Receiving Health Care Research Articles

Racial differences in transfusion practices: Time to address structural racism

See article on page 1519–1526, in this issue

The Use of Mobile Phones by Women Accessing Health Care Services in Bangladesh: A Cross-Sectional Study

Background: Maternal and neonatal mortality rates still pose a global challenge. Objectives: The present study aimed to identify the socio-demographic characteristics of mobile users trying to access antenatal care services, transportation to facilities, and postnatal care for mothers and newborns. Methods: This was a cross-sectional study that used data collected from the Bangladesh Demographic and Health Survey (BDHS) 2014. Data were gathered using a questionnaire. Participants comprised 4,494 mothers aged between 14 and 49. Models of logistic regression were used to determine associations. Results: The overall sample size was 4494, with only 22.23% of women using mobile phones. Among these, 29.9% used their mobile phones to obtain health services or advice and 70.1% did not. Women with mobile phones who had a higher level of education used them to receive more health care (secondary and higher: OR = 1.922, 95%CI = 1.225−3.014; primary: OR = 1.982, 95% CI = 1.738−2.654); they were of higher socio-economic status (rich: OR = 1.228, 95% CI = 1.009&−1.494; middle income: OR = 1.691, 95% CI = 1.256−2.333); they accessed more prenatal care (yes: OR = 1.993, 95% CI = 1.425−1.987) and antenatal care (yes: OR = 1.951, 95% CI = 1.765−1.998); they checked their health status after delivery (yes: OR = 1.966, 95% CI = 1.639−2.357). Conclusion: The results of the present study showed that young women who had a higher level of education and income and resided in urban areas were more likely to use a mobile phone to receive health care facilities in Bangladesh. Intervention studies are essential in recognising that mobile phone-based facilities improve maternal health care.

Addressing Inequities in Kidney Care for Indigenous People in Canada.

Addressing Inequities in Kidney Care for Indigenous People in Canada.

Self-Rated Health and Mental Health Among African Americans in the Rural South: The Influence of Social Determinants of Health.

The current study examines the influence of seven categories of social determinants of health (i.e., financial resource strain, food insecurity, transportation needs, housing instability, education and health literacy, social isolation, and interpersonal safety), as well as perceived race-related discrimination and disparities in received health care quality on self-rated health and mental health. Multiple linear regression was used to test whether social determinants of health and race-related stressors were associated with self-reported health status and self-reported mental health status in a sample of rural African Americans residing in the Southeastern United States. The results suggest that food insecurity was significantly associated with lower levels of self-rated health and mental health. In contrast, greater health literacy was significantly associated with higher levels of self-rated health and mental health. Surprisingly, greater transportation needs were also associated with higher levels of self-rated mental health status. Among the race-related stressors, racial discrimination was associated with lower levels of self-rated health status. Community-based interventions that seek to alter social determinants of health and reduce experiences with racial discrimination may improve self-rated health and mental health among rural African Americans.

Strengthening Integrated Health Center Service for the Elderly through Cadre Training and Mentoring

Posyandu for the elderly is a community-driven and agreed-upon integrated service station for the elderly in a specific location where they can receive health care. Currently, not all provinces in Indonesia (43.9%), including Maluku, hold Posyandu for the elderly. The Mosso Villages in Central Maluku Regency's Tehoru District has never offered posyandu services to the elderly. The absence of skilled cadres, infrastructure, and a small number of health workers causes posyandu's lack of action in this area. This community engagement aimed to strengthen the elderly posyandu in Mosso village by providing cadre training and mentoring. Ten cadres have been trained, and their knowledge and abilities have improved due to the training. The mentoring activities revealed that the Posyandu Wae BaK and Wae Lisa provided routine services every month and that the cadres could provide posyandu services for the elderly on their own.

Examination of individuals' depression, anxiety, and stress levels during the COVID-19 pandemic in Turkey

PurposeThis research was conducted to determine the depression, anxiety, and stress levels of individuals during the COVID-19 epidemic. In addition, the compatibility of the Depression-Anxiety-Stress Scale (DASS-21) scale results with the participants' feeling depressed, anxious, and stressed were examined. Design and methodsThe sample of the study consisted of 870 individuals over the age of 18 between May–August 2021. The data of the study were collected online, using the personal information form and DASS-21. ResultsIn our study, it was observed that 22.3 % of the participants were severely depressed, 19.0 % were highly anxious and 14.3 % were highly stressed. In addition, a relationship was determined between many sociodemographic variables and depression, anxiety, and stress levels. It was found that individuals who were not vaccinated, did not receive health care, and were not satisfied with health care were more depressed, anxious, and stressed. The agreement between all DASS-21 sub-dimensions and participants' feeling is poor in terms of Cohen's kappa. The agreement is poor in the anxiety sub dimension, but moderate in the other sub-dimensions in terms of Gwet's AC1. Practice implicationsIt is recommended that nurses develop new care and evaluation strategies for the psychosocial field in order to protect and maintain the health of individuals during the COVID-19 pandemic process, as well as more practices promoting the COVID-19 vaccine in our country.

A Need for Digitally Inclusive Health Care Service in the United States: Recommendations for Clinicians and Health Care Systems.

The COVID-19 pandemic led to digital health service expansion that widened the existing digital divide. Residing in areas of limited broadband internet connectivity, lacking access to smart devices, and/or having low digital health literacy (ease, comfort, and skills to use technology) pose barriers to receiving health care remotely. This unequal access to health care is further exacerbated for older adults, those with lower income and less education, racial and ethnic minorities, and those who do not speak English. Because an individual's digital access (broadband internet connectivity and access to smart devices) and literacy can affect health care quality and outcomes, it is proposed that those 2 factors should be categorized as a key domain of social determinants of health. In this commentary, the authors highlight digital access and literacy barriers in the context of the United States health care service delivery. They underscore the importance of screening every patient during regular clinical visits for digital access and literacy as social determinants of health, using the electronic health record. The authors believe this will enhance digital health care by creating a more person-centered, inclusive method for clinicians and health care systems to digitally connect to patients of all backgrounds.

Beliefs about influenza and avoidance of free influenza immunization among people with chronic diseases.

People with chronic diseases may have poor influenza-related outcomes. The study objective was to examine the association between the dimensions of the Health Belief model and noncompliance with influenza immunization. study participants were community-dwelliing individuals from the Foča region (Republic of Srpska, Bosnia and Herzegovina) listed to receive free influenza immunization for the season 2017/2018 due to chronic diseases. After vaccination season was completed, we included all nonvaccinated people and the corresponding number of vaccinated people. The data collection lasted from April to December 2018 using a sociodemographic questionnaire and modified Health Belief model Applied to Influenza. The study sample consisted of 295 people of which 149 (50.5%) were immunized against influenza in the past season. Adjusted logistic regression model suggested that people who scored lower on domains of Seriousness (odds ratio [OR] = .79, 95% confidence interval [CI] [.69, .91]), Benefits (OR = .83, 95% CI [.76, .91]) and Cue to action (OR = .79, 95% CI [.73, .86]), but higher the Barriers domain (OR = 1.10, 95% CI [1.03, 1.17]), were less likely to receive vaccination in the past season. People who did not receive recommendation from a health care worker and who were never vaccinated against influenza did not comply with influenza vaccination across all models (p < .01). Perceiving influenza as less serious, less beneficial, having fewer cues to action, and perceiving more barriers to influenza vaccination were associated with skipping influenza immunization. Not receiving health care worker recommendation and never being vaccinated against influenza were also associated with avoidance of vaccination. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Impact of the COVID-19 pandemic on neuromuscular rehabilitation setting. Part 2: patients and families' views on the received health care during the pandemic.

This study explored views of users with muscular dystrophies and their caregivers on staff-user relationships and the treatments provided by a Rehabilitation Centre during the pandemic. Patients and relatives were asked to anonymously complete an open-ended questionnaire exploring their views on these aspects. Fifty-four patients and 40 caregivers gave their informed consent and participated in the survey. Fifty-three patients were adults, 28% suffering from Duchenne/Becker muscular dystrophy. Patients reported 269 comments on health care services provided during the pandemic, 132 (49%) concerning positive aspects and 137 (51%) negative aspects. The prompt restart of the rehabilitation therapies and the staff closeness over the pandemic were the practical aspects most frequently appreciated (46.9%), while closer family contacts and the perception of being able to rely on the Centre’s constant support were the most cited psychological aspects (53.1%). Architectural barriers, difficulties in accessing public health services, economic difficulties, and lack of support from welfare and other agencies were the practical critical points most frequently reported (89%). In addition, social isolation, and loneliness due to fear of contagion were the most negative psychological aspects (10.1%). As regard the caregivers’ views, participants reported 151 comments. Of these, 86 (56.9%) were positive and 65 (43.1%) were negative. Among the positive aspects, the psychological ones – such as closer family contacts, not feeling abandoned and counting on the constant Centre’s professional support prevailed (53.5%). As for the negative aspects, most caregivers (92.6%) believe that the pandemic exacerbated their financial and bureaucratic difficulties, particularly in poorer families.

The Prevalence of Nosocomial Infections and Related Microbial Agents Based on the NNIS System in Sabzevar During 2011-2015

Background: Nosocomial infection is an infection that hospitalized patients get while receiving health care. This study aimed to determine the prevalence and factors involved in the incidence of nosocomial infections, related microbial agents, and antibiotic resistance profiles. Methods: This cross-sectional study was conducted on 390 patients with nosocomial infection admitted to Shahid Beheshti Hospital in Sabzevar from 2011 to 2015. The acquired data were assessed by the standard checklist of the National Nosocomial Infections Surveillance (NNIS) system of the Ministry of Health. The collected data were analyzed using the Stata 12 software. Results: Of the 41979 admitted patients during the mentioned period, 390 patients with an average age of 48.08 years suffered from a hospital-acquired infection. The prevalence of nosocomial infections was 1% with the highest rate related to the respiratory tract in men and surgical sites in women. Intravenous catheters, surgical wounds, urinary catheters, suction, ventilator, tracheotomy, and tracheostomy were the most commonly encountered factors (invasive measures) of nosocomial infection, respectively. The most prevalent causes of nosocomial infections were Klebsiella, Staphylococcus aureus, and Acinetobacter. Conclusions: Based on our findings, several factors play a pivotal role in preventing hospital-associated infections, including proper follow-up and timely reporting of nosocomial infection cases. The other influential factors were accurate identification of microorganisms involved, allocation of sufficient funds to provide appropriate facilities for infection prevention, the appropriate and timely medical interventions, and the rational use of antibiotics.

Sexual Orientation Discrimination and Exclusive, Dual, and Polytobacco Use among Sexual Minority Adults in the United States.

Research on whether sexual orientation discrimination is associated with multiple tobacco product use among sexual minority (SM) adults is limited. Thus, we explored the associations between sexual orientation discrimination and exclusive, dual, and polyuse among a subset of SM adults (18+) (n = 3453) using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. We evaluated six indicators of prior-to-past-year sexual orientation discrimination separately and as a summary scale and defined past-year exclusive, dual, and polyuse based on cigarette, electronic nicotine delivery systems, other combustible (cigars and traditional pipe), and smokeless tobacco products. Using multinomial logistic regression, we estimated adjusted associations between sexual orientation discrimination and exclusive, dual, and polyuse. Experiencing discrimination in public places, being called names, and being bullied, assaulted, or threatened were associated with dual use, while experiencing discrimination when obtaining health care or insurance and when receiving health care were associated with polyuse. Each one-unit increase in the sexual orientation discrimination summary scale was associated with 5% and 10% higher odds of dual (95% CI: 1.01–1.10) and polyuse (95% CI: 1.02–1.18), respectively. To conclude, we advise health professionals to consider the salience of discrimination against SM adults and how these experiences lead to dual/polyuse.

Trends and Disparities in Health Care Transition Preparation from 2016 to 2019: Findings from the US National Survey of Children's Health

To evaluate national trends in health care transitionpreparation over a 4-year period using the National Survey of Children's Health (NSCH) and to identify and examine disparities in receipt of health care transition preparation over the study period. Data from the NSCH, an annual serial cross-sectional survey conducted from 2016 to 2019, were examined. Caregivers answered questions regarding one of their children within each of a random sample of households across the US. The primary analysis examined trends in health care transition preparation based on the year of survey completion. A secondary analysis examined the associations of race/ethnicity, primary household language, insurance type, and children with special health care needs (CSHCN) with receipt of health care transition preparation. We included data from 54 434 youths (20 708 in 2016, 8909 in 2017, 12 587 in 2018, and 12 230 in 2019) aged 12-17 years whose caregivers completed the NSCH between 2016 and 2019. The sample was weighted to be nationally representative based on weights provided by the NSCH. The proportion of youths receiving necessary health care transition preparation increased over the study period, from 14.8% in 2016 to 20.5% in 2019 (P<.001). Multivariable logistic regression demonstrated increased odds of receiving health care transition preparation in 2018 and 2019, as well as for White non-Hispanic youths, those with English or Spanish as a primary household language, those with private insurance, and CSHCN. Although the proportion of youths receiving health care transition preparation has increased since 2016, the need for ongoing improvement and elimination of disparities in health care transition preparation remains.

Inpatient point-prevalence screening of New Delhi Metallo-β-lactamase (NDM)–producing Enterobacaterales and Candida auris

Background: Carbapenem-resistant Enterobacterales (CRE) are an increasing threat to patient safety but only a small percentage of CRE identified are NDMs. Since 2018, clinical CRE isolates have been submitted to the Ohio Department of Health for sequencing and NDM cases have notably increased since that time. Candida auris is an emerging pathogen with similar risk factors for colonization as CRE. Methods: A point-prevalence study was initiated after an index patient was identified with NDM CRE infection or colonization during their inpatient admission. Two patient populations were included in the study: current patients on the same unit as the index patient and currently hospitalized patients who overlapped on any unit with the index patient for at least 72 hours. Patients had perirectal screening for CRE (via PCR) and axilla or groin screening for C. auris (via Xpert Carba-R Assay). Patients were excluded if they had been discharged, expired, or refused testing. Results: We completed 5 point-prevalence studies from March 21, 2021, to October 15, 2021. The index patients were admitted at different times and across 2 campuses including medical, cardiac, and surgical ICUs as well as medical-surgical and inpatient rehabilitation units. Moreover, 3 species of NDM were identified from urine and 2 species were identified from bronchoalveolar lavage: Enterobacter hormaechei, Citrobacter freundii, and Enterobacter cloacae complex. C. freundii and E. cloacae complex both had dual mechanisms of NDM and KPC. Although some of the index patients overlapped temporally within the health system, none overlapped in the same unit or building. None of the patients had recently received health care outside the United States, although 1 patient had emigrated from Togo &gt;5 years prior and 4 had had prior local healthcare exposure within 12 months of admission. Also, 147 patients were identified for screening; 105 consented, 32 declined, and 10 were excluded due to being discharged, deceased, or unable to consent. Inpatient point-prevalence screening tests for all patients tested (n = 105) were negative for NDM CRE and C. auris. Conclusions: Despite an increase of inpatients with NDM CRE, evidence of patient-to-patient transmission was not identified, likely resulting from adherence to standard precautions. The diversity of species and lack of international travel suggests that these patients likely acquired NDM CRE from a local reservoir in the community or healthcare settings. Given the continued increase in NDM CRE without traditional risk factors, it is critical for hospitals and public health agencies to collaborate to identify these organisms and that they develop surveillance programs to clarify risk factors for colonization.Funding: NoneDisclosures: None

COVID-19 and food insecurity in a vulnerable rural state.

ObjectiveThis study explored variations in food insecurity across sociodemographic groups and changes specific to the COVID-19 pandemic, including income loss, stimulus check receipt, and changes in household size.DesignA cross-sectional online survey was conducted using a 2-item food insecurity screener. COVID-19 related factors and sociodemographic data were collected.SettingData were collected in Arkansas, United States, during July and August 2020.ParticipantsA sample of 1205 adults was recruited using ARresearch, a volunteer research registry. Participants were over the age of 18 and living, working, or receiving health care in Arkansas.ResultsThe prevalence of food insecurity was 24.9% during the COVID-19 pandemic. Food insecurity was elevated even after the majority of respondents received a stimulus check. Chi-square and t-tests revealed that food insecurity was more prevalent among those who are younger, Black, Hispanic/Latinx, lower-income, less educated, and living in households with children. Multivariate logistic regression revealed that odds of food insecurity were greater for individuals who reported income loss due to the pandemic (OR = 3.29; p < .001), Black respondents (OR = 2.06, p = .014), Hispanic respondents (OR = 3.34, p = .001), those earning less than $25,000 annually (OR = 4.92; p < .001) or between $25,000 to $49,999 (OR = 2.04; p = .023), respondents with a high school degree or less (OR = 4.21; p < .001) or some college (OR = 2.55; p < .001), and those living in households with children (OR = 1.62; p = .021). Odds of food insecurity were lower for those who had received a stimulus check (OR = 0.60; p = .026).ConclusionFood insecurity prevalence was high in Arkansas in July and August 2020. The risk of food insecurity was uneven across sociodemographic groups. Several factors related to the COVID-19 pandemic were indicators for increased risk of food insecurity. Interventions to address food insecurity that recognize social factors unique to the pandemic are needed to reduce levels of food insecurity.

A Study on The Effectiveness of Structured Teaching Programme on Knowledge regarding Prevention of Hospital Acquired Infection among student nurses of selected colleges of Meerut

Introduction: Hospital acquired infections are most common in the developing countries like India. Improper handling and management of the biomedical or hospital waste is also an important cause of the health associated infections. Hospital acquired infections also referred to as health care associated infections (HAI), are infections acquired during the process of receiving health care that was not present during the time of admission. Adequate knowledge regarding use of techniques like standard safety precautions, universal precautions and aseptic techniques can reduce hospital acquired infections to a great extent. Materials and method: The design used for study was experimental research design. The study was conducted on a sample of 50 student nurses. Self structured questionnaire was used as a tool for data collection. Results: The study result reveals that 0(0%) student nurses had good knowledge regarding prevention of hospital acquired infection and 30(60%) student nurses had average knowledge before administering structured teaching program and 20(40%) had poor knowledge. Post test results revealed that 9(18%) student nurses had good knowledge score and 41(82%) had average knowledge score after administration of structured teaching program on prevention of hospital acquired infection. Association of different demographical variables with the level of knowledge before undergoing structured teaching program was assessed using x2 and it has been found that there is no significant association between the level of knowledge and socio-demographic variable. Conclusion: The findings of the study revealed that application of structured teaching program has increased the level of knowledge of student nurses to a great extent and there is no association between the level of knowledge regarding prevention o hospital acquired infection among the student nurses of selected colleges in Meerut to their socio demographic variables.

DoD-VA Trauma Infection Research Collaboration.

In the aftermath of wars, there is a surge in the number of wounded service members who leave active duty and become eligible for healthcare through the Department of Veterans Affairs (VA). Collaborations between the Department of Defense (DoD) and VA are crucial to capture comprehensive data and further understand the long-term impact of battlefield trauma. We provide a summary of the development, methodology, and status of an effective collaboration between the Infectious Disease Clinical Research Program and the St. Louis VA Health Care System with the multicenter, observational Trauma Infectious Disease Outcomes Study (TIDOS), which examines the short- and long-term outcomes of deployment-related trauma. As part of TIDOS, wounded service members who transitioned to participating military hospitals in the United States (2009-2014) were given the opportunity to enroll in a prospective follow-up cohort study to continue to capture infection-related data after their hospital discharge. Enrollees in the TIDOS cohort who left military service and received health care through the VA also had the option of consenting to have relevant VA medical records abstracted and included with the study data. Infections considered to be complications resulting from the initial trauma were examined. Among 1,336 TIDOS enrollees, 1,221 (91%) registered and received health care through the VA with 633 (47%) consenting to follow-up using VA records and comprising the TIDOS-VA cohort. Of the first 337 TIDOS-VA cohort enrollees, 38% were diagnosed with a new trauma-related infection following hospital discharge (median: 88 days; interquartile range: 18-351 days). Approximately 71% of the infections were identified through DoD sources (medical records and follow-up) and 29% were identified through VA electronic medical records, demonstrating the utility of DoD-VA collaborations. The TIDOS DoD-VA collaboration has also been utilized to assess intermediate and long-term consequences of specific injury patterns. Among 89 TIDOS-VA cohort enrollees with genitourinary trauma, 36% reported sexual dysfunction, 21% developed at least one urinary tract infection, 14% had urinary retention/incontinence, and 8% had urethral stricture. The rate of urinary tract infections was 0.05/patient-year during DoD follow-up time and 0.07/patient-year during VA follow-up time. Wider capture of infection-related outcome data through the DoD-VA collaboration provided a clearer picture of the long-term infection burden resulting from deployment-related trauma. Planned analyses include assessment of osteomyelitis among combat casualties with amputations and/or open fractures, evaluation of mental health and social factors related to injury patterns, and examination of health care utilization and cost in relation to infectious disease burdens.

A 'plethora of services' but a lack of consistency: Aqualitative study of service providers' perspectives about transitioning from hospital to home for older South Australians.

We explored the perspectives of professionals working in health and aged care services in South Australia about factors that influenced successful transitions from hospital to home or residential aged care home for older people. We examined successful and recommended strategies that could support safe transitions following hospital discharge and reduce avoidable hospital admissions in South Australia. Nineteen professionals from acute, post-acute, primary, community and aged care settings in South Australia participated in semi-structured interviews. Qualitative content analysis was conducted. Participants reported that navigating service provision could be difficult, compounded by different funding arrangements for hospitals, community, primary care and aged care services. Some participants felt that there was an over-reliance on the hospital sector, leaving primary care and community-based services under-utilised to support hospital transitions. The importance of good communication between services and sectors was highlighted. Participants described different categories of services that supported safe transitions by supporting older people immediately post-discharge; services that provided support to stay at home in the weeks and months following discharge; and services that helped the person receive health care at locations other than hospitals or emergency departments when they were unwell. Participants noted that successful programs were not always maintained. Division of responsibility of aged and health-care services between state and national governance contributes to fragmentation of care in South Australia. Careful planning of transitions and coordination of services across sectors is required to ensure older people are supported in the months following discharge from hospital to reduce avoidable rehospitalisations.

Using Andersen's behavioural model to examine individual and contextual factors associated with dental service utilization in Brazil.

The study aimed to examine individual and contextual factors associated with the frequency of dental service utilization among adolescents, adults and older adults Brazilians. This cross-sectional study used secondary data from the Brazilian 2019 National Health Survey (94 114 individuals). The outcome 'when was your last dental appointment?' was categorized into three groups: up to 1 year, more than 1 year and never had a dental appointment. Andersen's behavioural model was used to select contextual and individual variables. Multinomial logistic regression analysis was performed to calculate the odds ratio (OR) and 95% confidence intervals (95% CI). The following variables showed increased probability to the outcome had the last dental appointment more than 1 year ago: older adult, illiterate or incomplete primary school, and without private dental insurance. The outcome never had a dental appointment was significantly associated with illiterate (OR 26.65; 95% CI 17.63-40.29), male (OR 2.38; 95% CI 2.17-2.61), without private dental insurance (OR 5.20; 95% CI 3.48-7.76), self-rated oral health as bad or very bad (OR 2.67; 95% CI 2.31-3.09), household not enrolled in primary care teams (OR 1.29; 95% CI 1.11-1.49), household in a rural area (OR 1.86; 95% CI 1.69-2.05), high household crowding (OR 1.08; 95% CI 1.04-1.14) and low household income per capita (OR 0.99; 95% CI 0.99-0.99). This study showed that contextual and individual factors induce inequity in dental appointments. Moreover, Andersen's behavioural model demonstrated inequitable access for dental services in Brazil, in which social structure and enabling characteristics, rather than the need for the service, determine who receives health care. Living in a household enrolled in primary care teams favoured regular dental appointments. Thus, these findings may help policymakers improve health access by expanding coverage of dental services in primary health care.

Effects of an educational intervention on nursing students' attitudes towards gypsy women: A non-randomized controlled trial

BackgroundThe cultural differences between health professionals and patients, together with the ethnocentric opinions that some health professionals sometimes hold, generate prejudice and negatively influence the experiences of these groups, for example, the Gypsy population. MethodsWe set up a quasi-experimental study to test the efficacy of an educational intervention among 40 nursing students in Spain based on the use of positive references in order to improve the students' attitude towards gypsy women receiving health care. Analysis of comparison of means and correlation analysis were carried out according to the type of variable compared. ResultsThe score in all the items that make up the Prejudicial Attitude Scale (PAT) decreased after the test, which demonstrated that their attitudes had become less prejudiced. The Stereotype Content Model (SCM), the perception of the outgroup and the stereotypes regarding the Roma population as “trustworthy” all improved showing a statistically significant difference between the periods (pre and post educational intervention). ConclusionNursing educators have the opportunity, through theoretical and practical exposure to positive references, to explore the students' experience and perceptions, analyze interventions and change their perceptions of threat, thus contributing to a more inclusive group identity.

The Relationship between Quality of Health Care with BPJS Patient Satisfaction

Hospitals are a health care institution that organizes multiple health services in a plenary, one of the important indicators that must be considered in health services is patient satisfaction. Patient satisfaction is one of the important elements in evaluating service quality by measuring the response of patients after receiving health care services. The patient satisfaction level also depends on the quality of services offered with patient expectations. This study aims to explain the relationship of the quality of health services with the satisfaction of BPJS participants. This research is a quantitative study with an analytic survey approach, using cross sectional design. The population in the study was all BPJS users in the inpatient room of the Grandmed Hospital Lubuk Pakam, the number of samples taken by 50 people with sampling techniques using purposive sampling. Data collection method using primary data and secondary data. Statistical test using chi square test with confidence level = 0.05. The results of the analysis showed that there was a relationship between patient satisfaction and reliability (p=0.016) and there was a relationship between patient satisfaction and responsiveness (p=0.001). It is hoped that the management, service department, health workers and all parties at Grandmed Lubuk Pakam Hospital to provide and improve services to patients in accordance with public service standards, because the services provided to patients show the quality of the hospital.