Community Hospital Staff Research Articles

The Rhetoric and Reality of Choice and Autonomy When Older People Are Discharged from Community Hospital at the End-of-Life in England: A Constructivist Grounded Theory Study

There has been an increasing acknowledgement in the UK of the importance of recognising frailty as a condition that leaves older people vulnerable to dramatic, sudden changes in health triggered by seemingly small events. In policy, the approach to managing frailty is often an emphasis on staying well with limited consideration to frailty as an end-of-life phase. Meanwhile, discharge from hospital continues to be complex. Overstretched acute hospitals are juxtaposed with community and social services that struggle to keep up with the demand of those being discharged and the labelling of older people as “bed blockers” at the centre of delayed discharges. This paper reports a study underpinned by constructivist grounded theory methodology, with the aim of exploring the experiences and perceptions of stakeholders. Semistructured interviews were conducted with 57 participants including patients, their informal carer(s), community hospital staff, community health professionals, and care home managers. The core category of “the drive to discharge conveyor belt” was derived from data analysis. A significant finding of this study was that of the carer, their burden, and their intrinsic role in facilitating discharge, filling in gaps in services, coordinating services, and enabling the patient to stay at home, with little consideration of their choices or autonomy. The “drive to discharge” impacts older people, their informal carers, and health professional. This study suggests how they may be supported, through an ethical lens.

Knowledge, attitudes and practices among medical workers toward outpatient diabetes information platform

BackgroundThis study aimed to assess the knowledge, attitudes and practices among medical workers toward outpatient diabetes information platform.MethodsThis web-based cross-sectional study was conducted between May 2023 and June 2023 at the First Hospital of Zhangjiakou, China. A self-designed questionnaire was developed to collect demographic information of medical workers, and assess their knowledge, attitudes and practices toward outpatient diabetes information platform.ResultsA total of 685 questionnaires were collected. Among the participants, 603 (88.03%) were female, 432 (63.07%) work in a tertiary hospital, 548 (80.00%) have a bachelor degree, 270 (39.42%) of them work in the department of internal medicine and 315 (45.99%) of them received previous training on outpatient diabetes information platform. The mean knowledge, attitudes and practices scores were 4.32 ± 1.27 (possible range: 0–6), 56.76 ± 5.72 (possible range: 14–70), and 32.22 ± 8.42 (possible range: 9–45), respectively. 350 (51.09%) of them have sufficient knowledge, 168 (24.53%) have positive attitudes and 395 (57.66%) have active practices. Pearson correlation analysis showed that knowledge was positively correlated with attitudes (r = 0.397, P < 0.001), and attitudes were positively correlated with practices (r = 0.306, P < 0.001). Multivariate analysis showed that primary hospital (OR = 0.32, 95% CI: 0.14–0.71, P = 0.005), secondary hospital (OR = 0.48, 95% CI: 0.32–0.72, P < 0.001), doctor (OR = 2.44, 95% CI: 1.39–4.28, P = 0.002) were independently associated with sufficient knowledge. Knowledge (OR = 1.49, 95% CI: 1.29–1.73, P < 0.001), community hospital staff (OR = 0.21, 95% CI: 0.05–0.88, P = 0.032) were independently associated with positive attitudes. Attitudes (OR = 1.13, 95% CI: 1.09–1.17, P < 0.001), junior college (OR = 1.72, 95% CI: 1.07–2.77, P = 0.026) were independently associated with active practices. The structural equation model demonstrated that knowledge had a direct effect on attitudes (path coefficient = 0.521, P < 0.001), and attitudes had a direct effect on practices (path coefficient = 0.542, P < 0.001). Moreover, the type of hospital had a direct effect on knowledge (path coefficient = 0.085, P < 0.001). Additionally, previous training on the outpatient diabetes platform had direct effects on attitudes (path coefficient = 0.191, P < 0.001) and practices (path coefficient = 0.184, P < 0.001).ConclusionThese findings revealed that medical workers have insufficient knowledge, positive attitudes and inactive practices toward the outpatient diabetes information platform. Comprehensive training programs are needed to improve medical staff’s practices in this area.

Exploring the delivery of end-of-life care by community nurses.

To understand what aspects of care and support were important to bereaved relatives and to explore the experiences of nurses delivering end of life care. Interviews and focus groups were undertaken with 17 family members, 31 community nurses and 13 community hospital staff. A workshop was held with 6 family members, 13 community nurses and 3 hospital nurses to review findings and make recommendations for improvement. Four themes were identified: relationships and being treated as a whole person; being able to make choices; getting help when and where it is needed; specialist advice and care, especially at the very end of life. Seeking feedback from relatives was valued both by family members and the staff and has provided an effective model to lead to focussed improvements.

Use of telemedicine to support neonatal resuscitation

Neonatal tele-resuscitation programs use synchronous audio-video telemedicine systems to connect neonatologists with community hospital care teams during high risk resuscitations. Using tele-resuscitation, remote neonatologists can visualize and actively guide the resuscitation and stabilization of at-risk neonates. The feasibility of tele-resuscitation has been proven, and early evidence suggests that tele-resuscitation improves the quality of care, reduces unnecessary medical transports, and may generate a net savings to the health system. Community hospital staff and remote neonatologists are highly satisfied with tele-resuscitation programs. Tele-resuscitation presents an opportunity to improve healthcare delivery for neonates regardless of their birth location. The neonatology community should work to identify and rigorously study the value tele-resuscitation can bring to neonates, their families, and care teams.

Teaching undergraduate students in rural general practice: an evaluation of a new rural campus in England

One approach to facilitating student interactions with patient pathways at Keele University School of Medicine, England, is the placement of medical students for 25% of their clinical placement time in general practices. The largest component is a 15-week 'student attachment' in primary care during the final year, which required the development of a new network of teaching practices in a rural district of England about 90 km (60 mi) from the main campus in North Staffordshire. The new accommodation and education hub was established in 2011-2012 to enable students to become immersed in those communities and learn about medical practice within a rural and remote context. Objectives were to evaluate the rural teaching from the perspectives of four groups: patients, general practice tutors, community hospital staff and students. Learning outcomes (as measured by objective structured clinical examinations) of students learning in rural practices in the final year were compared with those in other practices. Data were gathered from a variety of sources. Students' scores in cohort-wide clinical assessment were compared with those in other locations. Semi-structured interviews were conducted with general practice tutors and community hospital staff. Serial focus groups explored the perceptions of the students, and questionnaires were used to gather the views of patients. Patients reported positive experiences of students in their consultations, with 97% expressing willingness to see students. The majority of patients considered that teaching in general practice was a good thing. They also expressed altruistic ideas about facilitating learning. The tutors were enthusiastic and perceived that teaching had positive impacts on their practices despite negative effects on their workload. The community hospital staff welcomed students and expressed altruistic ideas about helping them learn. There was no significant difference between the rurally placed students' objective structured clinical examination performance and that of their peers in other locations. Some students had difficulty with the isolation from peers and academic activities, and travel was a problem despite their accommodation close to the practices. Students valued the learning opportunities offered by the rural practice placements. The general practice tutors, patients and community hospital staff found teaching to be a positive experience overall and perceived a value to the health system and broader community in students learning locally for substantial periods of time. The evaluation has identified some student concerns about transport times and costs, social isolation, and access to resources and administrative tasks, and these are being addressed.

Accuracy of Fine Needle Aspiration Cytology of Solitary Thyroid Nodules in Tertiary versus Community Hospital

Background: Fine needle aspiration cytology (FNAC) is considered as the gold standard diagnostic test for the diagnosis of solitary thyroidnodules (STN). Aim: To compare the accuracy of FNAC in diagnosis of thyroid nodules in Al Khor community hospital versus that of tertiary hospital (Hamad General Hospital) in Qatar. Methods: Retrospective, descriptive and comparative study of 320 patients of any age group and both sexes who have thyroid nodules and are subjected to surgical treatment [160 patients from Al Khor community hospital (group A) and 160 patients from Hamad General Hospital (group B)] during the period from May 2005 to Dec 2012. Each group was subdivided into free hand FNAC (done by physicians) and ultrasonography guided FNAC. All samples were prepared in the same histopathology laboratory and interpreted by the same histopathology team. Results: Free hand FNAC in group A and group B achieved a sensitivity of (10% vs. 50%), specificity of 93% in both groups, positive predictive value of (25% vs. 17%), negative predictive value of (82% vs. 98%), and a total accuracy of (82% vs. 94%) respectively, while US guided FNAC in group A and group B achieved a sensitivity of (10% vs. 86%), specificity of (98% vs. 94%), positive predictive value of (50% vs. 60%), negative predictive value of (86% vs. 98%), and a total accuracy of (85% vs. 97%) respectively. Conclusion: The overall accuracy of FNAC of STN in tertiary hospital was better than community hospital. More training is required for community hospital staff.

Revenue, relationships and routines: The social organization of acute myocardial infarction patient transfers in the United States

Heart attack, or acute myocardial infarction (AMI), is a leading cause of death in the United States (US). The most effective therapy for AMI is rapid revascularization: the mechanical opening of the clogged artery in the heart. Forty-four percent of patients with AMI who are admitted to a non-revascularization hospital in the US are transferred to a hospital with that capacity. Yet, we know little about the process by which community hospitals complete these transfers, and why publicly available hospital quality data plays a small role in community hospitals' choice of transfer destinations. Therefore, we investigated how community hospital staff implement patient transfers and select destinations. We conducted a mixed methods study involving: interviews with staff at three community hospitals (n = 25) in a Midwestern state and analysis of US national Medicare records for 1996–2006. Community hospitals in the US, including our field sites, typically had longstanding relationships with one key receiving hospital. Community hospitals addressed the need for rapid AMI patient transfers by routinizing the collective, interhospital work process. Routinization reduced staff uncertainty, coordinated their efforts and conserved their cognitive resources for patient care. While destination selection was nominally a physician role, the decision was routinized, such that staff immediately contacted a “usual” transfer destination upon AMI diagnosis. Transfer destination selection was primarily driven at an institutional level by organizational concerns and bed supply, rather than physician choice or patient preference. Transfer routinization emerged as a form of social order that invoked tradeoffs between process speed and efficiency and patient-centered, quality-driven decision making. We consider the implications of routinization and institutional imperatives for health policy, quality improvement and health informatics interventions.

Investigation of the attitude of basic hospitals' female psychiatric nursing staff to mental illness and its influence factors

Objective To understand the attitude of psychiatric nursing staff to mental illness.Methods 190 and 76 female nursing staff from a community hospital in Beijing and a grade Ⅱ psychiatric hospital respectively were investigated with the attitude to mental illness questioniare.Results Significantly higher scores were obtained for the nursing staff in community hospital than in the grade Ⅱ psychiatric hospital in terms of the cause of the mental illness,hope for treatment,social value of the patients and avoidance of patients questions ( t =3.476,4.322,2.080,2.683,1.918,respectively; P＜0.05 ).Nursing staff from grade Ⅱpsychiatric hospital had significantly higher score in violence and aggressive behavior of mental patients[ (68.92±8.05)vs(72.24±9.361) ;t =-2.867,P＜0.01].Of all 266 nursing staff,working experience was shown positive correlated with the hope for treatment ( r =0.198,P ＜ 0.01).Working experience was negative correlated with avoidance of patients questions ( r =-0.295,P＜0.01) and discrimination to the patients and their families ( r=-0.149,P＜0.05 ).Professional ranking was negatively correlated with the restriction to the patients (r=-0.147,P＜0.05 ).Multivariate regression anaylasis showed the level of the hospital in evloved in the regression equation of cause of illness,violence and aggressive behavior of mental patients,social value of the patients,and avoidance of patients questions.Conclusions Even with increasing emphasis on psychological problems,understanding and acceptance of the mental illness for the community nursing staff and staff with less working experience would need to be increased to improve community-based rehabilitation work. Key words: Female; Nursing staff; Attitude; Basic hospital

Education in geriatric medicine for community hospital staff

Community hospitals provide many services for older people. They are mainly managed by nursing staff, with some specialist input. Little is known about education provided in these facilities. Most education in geriatric medicine is provided in hospitals, despite most elderly care being provided in the community. The authors surveyed senior nursing staff in Irish community hospitals to examine this area in more detail. Staff in all 18hospitals in the Health Service Executive (South) area were invited to participate. The response rate was 100%. Sixteen of the 18 respondents (89%) felt staff did not have enough education in geriatric medicine. Just over half of hospitals had regular staff education sessions in the area, with a minority of sessions led by a geriatrician, and none by GPs. Geriatrician visits were valued, but were requested only every 1-3 months. Staff identified challenging behaviour and dementia care as the areas that posed most difficulty.

Why Not Hospital Care?

Back to table of contents Previous article Letter to the EditorFull AccessWhy Not Hospital Care?E. Eliot Benezra, M.D.E. Eliot BenezraSearch for more papers by this author, M.D.Published Online:7 Mar 2003https://doi.org/10.1176/pn.38.5.0041Those of us who have been managing and treating psychiatric patients for some time are well aware of the difficulties, restrictions, and short-sidedness imposed by managed care. The less-experienced doctors and those still in training may not be aware of the therapeutic consequences of the current trend in hospital psychiatry.Compliance with managed care criteria has forced our community hospital staff to justify admissions to the inpatient services if patients show either serious self-destructive (suicidal) or violent (homicidal) acts.The intensive, comprehensive, therapeutic environment and constructive milieu program provided in an inpatient psychiatric service is intended to protect patients from perpetuating the pathogenic conditions in which they live and so help them find ways for a healthier life. To allow patients to stay with the persistent conditions of the physical and psychiatric traumata unfortunately may cause more prolonged, serious, and harmful consequences and certainly more expense.Imagine allowing a patient to be subjected to harmful allergens, malnutrition, sources of bacterial infection, or destructive relationships—that would certainly be considered abuse of the patient’s body and mind. By the same token, psychiatric patients who are suffering from severe states of depression, anxiety, misperceptions, delusions, hallucinations, and so on should have the opportunity for intensive therapeutic intervention. As one psychiatric patient who has frequent periods of depression, alcohol abuse, inability to go to work, and staying away from his family, said, “My five-day stay in the hospital was a turning point in my life. I couldn’t have done it any other way. I now know better how to go on.” And, indeed, he continued to function well in his professional position and as a family man.Should we not be compassionate doctors and allied professionals who care for our patients and their families more effectively and aggressively also in a hospital setting?Oak Brook, Ill. ISSUES NewArchived

Clinical guidelines in community hospitals.

The objective of this study was to investigate the attitudes of community hospital staff towards clinical guidelines. Twenty four staff members from 11 hospitals in one community trust were interviewed. The participants, primarily F and G grade nurses, but also some physiotherapists and occupational therapists, were asked about their use of, attitudes to and sources of clinical guidelines. A simple gap analysis identified that participants were familiar with local clinical guidelines and generally felt positively about them, but had a few reservations. However, they were generally unaware of national guidelines. This study has identified the reality of implementing and raising awareness of clinical guidelines in practice.

A regionalized perinatal continuing education programme: successful adaptation to a foreign health care system and language.

Much of the decline in perinatal mortality over the past two decades in the United States has been attributed to regionalization of perinatal care. Outreach education from regional medical centres to community hospitals is an essential component of regionalization. The Perinatal Continuing Education Program (PCEP) has been successfully used for outreach education in more than 30 states since 1979. This project tested the efficacy of implementing the PCEP strategy in Poland. PCEP was adapted to Polish conditions, translated, and implemented in four phases. The scheme allowed gradual transfer of ownership to Polish leaders and use of the existing regional structure to disseminate information from regional centres to community hospitals. Evaluation included measures of programme use (participation and completion rates) and acceptance (participant evaluation forms), cognitive knowledge (pre- vs. post-tests), and patient care (chart reviews). Of 2093 doctors, nurses and midwives who began, 1615 (77%) completed the programme, with higher completion by regional centre than community hospital staff. All participant groups responded favourably to the materials and expressed moderate confidence in their mastery of the information and skills. Test scores improved significantly for all phases and for all disciplines, with baseline and final scores consistent with degrees of previous professional education. Large baseline and inter-hospital variations in chart review data restricted analysis of care practices. A comprehensive perinatal education programme can be successfully transferred to a foreign health care system. We believe the following to be particularly important: multidisciplinary instructors and students; a self-instructional format; content aimed at practice rather than theory; and an organized implementation strategy co-ordinated by local personnel.

Perinatal outreach education. A continuation strategy for a basic program.

The Perinatal Continuing Education Program consists of a nine-month intervention with community hospital nurses, physicians, and support personnel. Components include a hospital self-inventory of resources, coordination by community hospital staff, a skills workshop, and self-instructional books. This article outlines a follow-up strategy to the basic program and describes changes in community hospital knowledge and care practices that occur between programs. The follow-up program presented includes a modified coordinators' workshop, identification of updated self-instructional materials for careful study by past participants, and a self-survey of "recommended routines" intended to facilitate change in hospital policies. Otherwise, except for the deletion of the resources inventory, the follow-up program is similar to the basic program. Testing of participants and detailed review of 1435 hospital charts at sequential time periods revealed a decline in mean knowledge scores between programs, higher scores by new participants before follow-up when compared to pre-basic program, a plateau of patient care quality between programs, and a further improvement in patient care quality after the follow-up program. We conclude that a follow-up program is best accepted after three years but that timing is not critical. Evaluation measures suggest that new knowledge and care practices become institutionalized as a result of this program and that altered care practices are not simply a result of improved performance by individuals.

Community Hospital and Medical School Linkage

The community hospital has become a major site for the formal continuing education of physicians. In California, hospitals currently supply more than 40% of reported continuing medical education hours, and there is every likelihood this trend will be repeated across the country. These findings were recently reported in January 1977 by the Department of Continuing Education of the California Medical Association. Medical schools serve as important resources for these programs, supplying faculty lecturers or acting as speakers' bureaus. Occasionally, short-term residencies or fellowships at the medical school are provided for community hospital staff physicians. 1,2 These relationships have been limited, however, and many community hospitals do not have the resources or staff to organize educational activities effectively. There is rich potential for cooperative efforts to develop effective practice-related continuing education at the hospital site, with the medical school providing assistance with educational planning, including needs identification and evaluation, resources and