Staff Shortages Research Articles

Integrating health and child protection systems: towards collaboratively improving health outcomes for children in kinship care in rural Australia

PurposeThere is a growing recognition that the integration of health systems will benefit children in out-of-home care (OOHC), especially those who have experienced trauma. This paper examines the adaptation of existing health systems and the persistent barriers between rural health and child protection programs. It focuses on health systems integration for children aged 0–6 years in kinship care and their siblings.Design/methodology/approachThe study applied a multi-methods qualitative approach involving individual interviews and focus groups with project members from operational or strategic reference groups, child protection personnel and the kinship carer program. We also reviewed documentary evidence.FindingsWe found evidence that health clinicians and child protection practitioners adapted and adjusted services as they collaboratively worked together to improve care delivery to children in kinship care. Yet, despite successful adaptations to systems and the appointment of a health navigator, systemic barriers remain. These include service and staff shortages in rural Australia, complications around information sharing, authority and power dynamics and siloed operations. Such barriers prevent better-integrated health systems and ultimately impair health outcomes for children in kinship care.Originality/valueThis paper contributes to knowledge and practice to improve the integration of child protection and healthcare services in Australian OOHC. It provides valuable insights into the challenges and successes of health systems integration, highlighting the need for continued collaborative effort to create effective, place-based models of care that benefit these children and their carers.

Challenges Afflicting Prisons – A First-hand Observation

Prisons encounter numerous challenges stemming from systemic, social, and administrative shortcomings. Overcrowding stands out as a significant problem, with facilities operating well beyond their intended capacities, leading to strained resources, increased tensions, and substandard living conditions. The high volume of pretrial detainees exacerbates overcrowding, prolongs the wait for justice, and creates excessive difficulties for those who are imprisoned. Deficiencies in infrastructure, a lack of initiatives to build new prisons or expand the capacity of current facilities, insufficient medical care - particularly in mental health services - and shortages of staff all jeopardize the well-being and safety of inmates. Additionally, gender-specific issues, such as insufficient facilities for women and the absence of open prisons, underscore the system's failure to support marginalized groups. Furthermore, the scarcity of rehabilitation programs hinders the reintegration of prisoners into society. Malpractices, gang activity, and substance abuse in prisons worsen these conditions, leading to violence and fatalities that hinder reform initiatives. Addressing these interconnected challenges requires extensive reforms that involve robust administrative commitment, investments in infrastructure and workforce, improvements to the legal framework, and the creation of rehabilitation programs aimed at cultivating a more humane and efficient prison system.

Clinical experiences of final-year RN and BSc nursing students during the first wave of the COVID-19 pandemic in Guyana: A mixed-methods study

Objective: The study aimed to explore the clinical experiences of final-year RN and BSc nursing students from four selected nursing schools in Guyana during the first wave of the COVID-19 pandemic.Methods: The study utilized a mixed-methods approach. The sampling involved final-year RN and BSc nursing students. The quantitative design included a survey with a convenient sample of 157 students, and the qualitative approach included seven focus group interviews. The survey data were analyzed using inferential statistics and thematic analysis.Results: The findings revealed the psychological and structural challenges experienced by final-year RN and BSc nursing students during the early months of the pandemic in Guyana. Of the respondents, 82.8% indicated fear of contracting coronavirus, 58% felt depressed, and 56.7% were insecure about daily nursing duties. Structural challenges experienced were that 58% needed PPE readily available, 80.9% felt unsafe in the clinical areas, 71.3% did not receive COVID-19 training, and 70.7% experienced financial burden. Positive responses included 91.7% did not take leave intentionally, and 74.5% felt confident. Thematic analysis yielded categories on stigmatization, fear of contracting, mental stress, shortage of staff and PPE, absence of risk allowance, and disaster planning. Coping strategies indicated were supporting one another, sharing information and resources, and praying, which enabled one to navigate the challenges and highlighted the strength of resilience and teamwork.Conclusions: Final-year nursing students encountered psychological, social, and structural challenges during their clinical placements in the early months of the pandemic outbreak. The findings underscored the need to strengthen material, academic resources, and mental health support services. Future research should focus on the experiences of registered nurses and male nurses during the pandemic. Cultivating an empowered and resilient nursing workforce is imperative to combat future healthcare challenges in Guyana.

Rethinking monuments as cultural commons: exploring alternatives to the existing legal and policy framework for conservation of ancient monuments in India

ABSTRACT The history of organized monument conservation in India dates back to the colonial rule. The colonial conservation programme sought to exclude local communities from conservation. Monument conservation became a centralized and technocratic enterprise. Post-independence, the trend of exclusion of local communities continued, deeply reflected in the laws governing ancient monuments. This has, on the one hand, contributed to the weakening of cultural ties between the communities and the monuments. On the other hand, issues such as staff shortage and inadequate monitoring by government agencies have plagued the physical governance of monuments. Globally though, there has been a substantial rethinking around the “value” of cultural heritage and the role that local communities may play both in the enhancement of their value and in their conservation. In light of the aforesaid, the authors in this article have argued for the need to rethink the ancient monuments of India as cultural commons.

Navigating transitions: a qualitative study of nursing teams' experiences of educational and cultural transitions in Germany.

The global migration of health professionals in general and nurses in particular, has led to nursing shortages and socioeconomic impacts on health systems in both source and destination countries. Adding to the complexity of the situation is the fact that the nursing profession itself is evolving from a vocational to an academic one. Although nursing migration and academization have been studied from either an institutional or an individual perspective, there is a gap in the literature regarding how nursing teams experience these transitions. This study aims to explore how nursing teams navigate through the transitions of academization and internationalization of the current dynamic nursing landscape in Germany. Based on social constructivism epistemology this qualitative study involved face-to-face focus group discussions conducted at several hospital sites in Germany from September 2021 to May 2023. The focus group discussions were audio-recorded, transcribed, and analysed using content analysis; the four dimensions of transition theory according to Schlossberg's Four S (4S) framework (self, situation, support, and strategy) were used as a priori items to construct the coding framework. Nine focus group discussions were conducted with a total of 40 nurses from different educational and migrant backgrounds. The analysis showed that the transition experiences of the nursing teams were heterogeneous, with educational and national backgrounds playing an important role in how realistic their expectations of their professional roles and identities were. The dynamic situation characterized by a shortage of qualified nursing staff, increases the pressure on nursing teams and underscores the importance of employer-provided and peer support. Onboarding and communication are key strategies used depending on the duration of the employee turnover. This study provides insights into the challenges and coping strategies of nursing teams in the current dynamic scene of migration, academicization and professional socialisation in Germany. Extending the Schlossberg 4S framework from the individual to the team perspective provides a comprehensive view of the transitional experiences of nursing teams. Within each domain of the framework, the experiences of nursing teams are remarkably diverse. Educational background (vocational or academic) and origin (German or foreign trained) play an important role in shaping the transitional experiences of nursing teams.

Exploring The Connection of Spirituality at Work in Enhancing Nurses’ Job Performance: Insight from Malaysian Hospitals

The performance of nurses can be seen as a reflection of healthcare organizations, as they constitute the most critical human resources within hospitals. However, challenges arise when issues such as staff shortages, high turnover rates, and burdensome workloads contribute to poor nurse performance. Conversely, the incorporation of spirituality in the workplace provides nurses with an opportunity to align their inner selves within a supportive community environment, fostering a deeper sense of purpose in their professional responsibilities. This study sought to determine the connection between spirituality at work and nurses’ job performance, surveying 350 nurses employed in public hospitals across Malaysia. Data analysis was conducted using Statistical Package for Social Sciences (SPSS) software version 27, revealing that all three aspects of spirituality at work, namely inner life, meaningful work, and sense of community, had a positive and significant influence on nurses’ job performance. This study provides potential aid to decision-makers in Malaysian healthcare organizations by offering significant insights for the development of strong spirituality at work values within their organizational setting. Additionally, this study presents recommendations for future research and proposes methods for the authorities to incorporate spirituality at work values into nurses’ jobs, ultimately enhancing the overall performance of healthcare services.

Organizational Climate and its Impact in a Women’s Prison on the Mental Health of Correctional Staff

The purpose of this study was to explore the organizational climate in a women’s prison from the shared perceptions of correctional staff. This study was part of the Prison Research and Innovation Network (PRIN) project, which began in the fall of 2020. Forty-two correctional staff from a low-medium security women’s prison in the Midwest were interviewed in spring 2021. Thematic analysis was conducted to identify staff’s perceptions of organizational climate in the women’s correctional facility. The themes identified as most important to staff were mental health, correctional practices, job satisfaction, and workplace culture. An item pool was developed from the themes identified, and a newly developed organizational climate survey was administered to 80 correctional staff. Qualitative data point to the issues of staff shortages and mandated overtime work impacting the mental health of staff. In addition, organizational climate and its impact on mental health were examined through multiple logistic regressions. The results indicated that having job promotion opportunities, having daily communication between staff and administration, and staff’s knowledge and awareness of correctional policies were positively associated with mental health. This mixed-methods study contributes to understanding the unique challenges correctional staff face working in women’s correctional facilities.

The decline of open-access youth work and how to turn it around

Academic's book charts the continued decline of open-access youth work over the past five years and concludes that positive moves could be undermined by a shortage of staff and focus on targeted services

Renal satellite units in Pakistan: Challenges, efforts, and recommendations.

This commentary delves into the complexities surrounding chronic kidney disease management in Pakistan, specifically examining the critical role played by renal satellite units in providing accessible dialysis services. Chronic kidney disease in Pakistan accounts for 3.9% of total deaths, warranting a focused exploration of challenges and potential solutions. RSUs, smaller entities affiliated with main renal units, emerge as key players in addressing issues of geographic accessibility and diminishing travel burdens for chronic kidney disease patients. Challenges such as financial constraints, limited resources, and staff shortages, particularly in rural settings, pose significant hurdles to the effective functioning of RSUs. This commentary emphasizes the importance of clear eligibility criteria, robust vascular access support, regular physician engagement, and the strategic integration of telemedicine. It explores diverse funding models, including government allocations, community contributions, and philanthropic partnerships, as potential solutions to alleviate cost-related concerns. The commentary advocates for a holistic, cost-effective approach to chronic kidney disease care, highlighting the transformative potential of renal satellite units in improving health outcomes across varied settings.

A Canadian national study of provincial and territorial correctional workers' suicidal ideation, plans, and attempts.

Correctional workers (CWs) endure several operational stressors (e.g., exposures to potentially psychologically traumatic events) and organisational stressors (e.g., shift work, staff shortages), which are associated with positive screens for mental disorders and self-reports of suicidal behaviours and thus urgently warrant further inquiry. The Canadian Provincial and Territorial Correctional Worker Mental Health and Well-Being Study (CWMH) used an online survey to collect data from Canadian correctional service organisations across all 13 provinces and territories. This national Canadian study investigates suicidal behaviours among CWs across diverse occupational roles and provincial and territorial jurisdictions (n=3740, 50.1% female). The results estimated prevalence proportions for self-reported past-year and lifetime suicidal thoughts, planning, and attempts across the 13 Canadian provincial and territorial correctional systems, with the exceptions of past-year suicidal planning in Alberta, Newfoundland and Labrador, New Brunswick, and Yukon where jurisdictional considerations and requests precluded the inclusion of select questions. Substantial proportions of participants reported past-year or lifetime suicidal ideation (i.e., 9.1%, 29.2%, respectively), planning (i.e., 4.1%, 14.7%, respectively), or attempts (i.e., 0.8%, 7.2%, respectively). Sociodemographic variables (i.e., sex, age, marital status, total years of service, occupational category) were associated with past-year and lifetime suicidal behaviours. Findings provide opportunities for future research and can inform tailored efforts by clinicians, service providers, and organisational leaders to support proactive interventions and treatments, including supporting the partners and families of CWs, fostering social support networks, and improving access to timely mental health treatment.

Beyond diagnosis: using a futurist approach to improve access to radiation oncology services in South Africa

Aim Radiation oncology is an integral aspect of comprehensive cancer treatment, with approximately 50% of patients requiring curative or palliative radiotherapy intervention. In the South African public sector, radiation oncology services are constrained by various factors including service coverage, equipment and staff shortages, causing consequent delays in access to care. The National Cancer Strategic Framework for South Africa (NCSF) (2017-2022) offers strategic direction for cancer services in the country. Methods Futurist causal layered analysis (CLA) provides a comprehensive approach to exploring the multifaceted factors that influence access to radiation oncology services. Using the established layers of CLA, namely, the litany, systemic, worldview and mythical layers, the NCSF, relevant literature, and expert perspectives, were used to explore the multiple levels of influence related to radiation oncology services in South Africa. Findings Considering litany, review of process flows and radiation oncology care models could offer strategic pathways for reducing waiting times and improving access to care. From the systemic layer analysis, health system strengthening should include improving clinical governance and access to available services within both the public and private sectors. This could simultaneously address the worldview of an unconstitutional lack of access to radiation oncology care within the public health sector. The final level considered myths related to radiation oncology in South Africa, including its perceived efficacy only in advanced cancer stages, and highlighted the importance of a business case for radiation oncology services to support enhanced planning and outcomes. Conclusions CLA methodology offers new insights into the challenges and opportunities facing radiation oncology services in South Africa. By comprehensively addressing the complex causal layers impacting radiation oncology services, policymakers and stakeholders can make more informed decisions to improve access to radiation oncology care in the country. The study recommends that the entire cascade of cancer care, including treatment pathways and multi-stakeholder perspectives, should be reviewed. Internal and external factors that delay the initiation of radiotherapy should be mapped and mitigated.

Intra- and inter-facility experiences of coordinating care for patients with lung cancer in KwaZulu-Natal public health facilities: a qualitative study

Aim Despite evidence that effective cancer care coordination has yielded positive results in facilitating and supporting high-quality care, it remains a complex and challenging system to implement. South Africa’s mortality of lung cancer is reported at 13.4%, ranking highest among all cancers. Coordinating the care of cancer patients is complex and can last several months or years, with multiple consultations, rounds of treatment, and follow-up in various settings. With so many health professionals, services, and settings involved, the care of these patients can become fragmented and uncoordinated. This interface between primary and specialty care offers a valuable opportunity to appreciate the challenges of delivering well-coordinated cancer care. Consequently, this paper explores healthcare professionals’ perspectives on coordinating lung cancer care within and between healthcare services. Methods This study was conducted through virtual, telephonic, and face-to-face in-depth interviews with 26 purposively selected participants from primary to tertiary health professionals, using a semi-structured tool and drawing from grounded theory design. Data generation and analysis were conducted iteratively, followed by systematic thematic analysis to organise data, review, and interpret the findings. Findings The overall public health system challenges reported by participants involved service fragmentation, staff shortages, and communication problems. Drivers of lack of care coordination varied widely across healthcare professionals, with interoperability and communication challenges standing out as the most prominent themes. Consequently, better communication, interoperability, and improved care transitions between providers and health systems were proposed. This study provides pertinent information for policymakers and healthcare professionals to develop appropriate strategies for improving cancer care coordination interventions. Conclusions A fundamental change is required to shift the direction of the KwaZulu-Natal public health system towards responsive, patient-centred, comprehensive, and coordinated care. Enabling the primary healthcare level to play a substantial role in care coordination may provide a plausible intervention to circumvent healthcare complexities.

평생학습도시 정책 사업 성과평가를 둘러싼 의미쟁투의 지형과 특징: 푸코의 헤테로토피아 관점에서

The purpose of this study is to analyze the terrain and features of the meaning contestation in the local scene surrounding the performance evaluation of the Lifelong Learning City policy project as a major change in the local lifelong learning promotion policy environment, and to extend the discussion of the implications and current affairs of this result from the perspective of Foucault's heterotopia. The analysis revealed that the meaning contestation surrounding the performance evaluation of the Lifelong Learning City policy project (hereinafter referred to as 'performance evaluation') is deeply intertwined with the role identities of lifelong educators who are closely connected to this work. Therefore, this study first structured the types of lifelong educator role identities, and then identified the meaning and issues, ramifications and impacts, challenges and directions of 'performance evaluation' in relation to them. In this study, the role identities of lifelong educators were categorized into four main types, which in turn were categorized into two groups with respect to their dominant perception of performance evaluation. First, the problematic perception and direction of 'performance evaluation' in the functional role approach and the organizational culture prescriptive approach were identified in relation to: ➀ discriminatory indicators that do not match the field, ➁ performance that is outside the management area of the dedicated department, ➂ the need to move away from a one-size-fits-all evaluation method, and ➃ the treatment of lifelong educators and the reality of staff shortages. Second, in the organizational culture structural role approach and socio-cultural interaction approach, the impact of the recent 'performance evaluation' (Lifelong Learning City redesignation evaluation) implemented by the Ministry of Education was first analyzed in the context of each local government, and then linked to the performance evaluation as an important basis for presenting the perspective and direction of the performance evaluation. The ramifications and impacts were discussed in three main pillars: ➀ organizational culture (triggering the organization's attention and awareness, and the role of raising its external status), ➁ business management (creating the Lifelong Learning City data archive, working to build a performance management system, thinking about characterizing the Lifelong Learning City business, and seeking ways to link and collaborate with other departments), and ➂ personal (recognition of expertise and growth as a lifelong educator). Based on this, the problem recognition and direction of 'performance evaluation' were presented as: ➀ Limitations of performance sharing due to compartmentalized administrative culture, ➁ Expansion of lifelong education network to create convergent performance, ➂ Performance management to increase the value of lifelong education across the city, and ➃ Evaluation index to share overall direction and data utilization. Finally, the results of this study were discussed through the main points of Heterotopia to deepen the discussion.

Sustaining Current Policies and Introducing New Initiatives: Strategic Five-year Plan for the Government of India

A review of key documents, including political manifestos and reports from NITI Aayog and WHO, outlines healthcare priorities for 2024-2029, aligned with Viksit Bharat 2047 and the UN SDGs. Key actions include expanding Universal Health Coverage through Ayushman Bharat, improving rural healthcare, addressing medical staff shortages, and leveraging digital health, telemedicine, and interoperable records. National missions targeting disease prevention, mental health, and non-communicable diseases aim to promote healthier lifestyles. Strengthening public health preparedness and health information systems, while promoting traditional medicine, is also essential. Expanding maternal and child health programs, increasing access via AB-PMJAY, ensuring quality through NQAS, and driving innovation with R&D funding are vital. Enhanced tobacco control through COTPA, higher taxes, and NTCP campaigns, along with investments in WASH infrastructure through Swachh Bharat and Jal Jeevan Missions, will improve health outcomes. Geriatric care, digitalisation, digital health, mental health, community health workers, and partnerships are critical. Initiatives like healthcare innovation hubs, mobile clinics, and health equity programs will build a resilient, inclusive healthcare system and improve national health.

Enhancing Education and Training for Professionals and Formal Carers: Implementing Microlearning

Abstract Background Current technological, economic and social changes trigger the need for new concepts and strategies to support lifelong learning. Education, including work-based learning, is in need of transformation, requiring renewal and innovative ways of relating appropriately to the way we live, work and learn today (Downes, 2005; Kuhlmann & Sauter 2008; Chisholm 2005). Staff shortages and heavier workloads has reduced the availability of health care staff to attend in-depth training courses. This, coupled with the recent moves away from traditional face-to-face learning to e-learning, we had to re-consider teaching theories and teaching methods. Methods In this poster I will present how we utilised microlearning to improve staff knowledge about dementia and nutrition. Microlearning is a method of delivering small, bite-sized pieces of information that can be easily consumed and retained by learners. It offers customised learning experiences that cater to the unique needs and preferences of each learner and provides an engaging and interactive learning experience through the use of multimedia, quizzes, and games. Results Microlearning facilitates self-directed lifelong learning, as short activities can be easily integrated into everyday activities. Small learning steps with small pieces of information can be used for learning in between and on-demand. In this way microlearning enables individuals to stay up to date in today’s knowledge society and offers a viable supplement to more time-consuming and formalized modes of learning, such as classroom courses or web-based trainings. Additionally, this poster will describe how we have applied microlearning as an emerging pedagogy that enables learners and clinicians to engage in short, focused, asynchronous and just-in-time learning. Conclusion Microlearning as an educational strategy has demonstrated a positive effect on the knowledge and confidence of health professions learners in performing procedures, retaining knowledge, studying, and engaging in collaborative learning.

Staffing of anaesthesiology and resuscitation services in obstetric hospitals the Russian Federation

Introduction. One of the strategies for reducing maternal mortality is to improve the provision of medical care to pregnant women, women in labor and maternity hospitals in need of intensive care. Sufficient provision of anesthesiology and intensive care units of maternity institutions with highly qualified personnel is the most important factor determining the availability and quality of medical care for women. The purpose of the study: to analyse the staffing of the anaesthesiology and resuscitation services of obstetric hospitals in the Russian Federation. Materials and methods. Based on the data of 83 subjects of the Russian Federation, the indicators of staffing (per 10,000 women of fertile age) with anaesthesiologists-resuscitators (for 2007–2022) and nurses anaesthesiologists (for 2021–2022), staffing levels and compatibility ratios of anaesthesiologist-resuscitators and nurses anaesthesiologists in obstetric hospitals of group II and III (level) (for 2022) in the Russian Federation, federal districts and subjects of the Russian Federation were analysed. Based on data from 29 subjects of the Russian Federation (for 2021), the average age of anaesthesiologists-resuscitators and nurses anaesthesiologists working in obstetric hospitals was analysed. Results. In 2007–2022, the number of anaesthesiologists-resuscitators in obstetric hospitals of the Russian Federation increased by 27.2 %, and the availability of anaesthesiologists-resuscitators (per 10,000 women of fertile age) increased by 43.9 %. The number of nurse anaesthesiologists in obstetric hospitals in 2021–2022 increased by 0.8 %, the availability of nurse anaesthetists (per 10,000 women of fertile age) decreased by 0.8 %. In 2022, the staffing level of anaesthesiologists-resuscitators in obstetric hospitals of Group II was 85.6 %, Group III – 86.0 %, and nurses anaesthesiologists – 87.8 % and 88.4%, respectively. The compatibility rate of anaesthesiologists-resuscitators in obstetric hospitals of group II was 1.42, group III – 1.53, and nurse anaesthesiologists – 1.23 and 1.34 respectively (2022). The average age of anaesthesiologists-resuscitators working in obstetric hospitals was 43.3 ± 4.3 years, nurse anaesthesiologists – 42.1 ± 3.9 years (2021). Conclusion. In order to eliminate staff shortages, it is necessary to implement measures to attract medical staff in the anaesthesiology and resuscitation services of obstetric institutions, which will decrease the burden on medical staff and prevent maternal deaths.

Forced centralized allocation in the emergency department-what has the COVID-19 pandemic changed?

IVENA eHealth (IVENA, interdisziplinärer Versorgungsnachweis, mainis IT-Service GmbH, Offenbach am Main, Germany) supports the coordination of emergency admissions by providing real-time data on treatment options in hospitals. Overload or technical problems can lead to hospitals having to temporarily deregister parts or the entire emergency department, which can lead to acute admissions. The COVID-19 pandemic may have further exacerbated the situation, which was analyzed as part of this study. This descriptive analysis used the IVENA eHealth information technology (IT) system to examine the occupancy and acute occupancy figures in the Munich ambulance service area from 2016-2022. Particular attention was paid to inpatient (SCII) and shock room + admissions in the specialties of internal medicine, neurology, trauma surgery and urology, as well as the development of acute occupancies, especially after the COVID-19 pandemic. During the COVID-19 pandemic in 2020, the number of patients in the surveyed specialist areas fell by 23.7% (2021: -15% and 2022: -11% compared to 2019). The proportion of acute admissions fell in 2020 compared to 2019 (5.9% acute admissions vs.6.8%) and rose disproportionately in 2021 (7.7% vs.6.8%) and 2022 (24.9% vs.6.8%). There are many reasons for the increase in acute admissions, including the increase in inpatient admissions, the bottleneck in transferring patients (exit block) and the shortage of staff in the healthcare system. The COVID-19 pandemic has exacerbated some of these problems, which could explain the increase in acute admissions. Acombination of different solutions is now needed to ensure adequate emergency care.

Nurses' health promotion practices in rural primary health care in Nigeria. A qualitative study.

Nurses play a vital role in providing high-quality primary healthcare and health promotion services. The state of research highlights their often complex operational realities and shows the need for an evidence-based understanding of nurses' perspectives on health promotion practices, especially in low-resource settings. This study focuses on how community health nurses in rural primary healthcare centers in Nigeria perceive their health promotion role and the opportunities and challenges of, and potential entry points for strengthening, their practice. A sample of 10 nurses from eight rural primary healthcare centers in eight local government areas of Anambra state, Nigeria, was purposively selected. Data were collected via semistructured telephone and written interviews and analyzed by qualitative content analysis using a deductive-inductive approach. Nurses emphasized their commitment to supporting patients and communities to develop skills and take control of their own lives. Nurses described their role as facilitators of behavioral and environmental change, individual and community empowerment facilitators as well as social activists. Factors that enhance the health promotion practice of nurses include adequate skills, sufficient human and material resources and community support and participation. Inhibiting factors included insufficient funding, poor working conditions, staff shortages, high workload, lack of training opportunities and low participation of community members. Overcoming challenges and facilitating health promotion activities in rural communities require bolstering nurses by providing further training opportunities for enhancing their health promotion competencies and creating supportive environments. Future research should focus on how to strengthen nurses' health promotion efforts through interprofessional and intersectoral collaboration.

Barriers and facilitators to implementation of intravenous cardiovascular treatments in ambulatory settings.

Intravenous (IV) therapies have transformed the management of various cardiovascular conditions in ambulatory patients. However, uptakeof these therapies in ambulatory care settings has several barriers. In this systematic scoping review, we aimed to identify the barriers and facilitators that influence the implementation of current IV therapies in ambulatory settings. We searched MEDLINE, Embase and CINAHL databases from inception to September 2023 for studies on barriers and facilitators of IV therapy uptake in ambulatory patients. We classified the identified factors and performed a thematic analysis. Fifteen studies, primarily conducted in North America and Europe, were included. Methodologies varied, precluding quantitative synthesis. Key barriers were identified across several levels. At the medication level, barriers included the need for multiple vials and lengthy preparation. Patient-level barriers included adverse effects, infections, painful venous access and non-adherence. Clinician-level barriers included understaffing, time constraints and safety concerns. Institutional barriers ranged from staff or equipment shortages to liability concerns and complex logistics. Healthcare system barriers included financial constraints and limited care delivery services. Facilitators included evidence-based indications, patient education and comfort, staff experience, guidance documents, safe settings, favourable insurance policies and supportive guidelines. As novel IV treatments emerge, addressing barriers and leveraging facilitators preemptively can enhance the successful implementation of IV therapies and improve clinical outcomes in ambulatory settings.

Samen zorgen

Introduction: Collaboration with relatives and volunteers is important to maintain the quality of life in times of growing care demands and rising staff shortages. It requires finding new ways of working. The aim of this study was to explore the experiences of care professionals, managers and coaches in taking care together with relatives and volunteers. Methods: Semi-structured online interviews were conducted with 17 respondents, including 6 care professionals, 4 managers and 7 coaches. The transcripts were then thematically analysed in MAXQDA in three phases: open -, axial -and selective coding. Results: Ten themes were identified and categorized on micro-, meso- and macro level. Themes of micro level concern the roles and alignment from care professionals, relatives and volunteers. Mesos level comprise themes on team-, department level and organisational level. Themes on macro level transcend individual care organisations. Discussion: The findings emphasize the relevance of the collaboration between care professionals, relatives and volunteers. Also the need for support and agreements on policy level were underlined. The results show that a cultural change is really needed to provide care together with relatives, volunteers and care professionals as one team.