Staff Team Research Articles

‘Helper’ or ‘punisher’? A qualitative study exploring staff experiences of treating severe and complex eating disorder presentations in inpatient settings

BackgroundEating disorders have been described as challenging to treat, with the most severe cases requiring inpatient admission. Previous studies have explored staff’s perspectives on eating disorders and service provision. However, little is currently known about how staff experience working with severe and complex eating disorder presentations in inpatient settings and how they may be impacted by their work.AimsThis study aimed to explore the experiences of staff who contribute towards the treatment of severe and complex eating disorder presentations in inpatient settings.MethodsParticipants were recruited purposively via clinical contacts and a private hospital group in the UK. Semi-structured interviews were conducted, recorded, transcribed verbatim, and analysed guided by the principles of reflexive thematic analysis.ResultsInterviews were completed with twelve staff members, including frontline nursing staff and multidisciplinary team (MDT) staff, from both private and public specialist settings. Participants expressed uncertainty about the treatment approach for service-users with severe and complex presentations. As service-users often resisted treatment, participants felt positioned as a ‘punisher’ rather than a ‘helper’ in initial treatment stages. Many had experienced physically and emotionally impactful events at work, including violence and aggression, as well as serious incidents of self-harm and suicide attempts. Participants generally found support in their colleagues, however considered organisational support insufficient.ConclusionsThis research highlights an urgent need to consider the wellbeing of staff who works in eating disorder inpatient settings, as well as their support needs. Retention and recruitment strategies should be reviewed to reduce staff turnover and improve patient care. Further research should investigate whether specialist inpatient staff are impacted by symptoms of vicarious or direct trauma, moral injury and compassion fatigue.

Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement

BackgroundDischarge to Assess (D2A) emerged as a critical process during the COVID-19 pandemic facilitating patient flow within hospitals, however research on the post-discharge community services of this pathway remains limited....

“Thin markets”: Recruitment and retention of disability staff to support effective post‐parental care planning in rural Australia

AbstractThe life expectancy of persons with intellectual disability is increasing, and this is often occurring concurrently with the aging of their long‐term parental carers. Research in both Australia and around the world indicates that proactive post‐parental care planning is not widely implemented, and transitions primarily happen suddenly following a personal crisis for the primary caregiver. Little focus in Australia has been placed on identifying the barriers that inhibit post‐parental care planning in rural areas, specifically in the context of the newly implemented National Disability Insurance Scheme. This paper examines the factors that limit disability services and their staff in supporting successful post‐parental care planning for individuals with intellectual disability and their aging carers in rural South Australia. Small focus groups were conducted with three groups of rural disability support workers using online technologies to assist with the participants' geographic disparity. A semi‐structured interview guide was developed prior to commencement and was used to initiate discussions on key points. A thematic analysis methodological approach was used for data analysis. There were three themes identified through the analysis; Recruitment; Provision of Care; and Retention. The key findings relating to these themes are presented and supported with exemplar quotes. This research proposes three recommendations for policy or practice change: developing a national advertising campaign for new disability staff that positively emphasizes the high‐level skillset need for proactive planning; supporting rural disability providers to collaborate to establish shared teams of staff with expertise in post‐parental care planning; and, using incentive payments to retain staff with these invaluable skillsets in the disability sector.

Exploration the Tea Industry Development Strategy --Taking Honey Snow City as an Example

With the development of economic globalization and information technology, the living standard and consumption level of residents have been significantly improved, and tea has become an indispensable thing in people's daily lives. As a leader in the affordable tea industry, Honey Snow City must have its own excellent business model. Taking the case of Honey Snow City, this paper first adopts the SWOT model to analyze its advantages such as low price, high brand recognition and superior geographical location, while its disadvantages include fewer products, obvious seasonality and fierce competition in the tea industry compared with other brands. The threat is that there are more and more competitive brands in the tea industry, the low price of products is difficult to maintain, and the products are easy to imitate and replaced by peers. The opportunity is that Honey Snow City has an excellent staff team, consumers have a high acceptance of the brand, and the main consumer group is a large number of students; Then it analyzes its development strategy, and according to its differentiated strategy development, it can be concluded that its development presents a vertical layout, and then horizontal perfection of the inverted "T" development mode; Finally, the paper studies the optimization strategy of enterprise management under the differentiation strategy, hoping to draw lessons for other businesses in the tea industry and formulate a marketing strategy suitable for their own development.

Abstract C104: Addressing health disparities: Enhancing knowledge and screening practices for liver disease risk factors among African Americans

Abstract Background: Liver cancer poses a significant health burden globally, with racial and ethnic disparities in its incidence. Among these disparities, the Black population in the United States faces a heightened risk of liver cancer due to the higher prevalence of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. This study aimed to evaluate the effectiveness of a culturally tailored educational intervention designed to enhance awareness of liver cancer prevention and screening among at-risk populations. Methods: Descriptive statistics were used to characterize participant demographics and clinical factors. Paired t-tests assessed the difference in knowledge scores before and after the intervention. Poisson regression with robust variance estimation determined the association between physicians' recommendations for testing and patients receiving blood tests. Results: The study included 137 African American participants. Prior to the intervention, the majority were aware that casual contact does not transmit HBV or HCV (79.6%) and that sharing needles for tattoos or drug injection can transmit the viruses (77.4%). The mean knowledge score increased significantly from 6.61 pre-intervention to 8.44 post-intervention (p-value<0.001). Poisson regression analysis showed that African American adults were less likely to receive physician recommendations for blood tests for HBV (RR=0.95, 95%CI:0.87,1.04) and HCV (RR=0.91, 95%CI:0.83,1.00) compared to other racial/ethnic groups. Conclusions: The culturally tailored educational intervention effectively improved knowledge of HBV and HCV among African American participants, indicating the importance of culturally sensitive programs in reducing liver cancer disparities. Efforts to increase awareness of liver disease and promote testing within the healthcare system are crucial for reducing the morbidity and mortality associated with HBV and HCV infections among African Americans. Character count (with spaces): 1,963 Acknowledgment: This study was supported by TUFCCC/HC Regional Comprehensive Cancer Health Disparity Partnership, Award Number U54 CA221704(5) from the National Cancer Institute of National Institutes of Health (NCI/NIH) and by NIGMS/NIH award # 1SC3GM131949[GXM1] . The author team would like to thank Community Advisory Board members, leaders, and staff members for collaborating with community/faith-based organization partners. We also acknowledge the research team staff of Planning Evaluation Core under TUFCCC/HC Regional Comprehensive Cancer Health Disparity Partnership for their support and contribution for their support and contributions to Community Outreach Core's data management. Its contents are solely the authors' responsibility and do not necessarily represent the official views of the NCI/NIH or the NIGMS/NIH. Citation Format: Jade A. Truehart, Thoin F. Begum, Keshanti Bruce, Lin Zhu, Ming-Chin Yeh, Evelyn Gonzalez, Marilyn A. Fraser, Ada Wong, Steven Zhu, Nathaly Rubio-Torio, Grace X. Ma, Yin Tan. Addressing health disparities: Enhancing knowledge and screening practices for liver disease risk factors among African Americans [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C104.

Palliative Extubation in Pediatric Patients in the Intensive Care Unit and at Home: A Scoping Review.

This scoping review is aimed at systematically mapping the evidence on palliative extubation in the pediatric intensive care unit. MEDLINE, EBSCO, and Cochrane databases were searched for articles published between January 2018 and December 2022, in English. Critical appraisal of sources of evidence was done using the Joanna Briggs Institute tools. PRISMA guidelines for scoping reviews were followed. Six studies were included, with 366 patients, from the USA (n = 4), Brazil (n = 1), and Germany (n = 1). Three were high-quality studies, two were moderate, and one was a low-quality study. Most studies were retrospective analysis; two were narrative approaches; two were evidence-based recommendation and quality improvement project; one study was a prospective intervention. Symptom control is crucial pre- and postextubation. A checklist (symptom management and family support) and a postdebriefing template improve team communication and staff support postextubation. Critical care transports from the hospital are feasible to provide extubation at home. A framework addressing common planning challenges and resource management is recommended for extubation at home. The provision of pediatric palliative extubation is necessary since futile measures and prolongation of suffering violate the principle of nonmaleficence. Future research on this subject will result in more benefits for patients, parents, and professionals.

Implementation of programmes for the transition of adolescents to adult care

Up to 15–20% of adolescents have a chronic health problem. Adolescence is a period of particular risk for the development or progression of chronic diseases for both individuals with more prevalent conditions and those affected by rare diseases. The transition from paediatric to adult care begins with preparing and training the paediatric patient, accustomed to supervised care, to assume responsibility for their self-care in an adult care setting. The transition takes place when the young person is transferred to adult care and discharged from paediatric care services. It is only complete when the youth is integrated and functioning competently within the adult care system. Adult care providers play a crucial role in welcoming and integrating young adults. A care transition programme can involve transitions of varying complexity, ranging from those required for common and known diseases such as asthma, whose management is more straightforward, to rare complex disorders requiring highly specialized personnel. The transition requires teamwork with the participation of numerous professionals: paediatricians and adult care physicians, nurses, clinical psychologists, health social workers, the pharmacy team and administrative staff. It is essential to involve adolescents in decision-making and for parents to let them take over gradually. A well-structured transition programme can improve health outcomes, patient experience, the use of health care resources and health care costs.

Recovery Methods in Basketball: A Systematic Review.

Although different strategies have been implemented to manage recovery-fatigue status in athletes, there is still a lack of consensus on which recovery protocols have the greatest impact and effectiveness when implemented with basketball players, including both physiological and psychological recovery methods. Thus, the purpose of this systematic review is to: (a) determine which recovery methods attain the greatest benefit in restoring the process of attenuating fatigue and (b) provide sports practitioners with guidelines on how some of the most effective recovery strategies can be used to optimize athletes' recovery and ultimately enhance their performance. Using the PRISMA guidelines, a total of 3931 research reports were obtained through four database searches (i.e., PubMed, Scopus, Cochrane, and Web of Science), from which only 25 met the inclusion and exclusion criteria. The recovery protocols analyzed in this systematic review were: sleep, nutrition, hydration, ergogenic aids, cold-water immersion, compression garments, massage, acupuncture, tapering, mindfulness, and red-light irradiation. The results revealed that all recovery strategies are capable of attenuating fatigue and enhancing recovery in basketball players to a certain degree. However, an individualized approach should be promoted, where a combination of proactive recovery modalities appears to result in the most rapid rates of recovery and athletes' ability to maintain high-level performance. Recovery should be programmed as an integral component of training regimens. Also, cooperation and communication between coaches, players, and the rest of the team staff members are essential in minimizing the risk of non-functional overreaching or injury and optimizing basketball players' on-court performance.

University and local recyclable material cooperative – building bridges around e-waste

Abstract An e-waste outreach project was developed with two overriding goals: (1) to strengthen the partnership between the university and the local recyclable material cooperative, which has been carrying out actions aimed at supporting the work of the Cooperative, and (2) to collaborate in the expansion of environmental education activities in the process of social and economic insertion of collectors and the reduction of environmental impacts. During this process, the materials and corresponding activities related to the theoretical and practical course followed by the cooperative workers were developed by a transversal team of (under)graduate students, faculty, and staff from the Chemistry, Electric Engineering, and Public Administration areas. In addition, social media materials were created to sensibilize and engage the university community regarding effective e-waste awareness, to adhere to the voluntary drop-off point of e-waste collection, and to address the issues that can affect our environment and health if e-waste is sent to landfills. It was an example of how chemistry contributes to the Sustainable Development Goals through an outreach project.

The Regulation Model of Public Services Based on The Integrity Zone in The Religious Higher Education in Indonesia

Since 2020, Indonesian Ministry of Religious Affairs commits to build the integrity zone in all its work units. Universitas Islam Negeri Maulana Malik Ibrahim Malang has been pointed to be the pilot project of The Integrity Zone Establishment in 2020 under the Ministry of Religious Affairs’ supervision. The emerged problem is that there is no Minimum Service Standard (MSS) as the requirement of integrity zone made by rector. This is a juridical-empirical study by applying qualitative approach. The primary data were from interview and Focus Group Discussion with structural team and academic staff who are directly involved in services in the said university. The FGD results reveal that the MSS is made based on The Organization and Work Procedures of UIN Malang, and that it is related to services in Tri Dharma both academic and non-academic. The MSS of UIN Malang must refer to Permen PAN-RB No. 10 of 2019 on the amendment to Permen PAN-RB No. 52 of 2014 concerning The Guidelines to Establish an Integrity Zone towards a Corruption Free Area and a Clean and Serving Bureaucratic Area in a Government Institution. The service regulation is also made based on international standard ISO 37001: 2016 as an anti-bribery management system that is able to provide access for complaint on bribery. This article is expected to be the policy reference for services in the State Religious Higher Education in Indonesia which follows the service standard of the integrity zone and international standard so they can lessen the corruption and collusion in the serving process.

Abstract 17246: Using Alerts vs Automated Tools to Better Document CHADS2-VASc Scores in Patients Hospitalized With Atrial Fibrillation

Introduction: Atrial fibrillation (Afib) is the most common cardiac arrhythmia in the United States and a significant burden on our healthcare system. Currently as many as six million people in the United States carry a diagnosis of Afib, with that number likely increasing as our population ages and our methods of detection improve. Accurate diagnosis and risk stratification are imperative as these patients may have stroke rates as high as 20% annually. Comprehensive documentation of the CHADS2-VASc score can better determine the need for Anticoagulation for patients hospitalized with Afib Hypothesis: What is the rate of recording of CHADS2-VASc scores in patients admitted to House Staff and Hospitalist teams and what interventions would lead to better data gathering: a best practice alert or an automated diagnosis tool in the Electronic Medical Record (EMR). Methods: At The University of Chicago Medical Center, attendings on the cardiology service and hospitalists documented CHADS2-VASc without intervention. Then the response rate was measured after implementing a best practice alert, or soft stop dialog box in the EMR. Later for Hospital Medicine teams, an auto diagnosis tool, a hard stop auto-generated in the note, was added to the EMR. Results: Over the course of three years (January 2018 to December 2021) CHADS2-VASc score was charted an average of 1% of the time for hospitalists and 7% of the time for House Staff Cardiology. After implementing the EMR Best practice alert (January 2022 to January 2023 for House Staff and January 2022 to November 2022 for Hospitalists) these rates increased to 19% (p <0.0001) for the hospitalist team and 54% for the House Staff Cardiology team (p<0.00001). With the Auto diagnosis tool (November 2022 to January 2023) the rate increased from 19% to 56% (p <1x10 -7 ) Conclusions: As our data shows, CHADS2-VASc scores recording rates remained low among both cardiology and medicine attendings. However, an EMR generated alert increased responses while an auto diagnosis tool increased documentation even more. This demonstrates the effectiveness of EMR tools. This improvement in adherence should also lead to better rates of prescribing Anticoagulation to patients with higher risk.

Staff Perceptions on the Effectiveness of GRiP-S, a New Approach to Clinical Supervision Incorporating Safewards: An Interpretive Phenomenological Analysis

This study explored the impact of an innovative approach to clinical supervision for mental health nurses which integrates Safewards, named Group Reflective integrated Practice with Safewards – GRiP-S. Qualitative data was collected through 10 individual semi-structured interviews with nursing staff who had participated within the clinical supervision approach. Interviews provided insights into the nursing staff’s perception and experience of the clinical supervision approach. Through interpretive phenomenological analysis six themes emerged (i) illuminating embodied practice of Safewards, (ii) building confidence through empowering connections, (iii) creating a culture of positive change, (iv) identifying internal motivation for and external barriers to supervision engagement, (v) navigating a global pandemic, and (vi) the transformative role of reflection. Findings demonstrated that the GRiP-S approach assisted mental health nurses’ adoption of Safewards interventions in practice, while supporting the development of a cohesive staff team. The impact of COVID-19 within the study setting was addressed and nurses identified how the Safewards model assisted in navigating challenges during this time. Findings further supported prior research on the role of the supervisor and supervisee relationship. This study supports the integration of Safewards within reflective clinical supervision for mental health nursing staff to assist in Safewards fidelity and nursing staff personal and professional development.

Power Threat Meaning Framework applied to staff support

The current article provides a practice example of using the Power Threat Meaning Framework (PTMF) within a staff support context. It was based within a community mental health team undergoing a service transformation. Some of the observed benefits of this approach to team reflective practice and staff support were highlighted, including open communication about the impact of organisational changes on a team and individual practitioner level. Reflections from the lead and co-facilitators are also described in detail.

The "Bubble": What Can Be Learned from the National Basketball Association (NBA)'s 2019-20 Season Restart in Orlando during the COVID-19 Pandemic.

The National Basketball Association (NBA) suspended operations in response to the COVID-19 pandemic in March 2020. To safely complete the 2019-20 season, the NBA created a closed campus in Orlando, Florida, known as the NBA "Bubble." More than 5000 individuals lived, worked, and played basketball at a time of high local prevalence of SARS-CoV-2. Stringent protocols governed campus life to protect NBA and support personnel from contracting COVID-19. Participants quarantined before departure and upon arrival. Medical and social protocols required that participants remain on campus, test regularly, physically distance, mask, use hand hygiene, and more. Cleaning, disinfection, and air filtration was enhanced. Campus residents were screened daily and confirmed cases of COVID-19 were investigated. In the Bubble population, 148 043 COVID-19 reverse transcriptase PCR (RT-PCR) tests were performed across approximately 5000 individuals; Orlando had a 4% to 15% test positivity rate in this timeframe. There were 44 COVID-19 cases diagnosed either among persons during arrival quarantine or in non-team personnel while working on campus after testing but before receipt of a positive result. No cases of COVID-19 were identified among NBA players or NBA team staff living in the Bubble once cleared from quarantine. Drivers of success included the requirement for players and team staff to reside and remain on campus, well-trained compliance monitors, unified communication, layers of protection between teams and the outside, activation of high-quality laboratory diagnostics, and available mental health services. An emphasis on data management, evidence-based decision-making, and the willingness to evolve protocols were instrumental to successful operations. These lessons hold broad applicability for future pandemic preparedness efforts.

Effectiveness of a Program to Improve the Verbal Response of Football Coaches: A Delayed-Intervention Experimental Design

The pressure that coaches usually apply on their athletes, alongside injuries and the lack of enjoyment during sport practice, are key factors involved in sports abandonment. Behavioral interventions through psychoeducational programs have proven to be useful to improve coaching behaviors, providing appropriate context in sports. This study aims to assess a brief psychological intervention in football coaches to reduce potentially harmful verbal responses and increase the use of positive feedback. Our research was conducted in an amateur football club where 15 coaching staff teams agreed to participate. The experimental design of this study is a randomized controlled trial with control (n=7) and experimental (n=8) groups with delayed intervention. Verbal responses from coaches were collected as count data with an adapted version of the Coaching Behavior Assessment System. Data was analyzed using the Poisson Regression Model. The results show a reduction in hostile feedback by 87.7% (CI = 71% - 94.9%), technical instructions with ball in play by 39.8% (CI = 24.2% - 52.2%), complaints to referees by 95.8% (CI = 82.8% - 99.3%) and an increase in praise contingent with successful action y 87% (CI = 13% - 209%) after the intervention. These findings have important implications for the implementation of programs that seek to improve delivery of instructions in sport coaches, providing a thorough procedure for the shaping of the verbal response. Valuable insights to foster a supportive learning environment for adolescents and young athletes are addressed in the discussion. Keywords: Psychological intervention, Behavioral intervention, Sport coach, Verbal response, Technical instructions, Randomized controlled trial, Experimental design, Coaching Behavior Assessment System.

The perspective of university students on the availability and effectiveness of cyberbullying prevention and response initiatives on campus: Virtual semi-structured interviews on resources, barriers, and solutions

Cyberbullying is a problem in educational settings, and much of the research has focused on the development of effective prevention and response initiatives. Because of the vulnerability of children, cyberbullying research and intervention programs have largely targeted elementary students. A growing body of research has shown that cyberbullying is not limited to elementary settings, but the problem is also prevalent in postsecondary institutions, with potentially severe negative consequences. Yet, there is a gap in research about interventions tailored to this life stage. To address this gap, we conducted virtual semistructured interviews through Zoom with 21 university students on the availability and the effectiveness of prevention and response initiatives on campus, existing barriers, and potential solutions. We found that university students were concerned about a lack of available initiatives, and they identified several barriers, including a lack of cyberbullying conversations occurring on campus, limited knowledge about the impacts of cyberbullying on university students, and stigmatization associated with cybervictimization, which made it difficult for students to openly talk about their experiences. To remedy these barriers, university students offered several solutions: increasing education for postsecondary students, faculty, staff, and support teams; conducting studies examining cyberbullying from the unique life stage perspective of young adulthood and employing an ecological point of view; and finally, creating age-appropriate cyberbullying resources, such as flyers, webpages, and anonymous reporting systems. A central theme across these solutions was the need for conversations around cyberbullying experiences at the postsecondary level, as students perceived that it was treated as a taboo topic.

The effect of a mental health literacy intervention on Chinese team officials and staff in elite sports: a two-arm non-randomised controlled trial

ABSTRACT Mental health issues among elite athletes have received much attention in recent years. A supportive sport promotes the mental health of its athletes, team officials and staff play a crucial role in assisting athletes to seek help for their mental health when needed. However, studies have demonstrated that these individuals do not have sufficient knowledge to provide the appropriate support and assistance. Mental health literacy (MHL) is a major factor influencing support and help-seeking attitudes. Therefore, the current study aimed to provide support staff with knowledge about MHL to increase their MHL levels, reduce their stigma towards mental health issues, and improve their help-seeking attitude and their confidence in helping athletes with mental health issues. To this end, a two-arm non-randomised controlled trial was used, during which one 4-hour MHL workshop was delivered to 74 team officials and staff between the ages of 22–54 (M = 35.65, SD = 8.16). Data were collected at three time points (pre-intervention, post- intervention and follow-up). The results showed that the participants in the MHL group significantly outperformed those in the wait list control (WLC) group in terms of improved MHL and help-seeking attitude and reduced stigma. However, compared with the WLC group, the participants’ confidence in helping athletes with mental health issues did not significantly improve at post- and follow-up examinations. This study has practical implications for interventions designed to promote MHL among Chinese team officials and staff in elite sports and provides suggestions for future research on MHL and help-seeking.

The Conceptualisation of the E(ducation)-Pizza Game as a Radical Collaborative Thinking and Curriculum and Learning Design Transformation Tool

A cross-disciplinary team of educators and Education Services staff at the University of Leeds collaborated with students to co-create a game which can be used to foster curriculum and learning conversations in playful and liberating ways. Inspired by the concept of food as a connector, the project used pizza and its toppings as a metaphor for a game design which fosters radical collaboration, exploration, and democratic participation, where all voices and perspectives matter. The game is designed to enable small groups to create their own pizza representing their university experience, a programme of study, a module, or a specific pedagogic dimension of one of those experiences, such as assessment, or personal tutoring. This contribution reports on the first three stages of the game design process namely the concept identification, research and defining game mechanics and the human-centred design process and experiences of the project team and what has been learnt so far.

Registered Nurses' beliefs about end-of-life care: A mixed method study.

To examine registered nurses' (RNs) behavioural, normative and control beliefs about end-of-life care for patients who are diagnosed with advanced and life-limiting illnesses; and to identify the barriers and facilitators they experience when providing end-of-life care. A sequential explanatory mixed methods study. An online cross-sectional survey was conducted using the Care for Terminally Ill Patient tool among 1293 RNs working across five hospitals in the Kingdom of Saudi Arabia. Online individual semi-structured interviews with a subgroup of survey respondents were then undertaken. Data were collected between October 2020 to February 2021. A total of 415 RNs completed the online survey, with 16 of them participating in individual interviews. Over half of the participants expressed the belief that end-of-life care is most efficiently delivered through multidisciplinary team collaboration. The majority of participants also believed that discussing end-of-life care with patients or families leads to feelings of hopelessness. Paradoxically, the study revealed that more than half of the participants held the negative belief that patients at the end of life should optimally receive a combination of both curative and palliative care services. The results showed that nurses' beliefs were significantly associated with their age, religion, ward type, level of education and frequency of providing end-of-life care. Data from the qualitative interviews identified four themes that explored RNs' beliefs and its related factors. The four themes were 'holistic care', 'diversity of beliefs', 'dynamics of truth-telling' and 'experiences of providing end-of-life care.' Wherever possible, patients at the end-of-life should be cared for in specialist settings by multidisciplinary teams to ensure effective, high-quality care. Where this is not possible, organisations should ensure that teams of multidisciplinary staff, including nurses, receive education and resources to support end-of-life care in non-specialist settings. Hospitals that employ foreign-trained nurses should consider providing targeted education to enhance their cultural competence and reduce the impact of different beliefs on end-of-life care.

Implementación de programas de transición de la adolescencia a la edad adulta

Up to 15%–20% of adolescents have a chronic health problem. Adolescence is a period of particular risk for the development or progression of chronic diseases for both individuals with more prevalent conditions and those affected by rare diseases. The transition from paediatric to adult care begins with preparing and training the paediatric patient, accustomed to supervised care, to assume responsibility for their self-care in an adult care setting. The transition takes place when the young person is transferred to adult care and discharged from paediatric care services. It is only complete when the youth is integrated and functioning competently within the adult care system. Adult care providers play a crucial role in welcoming and integrating young adults. A care transition programme can involve transitions of varying complexity, ranging from those required for common and known diseases such as asthma, whose management is more straightforward, to rare complex disorders requiring highly specialized personnel.The transition requires teamwork with the participation of numerous professionals: paediatricians and adult care physicians, nurses, clinical psychologists, health social workers, the pharmacy team and administrative staff. It is essential to involve adolescents in decision-making and for parents to let them take over gradually. A well-structured transition programme can improve health outcomes, patient experience, the use of health care resources and health care costs.