Shortage Of Health Care Workers Research Articles

Global Rate of Willingness to Volunteer Among Medical and Health Students During Pandemic: Systemic Review and Meta-Analysis.

During health crises such as the COVID-19 pandemic, shortages of health care workers often occur. Recruiting students as volunteers could be an option, but it is uncertain whether the idea is well-accepted. This study aims to estimate the global rate of willingness to volunteer among medical and health students in response to the COVID-19 pandemic. A systematic search was conducted on PubMed, Embase, Scopus, and Google Scholar for studies reporting the number of health students willing to volunteer during COVID-19 from 2019 to November 17, 2023. The meta-analysis was performed using a restricted maximum-likelihood model with logit transformation. A total of 21 studies involving 26,056 health students were included in the meta-analysis. The pooled estimate of the willingness-to-volunteer rate among health students across multiple countries was 66.13%, with an I2 of 98.99% and P value of heterogeneity (P-Het)<.001. Removing a study with the highest influence led to the rate being 64.34%. Our stratified analyses indicated that those with older age, being first-year students, and being female were more willing to volunteer (P<.001). From highest to lowest, the rates were 77.38%, 77.03%, 65.48%, 64.11%, 62.71%, and 55.23% in Africa, Western Europe, East and Southeast Asia, Middle East, and Eastern Europe, respectively. Because of the high heterogeneity, the evidence from this study has moderate strength. The majority of students are willing to volunteer during COVID-19, suggesting that volunteer recruitment is well-accepted.

The impact of incentive scheme on rural healthcare workforce availability: a case study of Kazakhstan

BackgroundDuring the 1990–2000, Kazakhstan experienced a decline in the number of healthcare professionals working in rural areas. Since 2009, the national government has been implementing financial incentives to encourage healthcare professionals to relocate to rural areas. This study aims to investigate the temporal and spatial patterns in the distribution of the rural healthcare workforce and evaluate the impact of this incentive scheme.MethodsInterrupted Time Series Analysis using ARIMA models and Difference in Differences analyzes were conducted to examine the impact of the incentive scheme on the density of different categories of the healthcare workforce in rural Kazakhstan in the period from 2009 to 2020.ResultsThere was a significant increase in the number of rural healthcare professionals from 2009 to 2020 in comparison to the period from 1998 to 2008. However, this increase was less pronounced in per capita terms. Moreover, a decline in the density of internists and pediatricians was observed. There is substantial variation in the density of rural nurses and physicians across different regions of Kazakhstan. The incentive scheme introduced in 2009 by the government of Kazakhstan included a one-time allowance and housing incentive. This scheme was found to have contributed insignificantly to the observed increase in the number of rural healthcare professionals.ConclusionFuture research should be undertaken to examine the impact made by the incentive scheme on other medical subspecialties, particularly primary practitioners. Addressing the shortage of healthcare workers in rural areas is a complex issue that requires a multifaceted approach. Aside from financial incentives, other policies could be considered to increase relocation and improve the retention of healthcare professionals in rural areas.

Text message-based Cessation Intervention for People who Smoked or Used Smokeless Tobacco in India: a Feasibility Randomised Controlled Trial.

Despite the high burden of tobacco use in India, users do not have access to adequate help. This pilot trial aimed to evaluate the feasibility and acceptability of a text messaging intervention for tobacco cessation, generate preliminary estimates of its impact, and fine-tune procedures for a definitive trial. Parallel two-arm single blind individually randomised controlled pilot trial with nested qualitative study. Participants included adult current tobacco users (smoked and smokeless). Eligible and consenting participants were randomised to receive either (a) text messaging intervention (ToQuit) which covered specific content areas such as psychoeducation about consequences of tobacco use and benefits of quitting and tobacco avoidance strategies or (b) information about tobacco cessation helplines such as the helpline number and the languages in which tobacco cessation support was available (control). Feasibility data included screening and consent rates, treatment dropouts and outcome ascertainment. The primary abstinence outcome was self-reported abstinence from tobacco in the past seven days at three months post-randomisation. In-depth interviews were conducted with a sub-sample of participants primarily to collect acceptability data. The primary abstinence analysis used a chi-squared test and logistic regression (complete-case), and qualitative data analysed using thematic analysis. Ninety eight participants were randomised into the two trial arms; 77 (79%) completed outcome evaluation. No between-arm differences in abstinence were found though findings favoured the intervention (7-day abstinence: ToQuit 23%, control 19%; adjusted odds ratio 1.23, 95% confidence interval 0.38, 3.97). Participants appreciated the language, comprehensibility, and relevance of the messages; and reported overall satisfaction with and positive impact from the intervention on their lives. The findings indicate the acceptability and feasibility of ToQuit and if found effective, it could be a potentially scalable first-line response to tobacco use in low resource settings. Our pilot RCT provides sufficient findings supporting the acceptability and feasibility of an intervention for tobacco cessation which is suitable for a context which has a shortage of healthcare workers and for individuals who use smoked or smokeless tobacco. This is critical on a background of limited contextually relevant interventions for a problem with a high burden in low- and middle- income countries such as India.

Intention to leave, depersonalisation and job satisfaction in physicians and nurses: a cross-sectional study in Europe

The European healthcare sector faces a significant shortage of healthcare workers. Assessing the prevalence of this issue and understanding its direct and indirect determinants are essential for formulating effective recruitment programs and enhancing job retention strategies for physicians and nurses. A multicentric cross-sectional study was conducted, involving 381 physicians and 1351 nurses recruited from eight European hospitals in Belgium, the Netherlands, Italy, and Poland. The study focused on assessing turnover intentions among healthcare workers based on the Job Demands-Resources model, using an online questionnaire. Structural equation models were employed to test the data collection questionnaires’ construct validity and internal consistency. The turnover intention was assessed by agreement with the intention to leave either the hospital or the profession. Among physicians, 17% expressed an intention to leave the hospital, while 9% intended to leave the profession. For nurses, the figures were 8.9% and 13.6%, respectively. The internal consistency of the questionnaires exceeded 0.90 for both categories of health workers. Depersonalization and job dissatisfaction were identified as direct determinants of turnover intention, with work engagement being particularly relevant for nurses. We found a higher intention to leave the hospital among physicians, while nurses were more prone to leave their profession. To mitigate turnover intentions, it is recommended to focus on improving job satisfaction, work engagement and fostering a positive working climate, thereby addressing depersonalisation and promoting job retention.

Engaging Community Health Workers (CHWs) in Africa: Lessons from the Canadian Red Cross supported programs.

Universal Health Coverage (UHC) will not be achieved if health care worker shortages, estimated to increase to 18 million by 2030, are not addressed rapidly. Community-based health systems, which pivot to effective engagement of community health workers (CHW), may have an essential role in linking communities with health care facilities and reducing unmet health services needs caused by these shortages. The Canadian Red Cross (CRC) has partnered with different National Red Cross/Red Crescent Societies and Ministries of Health in Africa in the implementation of programs where CHWs contributed to the provision of various health services. This study reports on key findings (i.e., beneficiaries reached, CHWs engaged, programs implemented, intervention outcomes) and lessons learned from CRC supported CHW programs in Africa over the last 15 years (2007-2022). Qualitative methodology was employed to conduct document analysis on 17 sets of reports from each CRC-supported community health worker project in Africa over the past 15 years. Focus was on identifying challenges, facilitators, and lessons learned. CRC supported projects have trained over 9000 CHWs, benefiting nearly 7.5 million people across Africa. Key success factors include adaptability and agility in programming and project management, and considering contextual factors (political, social, and cultural systems). Investing in essential training for CHWs, staff, and volunteers is crucial, alongside employing an evidence-based approach to inform all aspects of programming and implementation. Additionally, projects prioritizing protection, gender and inclusion (PGI) while leveraging existing community structures and partnerships important for successful implementation. Despite challenges (i.e., weak health systems, lack of political commitment, insufficient funding, inadequate training) CHWs are recognized as crucial in promoting community-based health, improving access to care, addressing disparities, and contributing to achieving (UHC). Their unique position within communities enables them to provide culturally appropriate and localized primary health care- particularly in remote, resource limited and poverty-stricken regions.

Health systems' capacity in availability of human resource for health towards implementation of Universal Health Coverage in Kenya.

Kenya faces significant challenges related to health worker shortages, low retention rates, and the equitable distribution of Human Resource for Health (HRH). The Ministry of Health (MOH) in Kenya has established HRH norms and standards that define the minimum requirements for healthcare providers and infrastructure at various levels of the health system. The study assessed on the progress of Universal Health Coverage (UHC) piloting on Human Resource for Health in the country. The study utilized a Convergent-Parallel-Mixed-Methods design, incorporating both quantitative and qualitative approaches. The study sampled diverse population groups and randomly selected health facilities. Four UHC pilot counties are paired with two non-UHC pilot counties, one neighboring county and the second county with a geographically distant and does not share a border with any UHC pilot counties. Stratification based on ownership and level was performed, and the required number of facilities per stratum was determined using the square root allocation method. Data on the availability of human resources for health was collected using a customized Kenya Service Availability and Readiness Assessment Mapping (SARAM) tool facilitated by KoBo ToolKitTM open-source software. Data quality checks and validation were conducted, and the HRH general service availability index was measured on availability of Nurses, Clinician, Nutritionist, Laboratory technologist and Pharmacist which is a minimum requirement across all levels of health facilities. Statistical analyses were performed using IBM SPSS version 27 and comparisons between UHC pilot counties and non-UHC counties where significance threshold was established at p < 0.05. Qualitative data collected using focus group discussions and in-depth interview guides. Ethical approval and research permits were obtained, and written informed consent was obtained from all participants. The study assessed 746 health facilities with a response rate of 94.3%. Public health facilities accounted for 75% of the sample. The overall healthcare professional availability index score was 17.2%. There was no significant difference in health workers' availability between UHC pilot counties and non-UHC pilot counties at P = 0.834. Public health facilities had a lower index score of 14.7% compared to non-public facilities at 27.0%. Rural areas had the highest staffing shortages, with only 11.1% meeting staffing norms, compared to 31.8% in urban areas and 30.4% in peri-urban areas. Availability of health workers increased with the advancement of The Kenya Essential Package for Health (KEPH Level), with all Level 2 facilities across counties failing to meet MOH staffing norms (0.0%) except Taita Taveta at 8.3%. Among specific cadres, nursing had the highest availability index at 93.2%, followed by clinical officers at 52.3% and laboratory professionals at 55.2%. The least available professions were nutritionists at 21.6% and pharmacist personnel at 33.0%. This result is corroborated by qualitative verbatim. The study findings highlight crucial challenges in healthcare professional availability and distribution in Kenya. The UHC pilot program has not effectively enhanced healthcare facilities to meet the standards for staffing, calling for additional interventions. Rural areas face a pronounced shortage of healthcare workers, necessitating efforts to attract and retain professionals in these regions. Public facilities have lower availability compared to private facilities, raising concerns about accessibility and quality of care provided. Primary healthcare facilities have lower availability than secondary facilities, emphasizing the need to address shortages at the community level. Disparities in the availability of different healthcare cadres must be addressed to meet diverse healthcare needs. Overall, comprehensive interventions are urgently needed to improve access to quality healthcare services and address workforce challenges.

A study survey on molnupiravir treatment in COVID-19 patients at home in Ninh Thuan province, Vietnam.

Molnupiravir (MOV) is an oral antiviral drug that received use authorization in Vietnam for the treatment of mild COVID-19 (F0). There was a need to develop alternative approaches that allowed patients to access medication, decongest hospitals, clinics, and facilities, and protect people from infection. During the COVID-19 crisis, the Ninh Thuan Health Authorities implemented the home delivery of medication by community health workers. This study conducted in collaboration with two important Italian entities [the Aldo Moro University of Bari City and the 118 Department of Territorial Emergency System (118 SET) of Taranto City] aimed to evaluate the implementation of home delivery F0 treatment package assessing the rate of infection recovering during the coronavirus pandemic in Ninh Thuan province, Vietnam. A convergent mixed methods research, based on a longitudinal study with quantitative research and qualitative assessments, evaluated four implementation outcomes: the feasibility, fidelity, coverage, sustainability, and effectiveness of the initiative. Data sources included routinely collected data, a telephonic survey of patients, an analysis of set-up and recurrent costs, as well as descriptive exploratory qualitative and quantitative analysis. After taking the MOV for 5 days, only 35 out of the initial 400 F0 patients remained positive, while 365 patients (91.2%) were negative (CT≥30). Whilst, the successful rate after using the drug during the course accounted for 99.85% and 100% after the entire treatment course, without any death. After 5 days of taking the drug, a positive test result (CT<30) was associated with age group ≥60 (OR=2.7) and comorbidities (OR=3.0) (p<0.05) compared to negative and positive results (CT≥30). Negative factors impacting F0 at home include a shortage of healthcare workers, inadequate supply of thermometers and SpO2 meters, and insufficient financial support for healthcare workers. MOV caused a reduction in the risk of hospitalization or death in mild COVID-19 patients, and molnupiravir was also found to be well tolerated and safe without any major adverse events during the administration period.

Humanoid Robots administering Cognitive Stimulation Therapy to help improve cognition and reduce neuropsychiatric disorders

AbstractBackgroundDementia is a progressive disease that causes a continuous decline in cognition. People affected with dementia are also at high risk for neuropsychiatric disorders requiring frequent therapy sessions. The current healthcare worker shortages have made finding a therapist challenging, resulting in increased hospital admissions due to an increase in neuropsychiatric disorders in people affected with dementia. To address this problem humanoid robots and wearable sensors were programmed to administer Cognitive Stimulation Therapy(CST), a therapy that doesn’t require a clinician to be administered. CST is an evidence based therapy that is administered twice a week for seven weeks. The wearable sensors track and monitor the physiological data and are able to predict neuropsychiatric symptoms. The robots interact, communicate and administer the therapy while the participants are wearing the sensors along with artificial intelligence algorithms that track the physiological data to help predict any neuropsychiatric symptoms.MethodA humanoid robot, Pepper was programmed to administer Cognitive Stimulation Therapy to be deployed in nursing homes to help improve cognition and also help alleviate neuropsychiatric symptoms. The protocol involves conducting a cognitive assessment using the MMSE prior to initiation of the Cognitive Stimulation Therapy. The Cognitive Stimulation Therapy is administered twice a week for seven weeks. At the end of the fourteen sessions the MMSE is administered again to measure the cognition levels. Additionally pre and post surveys for depression, quality of life, Pittsburgh sleep index/ sleep quality and activities of daily living are conducted to monitor the neuropsychiatric symptoms. During the entire seven weeks the participants physiological data is tracked and analyzed using artificial intelligence algorithms to predict neuropsychiatric symptoms. The combination of the humanoid robots and the wearable sensors work in sync to improve cognition and reduce behavioral and psychological symptoms of dementia..ResultThe robot is successfully programmed and tested in the lab setting. The study is successfully designed.ConclusionRobots can be employed to administer cognitive stimulation therapy to help improve cognition and reduce neuropsychiatric symptoms in people affected with dementia. Robots have the potential to address healthcare worker shortages.

Humanoid Mobile Robots and wearable sensors improve the quality of care and address worker shortages in nursing homes

AbstractBackgroundTechnology has been identified as a solution to address the growing healthcare worker shortages(Harp, 2023). Humanoid robots have great potential to help augment care in elderly and people affected with dementia (Khan &amp; Anwar, 2020; Joseph et.al, 2018). Humanoid robots and wearable sensors were deployed in eight nursing homes to help address healthcare worker shortages and augment care of elderly and people affected with dementia. The resident satisfaction and quality of life annual survey conducted by the Minnesota Department of Human Services revealed an improved satisfaction and quality of life in the domain of activities in the nursing homes that deployed robots when compared to the nursing homes that did not deploy the robots. The pre and post data gathered revealed that the residents felt happier, more cared for, less tired and less frustrated after interacting with the robots. The staff feedback indicates that the staff had time to address their chores while the robots engaged teh residents.MethodTwo humanoid robots and ten wearable sensors per facility were deployed in 8 different nursing homes. The robots were programmed to address the domains of physical, emotional/social and cognitive wellbeing. Four forms of data ‐ 1) nursing home resident satisfaction and quality of life data gathered by the Minnesota Department of Human Services; 2) pre and post surveys conducted before and after interactions with the robots; 3) weekly feedback was from the healthcare staff and wearable sensor data.ResultThe nursing home resident satisfaction and quality of life data gathered annually by the Minnesota Department of Human Services revealed improvement in the satisfaction and the quality of life domain of activities in the nursing homes that deployed humanoid robots versus the nursing homes that did not deploy humanoid robots. The pre and post surveys conducted before and after the interactions with the robots showed 17.4% improvement in their happiness, 4.3% more cared for,10% less tired and 14.5% less frustrated after engaging in the activities with humanoid robots.ConclusionHumanoid robots and wearable sensors have proved to help improve the quality of life of elderly.

Humanoid Robots administering Cognitive Stimulation Therapy to help improve cognition and reduce neuropsychiatric disorders

AbstractBackgroundDementia is a progressive disease that causes a continuous decline in cognition. People affected with dementia are also at high risk for neuropsychiatric disorders requiring frequent therapy sessions. The current healthcare worker shortages have made finding a therapist challenging, resulting in increased hospital admissions due to an increase in neuropsychiatric disorders in people affected with dementia. To address this problem humanoid robots and wearable sensors were programmed to administer Cognitive Stimulation Therapy(CST), a therapy that doesn’t require a clinician to be administered. CST is an evidence based therapy that is administered twice a week for seven weeks. The wearable sensors track and monitor the physiological data and are able to predict neuropsychiatric symptoms. The robots interact, communicate and administer the therapy while the participants are wearing the sensors along with artificial intelligence algorithms that track the physiological data to help predict any neuropsychiatric symptoms.MethodA humanoid robot, Pepper was programmed to administer Cognitive Stimulation Therapy to be deployed in nursing homes to help improve cognition and also help alleviate neuropsychiatric symptoms. The protocol involves conducting a cognitive assessment using the MMSE prior to initiation of the Cognitive Stimulation Therapy. The Cognitive Stimulation Therapy is administered twice a week for seven weeks. At the end of the fourteen sessions the MMSE is administered again to measure the cognition levels. Additionally pre and post surveys for depression, quality of life, Pittsburgh sleep index/ sleep quality and activities of daily living are conducted to monitor the neuropsychiatric symptoms. During the entire seven weeks the participants physiological data is tracked and analyzed using artificial intelligence algorithms to predict neuropsychiatric symptoms. The combination of the humanoid robots and the wearable sensors work in sync to improve cognition and reduce behavioral and psychological symptoms of dementia..ResultThe robot is successfully programmed and tested in the lab setting. The study is successfully designed.ConclusionRobots can be employed to administer cognitive stimulation therapy to help improve cognition and reduce neuropsychiatric symptoms in people affected with dementia. Robots have the potential to address healthcare worker shortages.

Beyond burnout: Moral suffering among healthcare workers in the first COVID-19 surge

The U.S. is facing a national shortage of healthcare workers, as waves of clinicians quit their jobs or leave the profession entirely. Much of the public discourse around this exodus characterizes it as the result of widespread “burnout.” This study draws on in-depth interviews with 22 healthcare workers in New York City to gain deeper understanding of what is leading them to abandon their roles despite the abundant need for their services. It finds that “burnout” in healthcare may be largely explained by moral distress and moral injury inflicted on healthcare workers struggling to care for patients during the COVID-19 pandemic. After presenting a review of the recent literature on moral injury and moral distress, this study lays out five kinds of experiences that emerged during the interviews as the most salient contributors to moral distress, on the one hand, and moral injury, on the other, among healthcare workers. Taken together, these experiences are referred to as “moral suffering.” The key finding from this research is that moral suffering, even when undiagnosed and unnamed, affects HCWs’ ability to provide care and influences their decisions to leave the healthcare profession. Ultimately, this article suggests a need to rethink the ways in which moral distress and moral injury are applied in social scientific research and concludes by indicating how future research can promote the transformation of networks of injury in healthcare into networks of care.

Country ownership and sustainable programming of the HIV response in South Africa: A scoping review.

Concerns have arisen regarding the extent to which South Africa's HIV response can be country-owned and sustainable given substantial foreign investment and technical support. To assess the extent to which South Africa's national HIV response is country-owned. We conducted a scoping review of South African literature using the Global Health Initiative Framework for country ownership. South Africa has clear aspirations for what should be accomplished and strategies are aligned with national and international priorities. Although South Africa has leveraged community-based strategies to reach key populations (KPs), most are supported by international donors, which poses a sustainability challenge. Despite robust capacity strengthening and training programmes, South Africa continues to face healthcare worker shortages. While it is commendable that South Africa funds nearly 70% of the national HIV response, the funds mainly support HIV treatment. This may create dependency on international partners. South Africa appears to be progressing well along the spectrum of country ownership, but sustained efforts are required to combat HIV. Greater ownership over KP programming and prevention services are especially needed to achieve greater impact.

Balancing Routine and Pandemic: The Synergy of India's Universal Immunization Program and COVID-19 Vaccination Program.

The COVID-19 pandemic posed substantial challenges to healthcare systems globally and severely disrupted essential health services, including routine immunization programs. In India, these disruptions were exacerbated due to the sudden emergence of the pandemic and lockdown measures, leading to mass migrations and a shortage of healthcare workers. Caregivers' concerns about routine immunization sessions further compounded the problem, resulting in a sharp increase in zero-dose children. This review paper examines India's strategies for conducting one of the world's largest COVID-19 vaccination programs while effectively restoring and perpetuating its Universal Immunization Program (UIP). The UIP played a pivotal role in sustaining immunization services during the pandemic, ultimately improving immunization coverage compared to pre-pandemic levels. India's accomplishments in this regard are highlighted through key performance indicators, the reach of immunization services, a reduction in zero-dose children, and antigen-wise coverage. The paper also discusses the successful integration of COVID-19 vaccination within the UIP framework, underscoring the significance of existing infrastructure, technology, and capacity building. India's dedication to concurrently managing routine immunization and COVID-19 vaccination showcases the adaptability and resilience of its healthcare system. India's journey serves as a global example of efficient mass immunization during challenging times, emphasizing the importance of political will, healthcare infrastructure investment, skilled healthcare workforces, and comprehensive vaccination programs. In a world grappling with the dual challenge of COVID-19 and routine immunization, India's experience provides a roadmap for strengthening healthcare systems and promoting public health as the critical agenda in challenging times.

The impact of meaning in life and professional happiness on the turnover intention of health care workers: a cross-sectional study from China

IntroductionThe turnover and shortage of health care workers (HCWs) have been a worldwide problem for healthcare organizations. The primary aim of this study was to identify the factors influencing the intention of Chinese HCWs to leave their job, especially meaning in life and professional happiness.MethodsThis observational cross-sectional study, conducted among 1125 full-time HCWs, assessed demographic variables, meaning in life, professional happiness, and turnover intention by a survey. The survey was distributed to HCWs in three tertiary hospitals. The data were analyzed by T-tests, ANOVA, Kruskal–Wallis tests and hierarchical linear regression model.ResultsThere were statistically significant differences in turnover intention of HCWs by gender, age, role, educational level, years in practice, and number of monthly night shifts. HCWs’ meaning in life and professional happiness were negatively associated with the turnover intention. Furthermore, after controlling for other factors, meaning in life explained 3.7% of the turnover intention and professional happiness explained 13.4%.ConclusionIn our study, positive psychological factors were related to turnover intentions. Professional happiness was the strongest predictor. Thus, health human resource managers should foster positive psychology among HCWs to reduce their turnover.

Nurses’ job preferences for working in deprived areas in Tehran: a discrete choice experiment

BackgroundIn Iran, the issue of the nursing shortage and unequal distribution exist simultaneously. The shortage of healthcare workers is one of the most important concerns of the health systems. In addition, the disparity in the distribution of healthcare workers between large metropolises and remote or non-capital areas has become a serious concern and a top priority to address. We conducted this study to identify and create a sufficient understanding of the different financial and non-financial preferences of nurses for working in deprived areas.MethodsThis research was carried out in June and April 2022. It was carried out in three major phases. The factors influencing the nurses' job preferences were first discovered using qualitative methods. The second phase was conducting a pilot study and determining the best design for discrete choice experiment scenarios. The last phase involved publishing the questionnaire to gather information. Data were analyzed (discrete choice analysis) using JMP Pro 16 software.ResultsA desirable job for the participants (nurses) in this study would have a higher salary, work in a city, the Rasmi employment contract, a low workload, adequate workplace facilities, an appropriate work schedule, and 1 to 3 years spent on the assigned job to promote to a higher position. Willingness to pay (WTP) and the probability of selecting different attribute levels were also calculated and reported. For example, the highest amount of money that a nurse expected to be paid was for changing the geographical location of the workplace from a city to a deprived area. In this case, a nurse tends to receive 91.87 million IRR more to move from a city to a deprived area to work. This amount of money was by far the most among other WTPs.ConclusionThe results of this study indicated that nurses are willing to forego net income in exchange for other favorable characteristics of their working environment and conditions. This shows that a variety of actions are accessible to policymakers that can greatly enhance the working conditions for nurses. The WTP and the probability of selecting various attributes may help policymakers plan more effectively.

Healthcare workers’ freedom of movement in times of pandemics: an emerging norm of customary international law

BackgroundA shortage of healthcare workers can hinder the ability to prepare for and respond to global security threats caused by diseases that are prone to pandemics. During the COVID-19 pandemic, the shortage of healthcare workers became a growing concern worldwide. Recognizing these challenges, countries adopted measures to ensure healthcare workers’ freedom of movement in the face of the COVID-19 pandemic. As the WHO continues the negotiation process to reform the 2005 International Health Regulations and to adopt a new Pandemic Treaty, with one key provision relating to healthcare workers’ mobility, questions remain as to whether States will actually adopt a binding international legal instrument or whether its effectiveness will be watered down by the intrinsic vulnerabilities of an international legal system that has (too) often been unable to tame geopolitical interests. Considering these challenges, we assessed the emergence of a norm of customary international law allowing the free movement of healthcare workers during pandemics.MethodsOur study examined the laws and policies adopted during the COVID-19 pandemic concerning healthcare workers’ mobility in 10 countries, representing all continents. The country selection was based on regional representation and a preliminary analysis indicating their early adoption of measures related to healthcare workers’ mobility. Temporal limits were set. To gather relevant data, we employed various methods including research databases, media sources, and the COVID-19 Law Lab database.ResultsOur research identified and assessed instances of state practice and evidence of opinio juris to determine whether a norm of customary international law mandating states to ensure healthcare workers’ freedom of movement during pandemics exists.The findings indicate a strong consensus towards ensuring the free movement of healthcare workers in times of pandemics as a way to respond to outbreaks of disease. Within months, Argentina, Colombia, Kenya, South Africa, India, Japan, Spain, the United Kingdom, Canada, and the United States, ten nations representing most regions of the world, recognized, as law, the practice of excluding healthcare workers from prohibitions on movement.ConclusionUltimately, this discussion is critical for global health because if a norm does exist in this regard, it will further strengthen pandemic legal preparedness efforts. As such, it becomes clear that the reform of the 2005 International Health Regulations and/or the adoption of a new pandemic treaty will bolster the strength of this emerging norm of customary international law and crystallize it. These legal instruments would propel a norm that is already in the process of formulation into existence. Thus, crystallizing a norm that is otherwise emerging among states.

Enhancing care quality and accessibility through digital technology-supported decentralisation of hypertension and diabetes management: a proof-of-concept study in rural Bangladesh

ObjectiveThe critical shortage of healthcare workers, particularly in rural areas, is a major barrier to quality care for non-communicable diseases (NCD) in low-income and middle-income countries. In this proof-of-concept study,...

Abstract 243: Impacts and Effects of COVID‐19 on Acute Ischemic Stroke Treatment in North America

Introduction The goal of this research project is to investigate the impacts and effects of the COVID‐19 pandemic on acute ischemic stroke treatment in North America. Acute ischemic stroke is the most common type of stroke in North America accounting for 87%, and occurs when blood traveling to the brain is blocked by a clot or other structural barrier (CDC, 2023). The most common way to treat these strokes is a mechanical thrombectomy. Stakeholders note that COVID‐19 exacerbated accessibility to treatment for ischemic and other strokes by increasing the door‐to‐needle time by up to 26% early in the pandemic through the barriers it created and/or intensified. Methods NCBI PudMed database searches, along with interviews with a diverse array of stakeholders from North America, were conducted to analyze the overarching effects COVID‐19 had on stroke treatment. The stakeholders interviewed during this project include neurologists from Boston, Kentucky, and Texas, as well as a neurologist and a physician from Mexico City. Results The barriers to stroke treatment discovered through this research project included staff shortages, a lack of patient awareness of stroke symptoms, and region‐specific geographic discrepancies increasing door‐to‐needle time. Among patients with an ischemic stroke, thrombectomy administration decreased by up to 25% in February 2020 compared to February 2019 (Zhao et al., 2020). This is likely due to an increasing focus on COVID‐19 treatment during the pandemic. In addition, hospital admissions related to stroke dropped by up to 46% in 2020 compared to 2019 (Sharma et al., 2020). Patients treated with thrombolysis during the pandemic were also required to wait upwards of 4 minutes longer for treatment, resulting in a small but significant delay in thrombolysis (Siegler et al., 2020). According to various stakeholders in North America, COVID‐19 also reportedly caused healthcare workers to become overworked and underpaid, creating pockets of highly competitive micro‐markets for workers. Regarding education, increased social isolation due to COVID‐19 shifted focus away from spreading stroke awareness, with more people being unfamiliar with the signs of stroke. Additionally, for populations relying on one stroke facility, hospital location and distance barriers delayed treatment time, increasing door‐to‐needle time in those regions, and dramatically decreasing the patient’s odds of survival. Stakeholders in urban areas note that door‐to‐needle time in major hospitals in the United States has decreased by about 3 minutes, and the administration of mechanical thrombectomies has increased by up to 25% following the pandemic. Conclusion The health issues caused by the incidence of stroke have amplified following the pandemic. This may be linked to healthcare worker shortages, wage gaps, geographical discrepancies, and decreased patient education. A continuing area of concern in the healthcare community is the lack of availability of thrombectomies and equipment required for effective stroke treatment in rural regions. Geographic and accessibility issues could be tackled by increasing the number of mobile stroke units and stroke centers in rural areas. Additionally, educational initiatives aimed at at‐risk populations and youth about the symptoms and types of strokes will help spread stroke awareness.

Improvement in medical consultation by using an AI-powered symptom assessment application (SAA)

Abstract Introduction The shortage of healthcare workers affects countries worldwide and primarily affects people in rural areas. Although Romania trains a high number of physicians, the absence of effective retention and motivation policies leads many of them to opt for higher-paying jobs in other countries. As a result, patients experience long travel and wait times. Our study assessed if using an AI-powered SAA, Ada, in a waiting room is feasible for patients, can improve consultation efficiency, and enhance patient-physician communication. Methods This study was conducted in the waiting room of a GP in Cluj-Napoca, Romania, from May to July 2022. Consenting patients completed a symptom assessment while waiting for their consultation. A survey was administered to patients, the study nurse, and physician to gather feedback on their experience. Results The study enrolled 49 patients (29 women, 20 men). Most of the patients found the questions in Ada to be of appropriate length (94%), understandable (90%), and engaging (86%). Patients using Ada felt that they could express all their health issues (79%) and explain their symptoms better to the doctor (84%). They also felt more confident to discuss symptoms that their doctor may have missed (86%) and would use Ada again (84%). Most patients completed the assessment independently (65%). The study physician reported that 70% of patients who used Ada answered questions quickly and asked more questions related to their symptoms. Discussion By providing personalized health information, Ada prepared patients for their consultation, resulting in improved patient engagement and facilitation of clinical conversation. Incorporating a SAA into routine patient care has the potential to enhance the quality of medical care and reduce consultation time, thus, compensating for physician shortages. Further studies to determine the efficacy of integrating SAA with telemedicine can further help tackle the issue of uneven health workforce distribution. Key messages • Patients found Ada, a mobile AI-powered symptom assessment application, easy to use, understandable, and would use it again. The app helped prepare patients for their doctor’s consultation. • Doctors reported increased patient engagement in consultation among users of Ada. These apps can help save time when used by patients in the waiting room and the results are shared with the doctors.

Turnover Intention determinants of EU hospital doctors and nurses: results from the METEOR survey

Abstract Background To contrast effectively the shortage of healthcare workers in the EU, it is essential to find the determinants of the intention to leave the hospital (ITL) by analyzing the role of burnout (BO), job satisfaction (JS), and other individual characteristics and working-related variables. This study aims to estimate the prevalence of ITL for physicians and nurses in Europe, to investigate the determinants of ITL, and to suggest possible job retention policies. Methods The METEOR survey is a cross-sectional study on 8 hospitals of Belgium, The Netherlands, Italy, and Poland. Data collection was from May to September 2022. The theoretical model was the Job demands-resources model and validated questionnaires were used. ITL was assessed as agreement with the sentence “I intend to leave my current hospital for another one in the near future” and the response items were scored on a 5-point Likert scale. Two multivariable logistic models for ITL were estimated for both physicians and nurses, including JS, BO, and workers’ individual and hospital characteristics as covariates. Results The study included 381 physicians, and 1351 nurses. Physicians and nurses who agreed with ITL were 17% and 9%, respectively. Logistic models for physicians showed that by increasing JS (OR = 0.31, p &amp;lt; 0.001) as well as age (OR = 0.91, p &amp;lt; 0.001), and living with partner (vs alone) (OR = 0.56, p &amp;lt; 0.039), the odds of ITL decreased. For nurses, the model revealed that by increasing JS (OR = 0.27, p &amp;lt; 0.001), as well as age (OR = 0.97, p &amp;lt; 0.001), and equipment (OR = 0.56, p &amp;lt; 0.039), the odds of ITL decreased. Conclusions Our survey showed high prevalence of ITL for both nurses and physicians. Recruitment and retention policies, at the micro/meso/macro-levels are needed. It is strategic to support healthcare workers’ categories at higher risk of ITL, such as the younger physicians and nurses. Key messages • Our survey found significant individual and work environment characteristics playing a role to explain ITL. • We provide an estimate of ITL prevalence of hospital physicians and nurses in EU.