Variety Of Health Professionals Research Articles

Enhancing effective healthcare communication in Australia and Aotearoa New Zealand: Considerations for research, teaching, policy, and practice

ObjectiveIn this article we present a conceptual framework for enhancing effective healthcare communication in Australia and Aotearoa New Zealand. MethodsThrough an iterative, deliberative dialogue approach, we, as experts from a variety of health professions and academic disciplines, worked together to identify core values and considerations for healthcare communication across numerous health professions and disciplines and within research, teaching, policy, and practice contexts. ResultsThe framework developed includes five core values at its centre: equitable, inclusive, evidence-based, collaborative, reflective. Around this are concentric circles showing key elements of collaborators, modality, context, and purpose. Each of these is explored. ConclusionThis work may support benchmarking for healthcare providers, researchers, policymakers, and educators across a breadth of professions to help improve communication in clinical practice. The framework will also help to identify areas across disciplines that are shared and potentially idiosyncratic for various professions to promote interprofessional recognition, education, and collaboration. InnovationThis framework is designed to start conversations, to form the foundation of a dialogue about the priorities and key considerations for developing teaching curricula, professional development, and research programs related to healthcare communication, providing a set of values specifically for the unique contexts of Australia and Aotearoa New Zealand. It can also be used to guide interdisciplinary healthcare professionals in advancing research, teaching, policy, and practice related to healthcare communication.

Reviewing academic coordination on the rural distributed training platform in South Africa.

Distributed training of students from a variety of health professions is increasing in South Africa because of the type of learning it offers and that it caters for the increasing number of students being accepted into health sciences programs. Challenges and facilitators to distributed training are well documented in the literature, and include increased distance from the academic home, human resources for health challenges, student access to support systems, and identifying learning environments to match learning outcomes. In the case of the Rural Clinical School in the Western Cape, South Africa, 'academic coordinators' were employed on site to fulfil the role of coordinating and supervising student learning and community engagement. This article explores their experiences. A large-scale qualitative study was conducted in 2017 exploring the history and development of the Ukwanda Centre for Rural Health and the Rural Clinical School. Part of this study included semi-structured individual and focus group interviews with consenting academic coordinators exploring their experiences of developing and working on a rural distributed training platform in South Africa. Data were inductively analysed. Ethical approval and institutional permission were obtained for this study, and all participants provided consent. In addition to previously published challenges that clinical supervisors who are employed by the health system face, the academic coordinators reported facing challenges related to professional isolation, boundary blurring between providing student support versus acting as clinical educator, juggling multiple line managers and administrative responsibilities, navigating the new field of academia, and not having the potential for career progression. Reflecting on the needs of academic coordinators expressed in this article, we identified four conditions that may promote sustained and continuous academic coordination at rural or remote distributed training sites. These conditions are (1) living and working local; (2) having a dual role in academia and the health system; (3) having access to academic support; and (4) regular engagement with the academic home, the value of which is detailed in this article. These recommendations can be adopted to optimise and sustain academic engagement on the distributed training platform, especially in light of the current expansion of health professions training and subsequent need to attract and retain clinician-academics in remote locations.

Impacts, Learner Diversity, and Curricular Framework of a Virtual Global Health Elective Catalyzed by the COVID-19 Pandemic.

Place-based international electives that build global health competencies have existed for decades. However, these electives require travel and are infeasible for many trainees around the world, particularly those with insufficient financial resources, logistical complexities, or visa limitations. The emergence of virtual approaches to global health electives, catalyzed by the travel pause related to the COVID-19 pandemic, necessitates the exploration of learner impacts, participant diversity, and curricular frameworks. Child Family Health International (CFHI), a non-profit global health education organization that partners with universities to expand immersive educational offerings, launched a virtual global health elective in 2021. The elective drew on faculty from Bolivia, Ecuador, Ghana, Mexico, the Philippines, Uganda, and the United States. This study aimed to describe a newly developed virtual global health elective curriculum and evaluate the demographics of and impacts on trainee participants. Eighty-two trainees who were enrolled in the virtual global health elective from January to May 2021 completed both 1) pre- and post-elective self-assessments of domains of competency mapped to the elective curriculum and 2) free text responses to standardized questions. Data were analyzed through descriptive statistical analysis, paired t-testing, and qualitative thematic analysis. The virtual global health elective had 40% of its participants hail from countries other than the United States. Self-reported competency in global health broadly, planetary health, low resource clinical reasoning, and overall composite competency significantly increased. Qualitative analysis revealed learner development in health systems, social determinants of health, critical thinking, planetary health, cultural humility, and professional practice. Virtual global health electives effectively develop key competencies in global health. This virtual elective had a 40-fold increase in the proportion of trainees from outside the United States, compared to pre-pandemic place-based electives. The virtual platform facilitates accessibility for learners from a variety of health professions and a wide range of geographic and socioeconomic environments. Further research is needed to confirm and expand on self-reported data, and to pursue approaches to greater diversity, equity, and inclusion in virtual frameworks.

Assessment of an Online Nutrition Education Program to Improve Mealtime Practices Among Families Receiving SNAP and WIC.

This study examines if participation in an online nutrition education program holds promise for improving mealtime practices in families using SNAP and WIC. Pre-post self-report surveys. Digital program delivered online, nationally in the United States. Two hundred fifty-seven parents receiving SNAP and/or WIC. Parents signed up to participate in Affordable Flavors, an online self-guided 30-day meal plan, developed by culturally diverse dietitians, aligned with the Dietary Guidelines, and linked with social media support. Overall program utilization and acceptability were assessed along with parent meal preparation practices, diet quality of meals served to children, self-efficacy, mealtime stress, grocery spending, and food insecurity. Paired t-tests (continuous variables) and McNemar's tests (categorical variables). Overall program utilization and acceptability were high. Participants reported improvements in meal preparation practices (t(255) = 6.6, P < .001), diet quality of meals served to children (t(245) = 4.0, P < .001), and self-efficacy (t(251) = 10.0, P < .001), and decreases in grocery spending (t(175) = -4.3, P < .001), mealtime stress (t(256) = -8.8, P < .001) and food insecurity (26.8% vs 10.9%, P < .001). Affordable Flavors is an acceptable, cost-effective, and easily disseminatable program that holds promise for improving parent self-efficacy to prepare and serve healthy meals to children and increase diet quality in families receiving SNAP and WIC. Engaging online nutrition education programs that can be used by a variety of health professionals, especially in settings where direct nutrition education services are not feasible or cost prohibitive, are needed.

Understanding palliative care learning: A narrative inquiry exploring health care professionals’ memorable experiences

Palliative care is an emotionally evocative domain of care, the complexities of which are not well understood. Palliative care has been described as a cultural shift in healthcare away from disease focused interventions toward a holistic and patient centered approach. Concerns have arisen around a lack of preparation for this approach to care following formal education programs across a variety of health professions. Demographics in many areas of the world demonstrate an increasing need for healthcare providers (HCPs) who are competent, confident, and engaged with this practice. Using narrative methodology to consider visual and verbal forms of storytelling, we explored memorable palliative care learning experiences of rural HCPs in Canada (2018–2019) to broaden understanding of how palliative care learning happens. HCPs across a variety of professions drew and recounted emotionally rich narratives that revealed personal and contextual dimensions as central to learning, inclusive of relationships, settings, and cultures. HCPs across professions recounted experiences that followed a common narrative arc that we call the 4Ds: difference, discomfort, disruptive, departure. This narrative arc is compatible with viewing learning as an ongoing process of transformation or becoming. Through considering the 4Ds and its implications for education, providers and educators can attune to opportunities to support students and colleagues as they emerge and grow as HCPs. Conversely, not attending to difficult, disruptive, and emotional aspects of learning may perpetuate hidden aspects of healthcare culture with possible negative impacts on provider experience and notions of professional identity.

A qualitative study investigating Australian cancer service outpatients\u2019 experience of distress screening and management: what is the personal relevance, acceptability and improvement opportunities from patient perspectives?

PurposePeople diagnosed with cancer experience high distress levels throughout diagnosis, treatment, and survivorship. Untreated distress is associated with poor outcomes, including worsened quality of life and higher mortality rates. Distress screening facilitates need-based access to supportive care which can optimize patient outcomes. This qualitative interview study explored outpatients’ perceptions of a distress screening process implemented in an Australian cancer center.MethodsAdult, English-speaking cancer outpatients were approached to participate in face-to-face or phone interviews after being screened by a clinic nurse using the distress thermometer (DT). The piloted semi-structured interview guide explored perceptions of the distress screening and management process, overall well-being, psychosocial support networks, and improvement opportunities for distress processes. Thematic analysis was used.ResultsFour key themes were identified in the 19 interviews conducted. Distress screening was found to be generally acceptable to participants and could be conducted by a variety of health professionals at varied time points. However, some participants found “distress” to be an ambiguous term. Despite many participants experiencing clinical distress (i.e., DT ≥ 4), few actioned referrals; some noted a preference to manage and prevent distress through informal support and well-being activities. Participants’ diverse coping styles, such as positivity, acceptance, and distancing, also factored into the perceived value of screening and referrals.Conclusion and implicationsScreening models only measuring severity of distress may not be sufficient to direct care referrals, as they do not consider patients’ varying coping strategies, external support networks, understanding of distress terminology, and motivations for accessing supportive care services.

Cancer care reform in South Africa: A case for cancer care coordination: A narrative review.

This review provides an overview of the existing literature on the importance of care coordination for lung cancer care and other cancers in general. The review is inclusive of the burden of cancer, with a special reference to lung cancer, as well as challenges and achievements relating to cancer care coordination. We conducted a search of online databases of peer-reviewed studies published in the English language. The analysis for this review has been packaged into themes in order to generate results that can inform researchers and cancer health professionals, on the existing gaps necessary for developing appropriate intervention strategies and policy guidelines. Cancer is a complex condition that often requires multiple interventions provided by a variety of health professionals within the healthcare continuum. This paper reviewed research studies that explored the supportive care needs of cancer patients. The results are presented in three superordinate themes, namely (a) cancer as a healthcare priority in South Africa (SA), (b) making a case for coordinated cancer care in SA, and (c) care coordination: a poorly defined, yet complex concept. One major need identified was the requirement of informational support. Other essential needs included referral, emotional, and financial support. The identification of current obstacles has the potential to guide the development of a model to improve quality coordinated cancer health care. It remains that limited research exists around cancer services and cancer care in the South African region. This narrative review identified common elements and barriers to care for lung cancer patients and survivors, and offers recommendations for developing clinical care models.

Exploring medical students' early experiences of interacting with the multi-disciplinary team (MDT): A qualitative study.

Interprofessional education relates to educators and learners from two or more different health professions working together to create a collaborative learning environment which aims to improve patient care and teamwork. Part of a doctor's role requires an understanding and respect for the multiple professions involved in patient care and an ability to work within an interprofessional team. Development of future NHS highlights a central role for IPE.This study aims to explore the early experiences that medical students have with the MDT, looking at IPE at Barts and London School of Medicine and Dentistry.It aims to understand students preconceptions of different professional roles involved in patient care, and the effect of these shadowing experiences on these views, and explore students opinions on what are the barriers to effective interprofessional collaboration. Phase 1: Thematic analysis of student reflections 50 reflections usedOrganised using NvivoThematic analysis approachTree like framework of codes and subcodes Phase 2: Focus group and interviews More detailed exploration of key themes and issuesTotal 50 minutes recording timeSame codes used and organised in NVivo Results: Students interacted with a variety of health professionals, developing awareness of interprofessional teamwork, and of the different roles involved in patient care. Students showed very limited prior knowledge and stereotyped views of some professional roles in healthcare, but demonstrated changes in attitude as a result of IPE, and were able to gain a greater understanding and appreciation of different professions. Students feel more comfortable approaching and learning from those who are actively involved in working and communicating with them and their team throughout their placement. It is important that opportunities for the students to shadow other professions are encouraged and supported as students find it challenging approaching and initiating these encounters themselves.

Awareness among Intern Doctors Regarding Privacy and Confidentiality in Medical Practice

Background: Privacy and confidentiality in medical care are deeply rooted in core professional ethical standards across a variety of health professions. Present project aimed to study perceptions of intern doctors regarding privacy and confidentiality in medical practice. Materials and methods: Total 100 intern doctors of GMERS Medical College, Valsad, Gujarat were subjected to pre-tested and pre-validated Likert scale type questionnaire regarding knowledge and awareness of privacy and confidentiality in medical practice after obtaining their informed written consent. Data obtained were analyzed via median score and tabulated. Results: Out of 100 respondents, 58 were male and 42 were female. Knowledge and awareness regarding many of the facts related to privacy and confidentiality of medical practice found to be satisfactorily with median score of more than 3. Professional secrecy is implied term of contract between doctor and patient, patient can sue the doctor for damages if disclosure is done without his consent and harm him and not in the interest of public, etc. showed median score of 3. Disclosure to parents without consent in case of major and breach of professional secrecy is professional misconduct of doctor showed median score less than 3. Conclusion: Intern doctors had little knowledge regarding disclosure to parents without consent in case of major and breach of professional secrecy is professional misconduct of doctor. Intern doctors were not sure about Professional secrecy is implied term of contract between doctor and patient and patient can sue the doctor for damages if disclosure is done without his consent and harm him and not in the interest of public. Knowledge and awareness regarding rest of the facts related to privacy and confidentiality of medical practice found to be satisfactorily among intern doctors.

Medical and allied health service use during acute and chronic post-injury periods in whiplash injured individuals

BackgroundIndividuals with whiplash associated disorder (WAD) frequently experience neck pain in addition to other physical, psychological and social symptoms. Consequently, treatment is sought from a variety of health professionals. The limited data available about health services use in this population are conflicting. This study aimed to characterise health service use in individuals with WAD from a motor vehicle crash.MethodsMedical (general practitioner (GP), medical specialist, emergency services (ED), radiology – x-ray, computed tomography, magnetic resonance imaging, ultrasound) and allied health service (physiotherapy, chiropractor, psychologist, osteopath, occupational therapy) use during acute (< 12 weeks) and chronic (12 weeks to 2 years) post-injury periods were analysed in adults claiming compensation for WAD in the no-fault jurisdiction of Victoria, Australia (n = 37,315).ResultsMost WAD claimants had an acute post-injury health service payment (95%, n = 35,348), and approximately one-third (29%, n = 10,871) had a chronic post-injury health service payment. During an acute post-injury period, the most frequently compensated services were for: ED (82% of acute claimants), radiology (56%), and medical specialist (38%). Whereas, physiotherapy (64.4% of chronic claimants), GP (48.1%), and radiology (34.6%) were the most frequently paid services during the chronic period. Females received significantly more payments from physiotherapists (F = 23.4%, M = 18%, z = − 11.3, p < .001, r = 0.13), chiropractors (F = 7.4%, M = 5.6%, z = − 6.3, p < .001, r = 0.13), and psychologists (F = 4.2%, M = 2.8%, z = − 6.7, p < .001, r = 0.18); whereas, males received significantly more medical services payments from medical specialists (F = 41.8%, M = 43.8%, z = − 3.7, p < .001, r = 0.03), ED (F = 74.0%, M = 76.3%, z = − 4.9, p < .001, r = 0.03) and radiology (F = 58.3%, M = 60.1%, z = − 3.4, p < .001, r = 0.02).ConclusionsIndividuals with WAD claimed for a range of health services. Radiology imaging use during the acute post-injury period, and physiotherapy and chiropractor service use during the chronic post-injury period appeared concordant with current WAD management guidelines. Conversely, low physiotherapy and chiropractic use during an acute post-injury period, and high radiology and medical specialists use during the chronic post-injury period appeared discordant with current guidelines. Strategies are needed to help inform medical health professionals of the current guidelines to promote early access to health professionals likely to provide an active approach to treatment, and to address unnecessary referral to radiology and medical specialists in individuals with on-going WAD.

Health mediators as members of multidisciplinary group practice: lessons learned from a primary health care model programme in Hungary

BackgroundA Model Programme of primary care group practices was implemented in Hungary between 2013 and 2017 – where virtually all GPs had worked in single practices – aiming to increase preventive service uptake and reduce inequalities based on a bilateral agreement between the Swiss and Hungarian governments. Group practices employed a wide variety of health professionals as well as support workers called health mediators. Employment of the latter was based on two decades of European experience of health mediators who specifically facilitate access to and use of health services in Roma minority groups. Health mediators had been recruited from local communities, received training on the job, and were tasked to increase uptake of new preventive services provided by the group practices by personal contacts in the local minority populace. The paper describes the contribution of the work of health mediators to the uptake of two new services provided by group practices.MethodsQuantitative analysis of depersonalized administrative data mandatorily reported to the Management of the Programme during 43 months of operation was carried out on the employment of health mediators and their contribution to the uptake of two new preventive services (health status assessment and community health promoting programmes).Results80% of all clients registered with the GPs participated at health status assessment by invitation that was 1.3–1.7 times higher than participation at the most successful national screening programmes in the past 15 years. Both the number of mediator work minutes per client and participation rate at health status assessment, as well as total work time of mediators and participants at community health events showed high correlation. Twice as many Roma minority patients were motivated for service use by health mediators compared to all patients. The very high participation rate reflects the wide impact of health mediators who probably reached not only Roma minority, but vulnerable population groups in general.ConclusionThe future of general practices lays in multidisciplinary teams in which health mediators recruited from the serviced communities can be valuable members, especially in deprived areas.

Delivering change

Theoretical models as a basis for midwives’ care have been developed over recent decades. Although there are similarities between these models, their usefulness in practice needs to be researched in specific cultural contexts.To explore whether, when adopted by midwives on labour wards, a midwifery model of woman-centred care (MiMo) was useful in practice from the viewpoint of a variety of health professionals.Data were collected from a variety of health professionals before and after an intervention of implementating MiMo at a hospital-based labour ward in Sweden, using nine focus group interviews with a total of 43 participants: midwives (n = 16), obstetricians (n = 8), assistant nurses (n = 11) and managers (n = 8). The text from interviews was analysed using content analysis.From expressing no explicit need of a midwifery model of woman-centred care before the intervention, there was a shift in midwives, obstetricians and managers perceptions towards identifying advantages of using the MiMo as it gives words to woman-centred midwifery care. Such shift in perception was not found among the assistant nurses.Clarification of the various roles of health professionals is needed to develop the model. Heavy workloads and stress were barriers to implementing the model. Thus, more support is needed from organisational management.The model was useful for all professional groups, except for assistant nurses. Further studies are needed in order to clarify the various professional roles and interdisciplinary collaborations in making the MiMo more useful in daily maternity care.

Can a complex adaptive systems perspective support the resiliency of the heart failure patient - informal caregiver dyad?

A holistic palliative approach for heart failure care emphasizes supporting nonprofessional informal caregivers. Informal caregivers play a vital role caring for heart failure patients. However, caregiving negatively affects informal caregivers' well being, and in turn heart failure patients' health outcomes. This opinion article proposes that complex adaptive systems (CAS) theory applied to heart failure models of care can support the resiliency of the heart failure patient - informal caregiver dyad. Heart failure care is enacted within a complex system composed of patients, their informal caregivers and a variety of health professionals. In a national study, we employed a CAS perspective to explore how all parts of the heart failure team function interdependently in emergent and adaptive ways. Salient in our data were the severe vulnerability of elderly heart failure patients and their long-term partners who suffered from a chronic illness. Novel approaches are needed that can quickly adapt and reorganize care when unpredictable disturbances occur in the couples' functional capacity. The linear protocol-driven care models that shape heart failure guidelines, training and care delivery initiatives do not adequately capture heart failure patients' social environment. CAS is a powerful theoretical tool that can render visible the most vulnerable members of the heart failure team, and incite robust specialized holistic palliative heart failure care models.

Is empathy an important attribute of midwives and other health professionals?: A review.

INTRODUCTIONThis paper is a report of a systematic review to identify and analyze studies of the measurement of empathy in midwives and other health professionals. Empathy has been recognized as an important factor in patient care, with positive outcomes for both patients and health professionals. There is a debate on the definition of empathy, on its measurement and on the possibility of improvement.METHODSSearches were made of the CINAHL, SCOPUS, PubMed and PsychINFO databases using the terms empathy, clinical, midwifery, nursing, medical students, measurement, and health professionals, singly or in combination, to identify literature published in English between 2002–2015. The included papers were critically reviewed and a narrative synthesis was conducted.RESULTSIn all, 22 papers met the inclusion criteria by studies that were conducted to measure the levels of empathy in a variety of health professionals and students. Their scores were analyzed in correlation with their sociodemographic factors.CONCLUSIONSDespite numerous studies, many correlations but also differences exist, indicating the complexity of empathy and the need to further study it.

Perspectives on the use of a telehealth service-delivery model as a component of school-based occupational therapy practice: Designing a user-experience.

Telehealth is an accepted service-delivery model in a variety of health professions, including occupational therapy. Telehealth holds potential for school-based occupational therapy evaluation, intervention, consultation, monitoring, and supervision. As the use of telehealth becomes prevalent, it will be important to describe the benefits and barriers to potential types of occupational therapy evaluation, intervention, consultation, monitoring, and supervision delivered via a telehealth service-delivery model. Querying stakeholder perceptions of telehealth may help guide additional precipitating factors that have not yet been explored. This study gathers information regarding perceptions, perceived barriers, and benefits of the use of telehealth in school-based occupational therapy practice. School-based occupational therapy practitioners (OTP), district administrators, and related technology staff were invited to complete a survey intended to explore attitudes about the use of telehealth. 28.57% of respondents stated that their districts were likely to adopt the use of telehealth. Participants noted perceived barriers and benefits to the use of telehealth. This study provides preliminary feedback regarding school-based OTP and administrator perceptions of telehealth as a component of school-based OT practice.

Cancer care in regional Australia from the health professional's perspective.

This study aimed to identify the factors which health professionals believe influence clinical care and outcomes for people with cancer in regional areas of Australia. Twelve semi-structured interviews were conducted with a variety of health professionals. Interview questions explored health professional's perspectives on barriers to cancer care for patients, factors which influence clinical care, and access to support in regional areas. Data were interpreted using an inductive thematic analysis approach. Two global themes were identified: rural culture and the health system. Within these global themes, health professionals discussed barriers to cancer care in regional areas, predominantly associated with travel, limited workforce, and poor communication within the health system. Participants also noted many positive aspects of cancer care in regional areas, including more personalised care for the patients and faster career progression for professionals. Despite several strategies to improve rural cancer care in recent times, including innovative models of care and increased infrastructure, health professionals still perceive many barriers to cancer care in regional Australia. These are predominantly associated with patient demographics, travel difficulties, and inadequate governance. However, there are also many notable benefits to receiving care in regional areas which have been absent from previous literature. These positive factors should be incorporated in efforts to enhance regional cancer care through the recruitment of health professionals to regional areas and development of regional community support networks.

EFEKTIVITAS PERMENKES NO. 71 TAHUN 2013 TERHADAP PELAYANAN OBAT PESERTA BADAN PENYELENGGARA JAMINAN SOSIAL KESEHATAN (Studi di Puskesmas Kabupaten Ciamis)

This study aims to analyze the effectiveness of Decree No. 71 Year 2013 on drug services in Puskesmas participants BPJS Ciamis Regency and analyze inhibiting the implementation of Decree No. 71 Year 2013 on drug services in Puskesmas participants BPJS Ciamis District. Legal research that will be done is the type of sociological studies. Sources of data include primary data in this study in the form of opinion from respondents in this case include the Chief Medical Officer of Ciamis, 6 (six) health center in the district of Ciamis, Head of the Social Security Agency of Health Ciamis, and Participant Social Security Agency of Health, while secondary data sources in the form of legislation, literature and official documents relating to the subject matter. The results of the study explained that Decree No. 71 Year 2013 About the Health Care to Care Medicine at the health center Ciamis Regency has not been effective, as seen from the size of the observance of a rule of law, it appears the subject of law, namely health centers in the district of Ciamis of 6 (six) of clinics 2 (two) puskesmas devout implement these rules, there are four (4) health centers were not obedient in implementing the regulation, so that the purpose of Decree No. 71 Year 2015 that participants benefited health care and protection to meet basic health needs were not met. The results of the study explained that Decree No. 71 Year 2013 About the Health Care to Care Medicine at the health center Ciamis Regency has not been effective, as seen from the size of the observance of a rule of law, it appears the subject of law, namely health centers in the district of Ciamis of 6 (six) of clinics 2 (two) puskesmas devout implement these rules, there are four (4) health centers were not obedient in implementing the regulation, so that the purpose of Decree No. 71 Year 2015 that participants benefited health care and protection to meet basic health needs were not met. Factors - factors inhibiting the implementation of Decree No. 71 Year 2013 on drug service participants BPJS in Puskesmas Ciamis, among other rules or its own laws collide with a variety of health professions, void of drugs in industrial plants such drugs, human resources visible from education less coaching in exercising its rights and obligations, and the people considered officers and officials do not obey the rules so that there is disappointment with the participants BPJS, so it tends to affect disobedience in compliance with the regulations in the payment of dues each month. Keywords: Drugs Service, Effectiveness, Health Center

Knowledge Translation Plan to Diffuse, Disseminate and Apply Evidence on Children Exposed to Intimate Partner Violence

Background: A consistent body of evidence shows that childhood exposure to intimate partner violence (IPV) represents a major risk factor for the development of a wide range of short- and long-term adjustment problems that span virtually all spheres of functioning. Although knowledge translation (KT) has the potential to improve the value of research evidence by making it available to professionals who can use them to promote the health of children exposed to IPV such as nurses, KT of research findings concerning this population has received very little attention in the literature.Aim: The purpose of the present paper is to propose a comprehensive end-of-grant KT plan to diffuse and disseminate clinically relevant research evidence on children who have been exposed to IPV to selected knowledge users. In the KT plan, we emphasize the key role that nurse practitioners play as relevant knowledge users and in the implementation of some of the proposed KT strategies.Methods: A systematic literature review was performed to identify research on children and adolescents exposed to IPV upon which we built an evidence-based KT plan targeting a variety of relevant audiences. In designing the KT plan, we adopted the definition of end-of-grant KT developed by the Canadian Institutes of Health Research (CIHR), which includes a wide range of activities targeting different audiences and involving a variety of health professionals, including nurses.Conclusions: Given the high prevalence of childhood exposure to IPV worldwide and the associated adjustment problems children experience, the development of KT strategies to transfer clinically relevant information on this population to relevant knowledge users should be deemed a priority in the professional practice of nurses worldwide.

Meaningful conversations in living with and treating chronic conditions: development of the ICAN discussion aid.

BackgroundThe needs of the growing population of complex patients with multiple chronic conditions calls for a different approach to care. Clinical teams need to acknowledge, respect, and support the work that patients do and the capacity they mobilize to enact this work, and to adapt and self-manage. Tools that enable this approach to care are needed.MethodsUsing user-centered design principles, we set out to create a discussion aid for use by patients, clinicians, and other health professionals during clinical encounters. We observed clinical encounters, visited patient homes, and dialogued with patient support groups. We then developed and tested prototypes in routine clinical practice. Then we refined a final prototype with extensive stakeholder feedback.ResultsFrom this process resulted the ICAN Discussion Aid, a tool completed by the patient and reviewed during the consultation in which patients classified domains that contribute to capacity as sources of burden or satisfaction; clinical demands were also classified as sources of help or burden. The clinical review facilitated by ICAN generates hypotheses regarding why some treatment plans may be problematic and may not be enacted in the patient’s situation.ConclusionWe successfully created a discussion aid to elucidate and share insights about the capacity patients have to enact the treatment plan and hypotheses as to why this plan may or may not be enacted. Next steps involve the evaluation of the impact of the ICAN Discussion Aid on clinical encounters with a variety of health professionals and the impact of ICAN-informed treatment plans on patient-important outcomes.

A Bigger Picture: Community Music Therapy Groups in Residential Settings for People with Learning Disabilities

This article introduces our development of the concepts of Community Music Therapy and systemic thinking within our music therapy service. The work, which was in a supported living setting for adults with learning disabilities (intellectual disabilities), was set up in response to the challenges of providing a more conventional music therapy service within the London Borough of Sutton Clinical Health Team for people with learning disabilities (Intellectual disabilities). We discovered that collectively our clients, their support workers, and ourselves were being reduced in our human value by not being seen or heard. The Clinical Health Team for people with Learning Disabilities is made up of a variety of health professionals and is part of the London Borough of Sutton's Disability Services. The creative therapy part of the service is music and dramatherapy. Creative therapies look at a wide range of emotional and mental health needs for people with learning disabilities such as depression, anxiety, challenging behaviour, transition, and change.