.

Exploring barriers to and facilitators of infection prevention and control practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital, Ethiopia

BackgroundAdherence to infection prevention and control (IPC) standards and guidelines by healthcare workers is essential for reducing the spread of healthcare-associated infections (HAIs). However, IPC practices among healthcare workers in low- and middle-income countries (LMICs), including Ethiopia, are generally inadequate. This research aims to identify the barriers to and facilitators of IPC practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital (TASH) in Ethiopia.MethodsWe employed a rapid ethnographic assessment (REA) approach for this study, using focus group discussions (FGDs), in-depth interviews (IDIs), and observations to collect data. Participants were selected from the Pediatrics and Child Health Department of TASH, and data collection took place in March and April 2022. Two FGDs and eight IDIs were conducted in the participants’ workplace within the department. Unstructured guides were used to facilitate the FGDs and IDIs. Nvivo version 10 software was used for data organization and analysis. The data were coded deductively through thematic analysis to identify similar ideas and concepts, based on the Systems Engineering Initiative for Patient Safety (SEIPS) model.ResultA total of 23 healthcare workers participated, with 15 in FGDs and 8 in IDIs. The study identified several barriers to IPC practices, including nonadherence to IPC practice protocols, lack of pre-employment training, space constraints, insufficient maintenance and repair of equipment, limited management engagement and support, shortage of resources and budget, incidents of needle stick injuries and infections, high workloads for healthcare workers, shortages of personal protective equipment and water supply, and inadequate waste management. We also identified some facilitators, including the existence of an IPC team and committee, a health education schedule for patients and visitors, morning sessions for healthcare providers, and the presence of television screens in waiting areas. By addressing the identified barriers and leveraging the facilitators, department heads, IPC team leaders, and decision-makers can develop targeted strategies and interventions to improve infection control, reduce the spread of HAIs, and ultimately enhance the quality of healthcare services.ConclusionThis study explored several barriers that contribute to inappropriate and suboptimal IPC practices in the study area. These barriers create significant challenges for healthcare workers and hindering their ability to effectively implement IPC practices. The findings highlight the complex and multifaceted nature of the problems, which not only affect the current working environment but also compromise the overall quality of care. The hospital administrator should address these critical issues to improving IPC practices and ensuring a safer healthcare environment.

Implementing a multidisciplinary approach for older adults with multiple sclerosis: Geriatric neurology in practice

BackgroundOlder adults with multiple sclerosis (MS) face unique challenges arising from age-related changes in MS pathophysiology and overlapping geriatric syndromes. There is a need for geriatrics-focused multidisciplinary care for the rapidly growing older MS population. ObjectiveTo design and implement a geriatric multidisciplinary clinic for older adults with MS. MethodsWe describe the development of a multidisciplinary approach to geriatric MS care within a single institution through the implementation of the Aging with MS Clinic. The clinic model was conceived through collaboration between neurology and geriatric medicine to provide comprehensive care for older adults with MS who are uniquely affected by overlapping symptoms of aging and MS (e.g., frailty, falls, functional decline, multiple comorbidities, polypharmacy, cognitive impairment, nutritional deficits, barriers to access healthcare). Multidisciplinary specialists were recruited to staff the clinic, and initial patient satisfaction outcomes were collected. ResultsThe team of multidisciplinary specialists staffing the clinic consists of a MS advanced practice practitioner, MS pharmacist, physical therapist, neuropsychologist, dietitian, and social worker. A clinic template was devised where 4 patients with MS over age 60 are seen by each specialist during each half-day clinic session. Initial patient satisfaction surveys from 25 participants showed overwhelmingly positive feedback. A majority of participants (92%) agreed that the clinic was well-organized, while 92% felt they benefitted from attending. Additionally, 80% of participants reported that the clinic improved their overall quality of care. ConclusionThe Aging with MS clinic outlines a model for comprehensive geriatric assessment and care in older adults with MS by a team of multidisciplinary specialists. Initial feedback from patients who attended the clinic conveyed improved quality of care.

Artificial intelligence in action: Improving breast disease management through surgical robotics and remote monitoring

ObjectivesThis article aims to discuss the transformative impact of artificial intelligence (AI) on the identification and management of breast diseases, with a specific focus on breast cancer. Materials and methodsHealthcare providers have integrated AI technologies such as surgical robots and remote monitoring systems to improve the accuracy and efficiency of breast disease diagnosis and treatment. ResultsSurgical robots equipped with AI algorithms provide real-time guidance to surgeons, analyze imaging data, and ensure precise procedures for better outcomes in breast cancer surgeries. AI-driven remote monitoring systems allow for close monitoring of patient health data, disease progression prediction, and personalized treatment recommendations. ConclusionsThe incorporation of AI technology into healthcare practices for breast diseases has revolutionized patient care delivery, enhancing outcomes, promoting patient engagement, and improving overall quality of care. These advancements offer personalized and tailored healthcare strategies that meet the unique needs of each patient, reshaping the healthcare industry.

Evaluating Short-Term Patient-Reported Outcome Measures Following Total Hip and Knee Replacement: A Comprehensive Review.

Total hip replacement (THR) and total knee replacement (TKR) are widely performed surgical procedures to alleviate pain and improve function in patients with joint-related diseases. Short-term patient-reported outcome measures (PROMs) have become a key metric in assessing the success of these surgeries from the patient's perspective, focusing on early recovery, pain management, mobility, and quality of life. This comprehensive review evaluates the significance of short-term PROMs following THR and TKR, highlighting commonly used tools such as the Oxford Hip Score (OHS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and short-form health survey (SF-36). The analysis explores the impact of various factors, such as age, preoperative health status, and surgical technique, on short-term outcomes. Findings from recent studies indicate that while patients generally report improvements in physical function and pain relief within the first six months post-surgery, individual outcomes can vary significantly. Factors like early rehabilitation, mental health, and the presence of postoperative complications can influence the trajectory of recovery and satisfaction levels. Moreover, the review addresses the limitations of current PROMs, including variability in reporting and sensitivity to different patient populations. This review emphasizes the need for more personalized and standardized approaches to PROM assessment to better capture patient experiences and optimize postoperative care. Future research should focus on integrating PROMs with long-term follow-up data and digital health tools to track real-time patient progress, thus enhancing the overall quality of care for THR and TKR patients. Short-term PROMs play a vital role in understanding patient outcomes and guiding clinical practice for joint replacement surgeries.

Motivations and Impact of Training of Home Care Workers for Older Adults in Nigeria

Background: The aging population in Nigeria presents a significant challenge to the healthcare system, particularly in providing adequate home care. This study addresses the urgent need for well-trained home care workers as traditional family-based care models become increasingly unsustainable due to urbanization and economic pressures. Objectives: The study explored the motivations and impacts of a two-week training program for home care workers, aimed at equipping participants with essential skills for caring for older adults in Nigeria. Methods: Using a descriptive qualitative approach, including semi-structured interviews with 20 participants, this study investigates the motivations for joining the training program and its impact on professional development and competency in elder care. Results: The findings reveal diverse motivations for participation, including aspirations for career advancement, personal growth, and a strong commitment to providing quality care. The training program significantly enhanced participants' skills, knowledge, and confidence, enabling them to manage complex caregiving situations more effectively and improve the overall quality of care. Conclusions: This research highlights the critical role of specialized training in improving the quality of life for older adults in Nigeria. It emphasizes the need for policy interventions to standardize training for home care workers, ensuring consistent quality of care for Nigeria's aging population and recognizing the profession's essential contribution to the healthcare system.

Bottleneck factors impacting nurses’ workflow and the opportunity to prioritize improvement efforts: factor analysis

PurposeMinimizing delays in delivering nursing care is paramount for enhancing the overall quality of care. Certain bottleneck variables restrict the workflow of nurses, resulting in extended shift times. This study is designed to pinpoint and analyze the principal factors contributing to bottleneck issues in nursing workflow, to direct improvement endeavors. This study seeks to provide insights into the key variables contributing to nurses’ extended shift times, with the ultimate goal of prioritizing efforts for improvement.MethodsA descriptive multicenter cross-sectional study was conducted. A scale was developed for this study by the authors after conducting a literature review, subsequently validated, and its reliability was assessed.ResultsAmong the 31 bottleneck variables, 29 were retained under three persistent bottleneck factors: (1) Nurse staffing— This pertains to the availability of sufficient nursing staff at all times across the continuum of care; (2) Working environment and quality of care—This refers to the availability of necessary skills and resources for nurses to perform their duties effectively and; (3) Medical devices— This factor concerns the availability of fully functional medical devices required for providing care.ConclusionEfforts aimed at enhancing the overall healthcare system should concentrate on addressing persistent bottleneck factors. This may involve the implementation of a healthcare workforce management system, the establishment of standards for a conducive and supportive working environment, and the utilization of a standardized system for the management of medical equipment. The outcomes of this study can be utilized by nurses and policymakers to devise comprehensive strategies for improvement.

EP442 - An Audit on the Application of Enhanced Recovery Post Emergency Laparotomy

Abstract Aim This audit aims to evaluate the efficiency of NG tube and catheter removal post emergency laparotomies, assess the occurrence of postoperative complications, and analyse hospital practices related to enhanced recovery in the context of emergency laparotomies. Methods Data was collected retrospectively from [Hospital Name] for a specified time period, including patient demographics, surgical details, time to NG tube and catheter removal, postoperative complications, and adherence to enhanced recovery protocols. The audit included a thorough review of medical records, nursing notes, and relevant documentation. Results Preliminary findings indicate variations in the time taken for NG tube and catheter removal across emergency laparotomy cases. The occurrence of postoperative complications, such as infections, delayed recovery, and prolonged hospital stays, was also assessed. Furthermore, an analysis of hospital practices, including the implementation of enhanced recovery protocols, was conducted. Conclusion The results of this audit will contribute valuable insights into the effectiveness of current practices related to NG tube and catheter management post emergency laparotomies. The findings may highlight areas for improvement in enhancing recovery, optimising patient outcomes, and minimising complications. Recommendations for refining hospital protocols and promoting timely interventions will be proposed based on the audit results, with the ultimate goal of improving the overall quality of care for patients undergoing emergency laparotomies.

Factors Influencing the Willingness of Clinical Nurses to Participate in Narrative Nursing: A Cross-Sectional Study.

Narrative nursing (NN) is a crucial component of modern medical humanistic care. It involves utilising storytelling as a means to guide nurses in devising future interventions for patients, and help patients in reconstructing positive psychological defences. The willingness of clinical nurses to engage in narrative nursing holds significant implications for both effective communication and the overall quality of care. However, there is limited knowledge regarding clinical nurses' willingness to engage in narrative nursing. This study aims to investigate the participation willingness of Chinese nurses, identify its predictors and explore its corresponding reasons. A cross-sectional study. Clinical nurses were enrolled in Hunan province, Central South, China, and a convenience sampling strategy was used. A structured questionnaire was distributed to clinical nurses by an online survey platform. Information on sociodemographic characteristics, willingness and possible influencing factors (experience, ability, perceptions on narrative nursing) was collected. Binary logistic regression was conducted to identify the predictors of willingness to participate in narrative nursing. A total of 2310 nurses were recruited, of which 2092 nurses completed the questionnaire (response rate: 90.6%). One thousand seven hundred and thirty-four nurses (82.9%) were willing to participate in NN, and 358 (17.1%) were not. Binary logistic regression analysis identified nine predictors of participants' willingness to participate, including working departments, professional title, working position, experience of received mobilisation and training of NN, understanding of related knowledge, NCS level, affirmation of NN and positive attitude towards clinical application (all p values < 0.05). These indicators explained 17.1% of the variances in the dependent variable (p < 0.001). A high proportion of nurses in Hunan province were willing to practice in clinic using NN. Willingness to participate may be increased by a focus on nurses with low professional titles, no administrative position and working in specialised departments, such as emergency departments, infectious departments, critical care units and operating theatres. The study identified a high proportion of nurses in Hunan Province who were willing to use NN. However, the figure was slightly lower than expected. Influencing factors were analysed to give insights for managers to develop more effective NN outreach programs. No patient or public contribution.

Age and expertise: The effects of ageism on professional recognition for senior nurses

This study explores the dual challenges of ageism and professional recognition faced by senior nurses in healthcare settings. Utilizing a phenomenological approach, we conducted semi-structured interviews with 20 registered nurses aged 50 and older in Abha City, Saudi Arabia. The analysis revealed four key themes: experiences of ageism, its impact on professional roles, discrimination and stigmatization, and the need for organizational support. Findings indicate that age-related biases lead to significant professional marginalization, reduced job satisfaction, and emotional distress among senior nurses. The study highlights the critical need for comprehensive policies, organizational support, and cultural changes to address ageism and recognize the valuable contributions of senior nurses. Promoting an inclusive work environment and equitable professional development opportunities can enhance the overall quality of care and job satisfaction for older nurses.

Enhancing Patient-Centered Care in Nigeria: Challenges, Opportunities, and Future Directions

Patient-Centered Care (PCC) is a healthcare approach that prioritizes the needs, preferences, and values of patients, aiming to enhance the overall quality of care by actively involving patients in their healthcare decisions. In Nigeria, the implementation of PCC faces significant challenges due to socioeconomic disparities, cultural influences, resource limitations, and infrastructural constraints. Despite these obstacles, there are substantial opportunities to improve Nigeria’s healthcare system through the integration of PCC principles. This review provides a comprehensive analysis of the current state of PCC in Nigeria, examining the healthcare system’s structure, successful PCC models, and the barriers hindering its widespread adoption. The review also explores strategies for enhancing PCC, including community engagement, technological innovations, and collaborative care models, and highlights the impact of PCC on health outcomes, such as improved patient satisfaction and cost-effectiveness. Additionally, the review discusses the critical role of policy and governance in promoting PCC, offering insights from international experiences and presenting case studies that illustrate the successes and challenges of implementing PCC in Nigeria. By addressing these key aspects, the review outlines a roadmap for advancing PCC in Nigeria, emphasizing the need for supportive policies, capacity building, and continuous evaluation to align the healthcare system with global standards and improve patient outcomes. Keywords Patient-Centered Care, Nigeria, Challenges, Opportunities, Future Directions

Factors Predicting the Quality of Care Among Nurses in Tertiary Hospitals in Fiji: A Cross-sectional Study

Quality of care by nurses is a key factor in determining the success of healthcare delivery around the globe, which is impacted by a shortage of nurses, excessive workloads, and unfavorable working conditions, including in the Republic of Fiji Islands. Using the Quality Health Outcome Model, this descriptive-predictive, cross-sectional study examined the quality of care and its predictors among 744 Fijian registered nurses from three tertiary hospitals. Instruments for data collection were the Demographic Data Sheet, the Quality of Care Scale, the Participation in Decision Making Scale, the Relational Coordination Survey, the Perception of Organizational Change Scale, the Job Satisfaction Scale, and the Organizational Commitment Questionnaire. Descriptive statistics and logistic regression analysis were applied to analyze the data. This study’s findings are informative and offer a glimmer of hope since 72.58% of participants perceived the overall quality of care as good/excellent, indicating a positive baseline. Two factors, relational coordination and job satisfaction, significantly affected the perception of the quality of care. The study model explained 8.90% of the variance in quality of care, with relational coordination being the strongest predictor. These findings provide a clear path to improvement. A comprehensive model should be developed and tested to better understand the factors predicting Fiji’s quality of care before it can be used to design an effective intervention. Developing nursing skills, improving good communication and work environments, and providing high-quality education and training among nurses can significantly improve the quality of care. In addition, support from the government for appropriate medical equipment, recruitment and retention strategies for nurses, and promotion of standard of care from the Ministry of Health and Medical Services are recommended to enhance the quality of care, further bolstering this hopeful outlook. Further Fijian nursing research is clearly needed on this topic in the future.

Bridging the gap: evaluation of preoperative patients’ education by comparing expectations and real-perioperative surgical experiences: a mixed-methods descriptive cross-sectional study

BackgroundEducating patients regarding surgery is an important aspect of the preoperative process. It helps individuals answer their queries, reduce anxiety, and improve overall satisfaction with the surgical experience.ObjectiveTo compare patients’ expectations with their real-perioperative surgical experiences. Also, to evaluate the effectiveness of preoperative education and, thus, improve the doctor-patient relationship.MethodologyThrough consecutive sampling, 65 adult patients were selected from the ENT department of Khyber Teaching Hospital. Preoperative education was provided to all the subjects using a 25-point pro-forma, and their queries were addressed. Postoperatively, all participants were interviewed regarding their expectations and real perioperative surgical experiences. The gaps were noted, and participants were asked about their preferences for addressing such gaps in future interactions. Postoperatively, patients were asked to give comments on how a certain part of preoperative education could have been better delivered.ResultsAmong the 65 patients, 28 (43.1%) were male, and 37 (56.9%) were female. The majority (38.5%) had a primary/secondary school education. Eight (12.3%) patients had ear surgery, 19 (29.2%) had nose surgery, and 38 (58.5%) had throat surgery. Almost 39 (60%) patients had preoperative fear/anxiety. After preoperative education, 17 (26.2%) patients experienced perioperative fear/anxiety, which was a significant reduction (p = 0.001). Preoperative anxiety was greater in females (M: F = 8:13, p = 0.00), while perioperative anxiety was comparable among both genders after patient education (M: F = 5:12, p = 0.18). The greatest dissatisfaction was noted regarding the surgical schedule (33.8%), range of motion (16.9%), deep breathing exercises (13.8%), and preoperative fasting (12.3%). Most importantly, patients’ comments were noted, when they were asked to suggest a better way to educate preoperatively in their respective area of dissatisfaction. Patients appreciated detailed explanations with practical demonstrations for range of motion exercises. One patient complained about no clear instructions on postoperative resumption of snuff.ConclusionPreoperative patient education should be a two-way process involving active participation and continuous feedback. By educating patients properly through a multidisciplinary approach, healthcare providers can further enhance patient satisfaction, alleviate anxiety, and improve the overall quality of care.

The Association Between Experienced Discrimination and Pain in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

The relationship between experienced discrimination and its effects on pain interference and management among racial disparities is not well explored. This research investigated these associations among Black and White U.S. adults. The analysis involved 9369 Black and White adults in the REasons for Geographic and Racial Differences in Stroke (REGARDS), assessing experiences of discrimination, pain interference (SF-12), and pain treatment, incorporating factors like demographics, comorbidities, and stress. Black participants experiencing moderate discrimination were found to have a 41% increased likelihood of pain interference (aOR 1.41, 95% CI 1.02-1.95), similaritythose facing high levels of discriminationalso showed a 41% increase (aOR 1.41, 95% CI 1.06-1.86) compared to those without such experiences. White individuals reporting moderate discrimination also faced a heightened risk, with a 21% greater chance of pain interference (aOR 1.21, 95% CI 1.01-1.45). Notably, the presence of moderate discrimination among Black participants correlated with a 12% reduced probability of receiving pain treatment (aOR 0.88, 95% CI 0.56-1.37). Furthermore, Black, and White individuals who reported discrimination when seeking employment had a 33% (aOR 0.67, 95% CI 0.45-0.98) and 32% (aOR 0.68, 95% CI 0.48-0.96) lower likelihood, respectively, of receiving treated pain. The study elucidates how discrimination exacerbates pain interference and restricts access to treatment, affecting Black and White individuals differently. These findings underscore an urgent need for strategies to counteract discrimination's negative effects on healthcare outcomes. Addressing these disparities is crucial for advancing health equity and improving the overall quality of care.

A home healthcare routing-scheduling optimization model considering time-balancing and outsourcing

Home care services have a significant role in lowering healthcare expenditure. Supply chain management in home healthcare (HHC) ensures efficient delivery of medical supplies and equipment to patients' homes, improving overall quality of care and patient outcomes. This study proposes a routing and scheduling optimization model for HHC by prioritizing patients, developing an effective delivery strategy, and considering home care logistics and services. The model primarily concerns reducing logistics activities’ overall expenses while considering patients’ priorities. A bi-objective optimization model for a multi-period HHC problem is developed by prioritizing patients with urgent critical needs. The best-worst method (BWM) and technique for order of preference by similarity to ideal solution (TOPSIS) are used to prioritize patients using a linear programming metric (Lp-metric). The BWM and TOPSIS have been uniquely used in this study for routing and scheduling in HHC. Eventually, the applicability of the proposed method is demonstrated through a real-life case study with a series of numerical examples and sensitivity analysis. For instance, by analyzing privilege, we see patients are carefully matched with caregivers possessing advanced skills, leading to increased patient satisfaction. Based on assigned routes, caregivers prioritize patients with higher weight and emergency conditions at the start of each path, followed by patients with less urgent conditions. This ensures that patients with more severe conditions are serviced first.

Specialist intellectual disability liaison nurses in general hospitals in England: cohort study using a large mortality dataset

ObjectiveIntellectual disability liaison nurses in general hospitals could enhance access to high-quality, adapted healthcare and improve outcomes. We aimed to explore associations between the input of intellectual disability liaison nurses...

Game Products: Innovative Pathways for Nursing Education and Clinical Training

To excel in their work, nurses must have specialized tools to support their tasks and professional development. Games, as a crucial pathway to achieving nursing education and clinical training goals, demonstrate significant potential and application value, making them an innovative product. Nursing education games come in various forms, including virtual reality, augmented reality, tabletop, and digital, and may be designed as needed for individual, two-player, or team play (Avşar et al., 2023; Bermejo et al., 2023; Tsai et al., 2024). These games, beyond their entertainment value, have clear educational objectives embedded in their design. Through levels, challenging tasks, and reward mechanisms, they stimulate learning enjoyment and promote nursing development. In this column, experts and scholars in the field of nursing engaged in game development share their experiences and achievements. Integrating games into nursing delivers a wealth of tools and resources for nursing education and clinical practice, offering immersive learning experiences, instant feedback, and individualized learning paths. For nursing students, gamified products offer safe and risk-free learning environments in which they can practice critical tasks and make decisions in simulated medical scenarios, increasing their clinical experience and confidence and enhancing their clinical judgment and decision-making skills (Wu et al., 2023). For patients, many therapeutic games have already been designed that use gameplay to improve health by facilitating user engagement in rehabilitation exercises, promoting healthy eating, and fostering social interactivity (Tsai et al., 2024). For nurses, various games are being used to promote continuous professional growth in an interactive and enjoyable learning environment, improving overall quality of care and job satisfaction (Hsieh et al., 2023). In summary, the application of game products in nursing education and clinical training has introduced new learning and training models that provide multifaceted benefits for nurses, nursing students, and patients. We hope that readers will gain a deeper understanding of related game products after reading this column and use games effectively to enhance nursing quality.