Workload Pressures Research Articles

Caregiver and service provider vaccine confidence following the Changchun Changsheng vaccine incident in China: A cross-sectional mixed methods study

IntroductionThe Changchun Changsheng Vaccine Incident (CCVI) occurred mid-2018 and involved irregularities in the manufacture and quality control of diphtheria-tetanus-acellular-pertussis and rabies vaccines. This study investigates vaccine confidence amongst Chinese caregivers and vaccination-service providers (VSPs) six months after the CCVI. MethodsQuantitative surveys were conducted in January 2019 with 2124 caregivers of children and 555 VSPs in three areas in China. The proportions of respondents who agreed to the four statements from the Vaccine Confidence Index™ were used to measure vaccine confidence. Descriptive and univariate analyses were performed to study the level of vaccine confidence. Semi-structured interviews were conducted with 48 caregivers, 43 VSPs and 9 immunization program managers. Interviews were analyzed thematically using a combination of deductive and inductive coding. Media surveillance was conducted to monitor public responses to the CCVI. ResultsMedia surveillance indicated that public attention to vaccine-related issues increased sharply immediately post-CCVI but declined rapidly thereafter. Six months post-CCVI, 96.0% of caregivers and the same proportion of VSPs reported that vaccination was important and compatible with their religious beliefs. 82.7% and 88.2% of caregivers agreed that vaccines were safe and effective. 92.8% and 94.6% of VSPs agreed that vaccines were safe and effective. Both caregivers and VSPs reported an immediate decline in vaccine confidence post-CCVI. In most cases this trust was regained over time following government and public health responses, however some people remained hesitant about vaccinating their children. Many VSPs were overwhelmed by consultations, workload and psychological pressure after the CCVI. ConclusionAfter an initial decline, vaccine confidence recovered to pre-incident levels six months after the CCVI. However, some caregivers moved from the higher to the lower end of the vaccine confidence spectrum, pointing to the need to promote the acceptance of vaccination especially given the need for new vaccines to control the coronavirus epidemic.

Factors contributing to healthcare professional burnout during the COVID-19 pandemic: A rapid turnaround global survey.

Healthcare professionals (HCPs) on the front lines against COVID-19 may face increased workload and stress. Understanding HCPs' risk for burnout is critical to supporting HCPs and maintaining the quality of healthcare during the pandemic. To assess exposure, perceptions, workload, and possible burnout of HCPs during the COVID-19 pandemic we conducted a cross-sectional survey. The main outcomes and measures were HCPs' self-assessment of burnout, indicated by a single item measure of emotional exhaustion, and other experiences and attitudes associated with working during the COVID-19 pandemic. A total of 2,707 HCPs from 60 countries participated in this study. Fifty-one percent of HCPs reported burnout. Burnout was associated with work impacting household activities (RR = 1·57, 95% CI = 1·39-1·78, P<0·001), feeling pushed beyond training (RR = 1·32, 95% CI = 1·20-1·47, P<0·001), exposure to COVID-19 patients (RR = 1·18, 95% CI = 1·05-1·32, P = 0·005), and making life prioritizing decisions (RR = 1·16, 95% CI = 1·02-1·31, P = 0·03). Adequate personal protective equipment (PPE) was protective against burnout (RR = 0·88, 95% CI = 0·79-0·97, P = 0·01). Burnout was higher in high-income countries (HICs) compared to low- and middle-income countries (LMICs) (RR = 1·18; 95% CI = 1·02-1·36, P = 0·018). Burnout is present at higher than previously reported rates among HCPs working during the COVID-19 pandemic and is related to high workload, job stress, and time pressure, and limited organizational support. Current and future burnout among HCPs could be mitigated by actions from healthcare institutions and other governmental and non-governmental stakeholders aimed at potentially modifiable factors, including providing additional training, organizational support, and support for family, PPE, and mental health resources.

Workload pressure of nurses at an emergency satellite hospital in Peshawar Pakistan

Abstract Introduction Health managers face challenges to respond to the demands of the population with limited resources. Balancing the health workforce is of high concern as the health workers are indispensable resource in a health system. The objective of this study was to determine the workload pressure of nurses working at an Emergency Satellite Hospital for efficient planning and management. Methods The Workload Indicators of Staffing Need (WISN) method was used for this study which is a human resource management tool which determines the number of health workers required to cope with the workload and asses the workload pressure by using the available service statistics. It calculates the level of staff shortage or surplus in a facility and the ratio of actual to the required number of staff determines the workload pressure with which the staff is coping. Results According to the findings of the study there were 1966 available working hours for the nurses in a year. Out of this time 33.33% was taken by support activities of all nurses, 18.75% by additional activities of some of the nurses and 47.92% by health services activities of all the nurses. At the time of the study there were 4 nurses working in the in the hospital but according to the calculations based on WISN 3 nurses were required to carry out the activities identified by the experts working group. The study shows that there was no workload pressure on the nursing staff as the WISN ratio was 1.33 and one nurse was surplus. Conclusions The study found that there was no workload pressure on the nursing staff and one nurse was surplus who can be adjusted in any other unit where there is more need of nursing staff. This can increase the overall productivity and the demands of the population for health services can be responded to in an efficient way. Key messages Balancing the health workforce in any institution is of high concern as the health workers are the most costly, least readily available and indispensable resource in a health system. Efficient planning and management of health workforce is essential for better productivity.

Challenges of tracheostomy in COVID-19 patients in a tertiary centre in inner city London

The rapid global spread of SARS-CoV-2, the causative agent of COVID-19, has dominated healthcare services, with exponential numbers requiring mechanical ventilation in the intensive care unit (ICU). Tracheostomy facilitates respiratory and sedative weaning but risks potential viral transmission. This study reviewed the tracheostomy provision, techniques, and outcomes for a single-centre prospective cohort during the resource-pressured COVID-19 period. Seventy-two of 176 patients underwent tracheostomy at a median 17 days: 44 surgical (open), 28 percutaneous. Their median age was 58 years, the male to female ratio was 2.4:1, 75.1% were of BAME backgrounds, 76% had a BMI≥25kg/m2, and 65% had ≥2 major co-morbidities. Seventy-nine percent of patients were weaned from sedation at a median 2 days, 61% were weaned from mechanical ventilation at a median 10 days, 39% were discharged from the ICU at a median 11.5 days, and 19.4% were discharged home at a median 24 days. All patients survived the procedure. The mortality rate was 9.7% at a median 12 days. No clinician reported COVID-19 symptoms within 14 days of the procedure. The role of tracheostomy in COVID-19 is currently unclear. Delivery of tracheostomy by maxillofacial surgeons relieved the workload pressure from ICU clinicians. The choice of technique was influenced by the patient and resource factors, resulting in a mixed cohort of open and percutaneous tracheostomy in COVID-19 patients. Preliminary data suggest that open tracheostomy is as favourable as percutaneous tracheostomy for COVID-19 patients, and is safe for clinicians.

Climate of Service Priority &amp; Service Performance: The Role of Emotional Labor and Workload Pressure

Service employees face a complex organizational environment that constantly poses multiple demands in order for them to achieve organizational goals. Hence, there is a persistent tradeoff between service as a key element of the organization's strategy and other competing or even conflicting demands. Using the Job Demands- Resources model as an overarching theoretical framework, we investigated why and when shared perceptions of the relative priority assigned to service are related to service performance. Specifically, we examined employee's use of deep acting emotional labor strategies as a mechanism that explains this relationship and workload pressure, as a bounding condition of this relationship. A sample of 245 hospitality employees nested within 39 departments in thirteen hotels participated in the study. Results demonstrated that when service was perceived as a relative priority compared to other competing goals, employees reported using a higher level of deep acting emotional labor strategies, which in turn led to better service performance. Yet, this was apparent only under specific circumstances or contexts, i.e., when workload pressure was low.

Identification of the Direction and Strength of Relationship between Complaints of Musculoskeletal Disorders (MSDs) to Smoking Habits and Repetitive Movements of Informal Workers in Surabaya, Indonesia Using Spearman Correlation Test Methods

The right statistical test to find out the relationship between variables that have ordinal data scale is a spearman correlation test. Spearman correlation shows how strong the relationship and the direction of the relationship between variables. The increasing muscle complaints have a close relationship with smoking habits. The longer and the higher the frequency of people smoke, the smaller the lung capacity. It then results in a decrease in the lung ability to consume oxygen. It also causes one more easily tired when carrying out tasks that require exertion. In addition, complaints due to repetitive movements occur because the muscles continuously receive workload pressure without a chance for relaxation. This condition triggers the occurrence of nerve swelling which will cause pain in the musculoskeletal area. This is an observational study with a cross sectional design. The study used a total sampling population of 12 workers. Spearman correlation is used to examine the strength and direction of the relationship between the dependent variable, MSDs complaints, an ordinal data scale, with independent variables, smoking habits and repetitive movements. This study found that smoking habits and the level of complaints of MSDs in the shelf frame bending workers have fairly strong, positive and unidirectional relationship with correlation coefficient value of 0.357. It also found that repetitive movements and complaint levels MSDs have a positive and perfect relationship with the correlation coefficient value of 1,000.

Implementation of the Workload Indicators of Staffing Need (WISN) Method in Determining Staff Requirements in Public Health Laboratories in Serbia.

This study aimed at identifying the needs for the health workforce in 16 public health laboratories in the Serbian capital by assessing the workforce stock, workload activities, activity standards, and workload pressure. A review of laboratory records and regulations, interviews with key respondents, and observing work processes provided data for the World Health Organization method for determining staffing needs based on workload indicators (Workload Indicators of Staffing Need, WISN). A total of 99 laboratory workers spend almost 70% of their available working time in undertaking core activities. Core activities per sample can take from 0.25 to 180 min. Laboratory workers are under moderate or high workload pressure (the WISN ratio from 0.86 to 0.50). The WISN difference indicates a shortage of 22.22% of laboratory analysts and 20.63% of laboratory technicians. To balance the staffing to workload, these laboratories need an additional 8 FTE analysts and 13 FTE technicians. They could also consider selectively reducing workload pressure by automating some of the additional activities while maintaining the competence of laboratory workers and opportunities for professional development. Staffing policy should account for work processes, activity standards, and workload pressure to determine necessary staffing to meet the need for laboratory services in the local context.

Risk Perception and Its Influencing Factors among Construction Workers in Malawi

This study employed a deductive research approach and a survey strategy to assess risk perception and its influencing factors among construction workers in Malawi. Three specific construction hazards and their associated risks were selected. The hazards were “working at height (WAH)” “manual handling of loads (MHL)” and “heavy workload or intense pressure to be more productive (HWP).” The study engaged multistage sampling of 376 subjects. Univariate analysis, factor analysis and multiple linear regressions were performed in order to determine the main influencing factors among the independent variables. The study established that workers were aware of risks posed by their work. The majority perceived the risk associated with WAH, MHL and HWP as very high (62.7%, =8.80 ± 1.95); (48.5%, =8.10 ± 2.38); (57.9%, =8.49 ± 2.22) respectively. The study identified six factors as variables that showed a significant effect on workers’ perception of risk (p &lt; 0.05). These factors were: “dreaded factor,” “avoidability and controllability,” “expert knowledge,” “personal knowledge,” “education level,” and “age”. It is concluded that contractors in the Malawian construction industry should integrate analysis of behaviors and risk perception of the workers and other players to guide the identification of better health and safety interventions at their worksites.

Institutional and supervisory support for the Thesis by Publication

The Thesis by Publication is garnering increasing interest across nations and disciplines. However, more needs to be learned about institutional and supervisory support for this thesis mode to ensure that doctoral candidates pursuing this approach enjoy the best possible outcomes. This paper draws on data from 246 recent successful doctoral candidates who took part in the 2018–2019 PhD candidates’ motivations, experiences, and opinions of the thesis by/with publications study. Findings suggest that perceived institutional support may be more common than supervisory support, and initial institutional support may be eclipsed by ongoing support. Findings suggest that more can be done to support students intending to embark on Thesis by Publication at induction, and that high quality supervisory support can be perceived as integral to candidate success in most cases. However, high dependence on supervisory support paired with comparatively limited institutional support can place workload pressure and increased accountability on supervisors, and may raise ethical implications that require close consideration.

Adherence to prescription-writing guidelines for outpatients in Southern Gauteng district hospitals.

BackgroundMedical prescription writing is legally and professionally regulated in order to prevent errors that can result in patients being harmed. This study assesses prescriber adherence to such regulations in primary care settings.MethodsA cross-sectional study of 412 prescriptions from four district hospital outpatient departments (OPDs) was conducted in March 2015. Primary outcome data were obtained by scoring prescriptions for accuracy across four categories: completion of essential elements, use of generic names of medications, use of recommended abbreviations and decimals and legibility. Secondary outcome data sought associations between accuracy scores and characteristics of the OPDs that might influence prescriber adherence.ResultsCompletion of the essential elements, including patient identifiers, prescriber identifiers, treatment regimen and date scored 44%, 77%, 99% and 99% respectively. Legibility, the use of generic names of medications and the use of recommended abbreviations and decimals scored 90%, 39% and 35%, respectively. Only 38% of prescriptions achieved a global accuracy score (GAS) of between 80% and 100%. A significant association was found between lower GAS and the number of prescriptions written per day (p = 0.001) as well as with the number of prescribers working on that day (p = 0.005), suggesting a negative impact on prescribers’ performance because of workload pressures.ConclusionLow GAS values indicate poor adherence to prescription-writing regulations. Elements requiring substantial improvement include completion of patient and prescriber identifiers, use of generic medication names and the use of recommended abbreviations and decimals. This study provides baseline data for future initiatives for improvement in prescription-writing quality.

The important role of the histopathologist in clinical trials: challenges and approaches to tackle them.

High-quality histopathology is essential for the success of clinical trials. Histopathologists have a detailed understanding of tumour biology and mechanisms of disease, as well as practical knowledge of optimal tissue handling and logistical service requirements for study delivery, such as biomarker evaluation, tissue acquisition and turnaround times. As such, histopathologist input is essential throughout every stage of research and clinical trials, from concept development and study design to trial delivery, analysis and dissemination of results. Patient recruitment to trials takes place among all healthcare settings, meaning that histopathologists make an invaluable contribution to clinical trials as part of their routine day-to-day work that often goes unrecognised. More complex evaluation of surgical specimens in the neoadjuvant setting and ever-expanding minimum data sets add to the workload of every histopathologist, not just academic pathologists in tertiary centres. This is occurring against a backdrop of increasing workload pressures and a worldwide shortage of histopathologists and biomedical scientists. Providing essential histopathology support for trials at grassroots level requires funding for adequate resources including histopathologist time, education and training, biomedical scientist and administrative support and greater recognition of the contribution made by histopathology. This paper will discuss the many ways in which histopathologists are involved in clinical trials and the challenges faced in meeting the additional demands posed by trial participation and potential ways to address this, with a special emphasis on the UK model and the Cellular-Molecular Pathology Initiative (CM-Path).

Handover practices of nurses transferring trauma patients from intensive care units to the ward: A multimethod observational study

Poor-quality patient handover leads to adverse patient outcomes. Consequently, handover has been identified as a national and international priority for preventing patient harm. Risks are exacerbated during transfers of trauma intensive care unit (ICU) patients to a ward because of the complexity of their injuries coupled with a de-escalation in care and monitoring. This study assessed current handover practices for ICU trauma patients, identifying barriers and facilitators to best practice handover.A multimethod design was used, including naturalistic observations of clinical handover of trauma patients transferred to a ward and semistructured interviews with both the ICU and ward nurses caring for the trauma patient. The study was conducted at an Australian metropolitan public adult teaching hospital ICU. Purposive maximal sampling of patient handover opportunities was sought. Recruitment continued until data saturation was reached using thematic analysis.Ten ICU and ward nurses were recruited, with 10 observations of handover and 20 interviews conducted. Observations of the handovers identified multiple issues, including deficits and discrepancies in the information communicated that could impact patient safety, variable handover processes, and poor patient and family involvement. Interviews elicited two major themes around the handover: practices and processes. Nurses identified that interruptions, time, and workload pressures presented barriers to handover, whilst teamwork, using a structured and systematic approach, preparation time for handover, and communication before transfer facilitated effective handover and transfer. Nurses suggested a structured tool to aid handover.This study identified clinically significant deficits and discrepancies in the information communicated to the ward nurses. Nurses identified that interruptions, time, and workload pressures presented barriers to effective handover. Teamwork where preparation and the handover event are prioritised over other activities is needed. A minimum data set for handover in conjunction with patients and family members is recommended.

Implementing a digital patient feedback system: an analysis using normalisation process theory

BackgroundPatient feedback in the English NHS is now widespread and digital methods are increasingly used. Adoption of digital methods depends on socio-technical and contextual factors, alongside human agency and lived experience. Moreover, the introduction of these methods may be perceived as disruptive of organisational and clinical routines. The focus of this paper is on the implementation of a particular digital feedback intervention that was co-designed with health professionals and patients (the DEPEND study).MethodsThe digital feedback intervention was conceptualised as a complex intervention and thus the study focused on the contexts within which it operated, and how the different participants made sense of the intervention and engaged with it (or not). Four health care sites were studied: an acute setting, a mental health setting, and two general practices. Qualitative data was collected through interviews and focus groups with professionals, patients and carers. In total 51 staff, 24 patients and 8 carers were included. Forty-two observations of the use of the digital feedback system were carried out in the four settings. Data analysis was based on modified grounded theory and Normalisation Process Theory (NPT) formed the conceptual framework.ResultsDigital feedback made sense to health care staff as it was seen as attractive, fast to complete and easier to analyse. Patients had a range of views depending on their familiarity with the digital world. Patients mentioned barriers such as kiosk not being visible, privacy, lack of digital know-how, technical hitches with the touchscreen. Collective action in maintaining participation again differed between sites because of workload pressure, perceptions of roles and responsibilities; and in the mental health site major organisational change was taking place. For mental health service users, their relationship with staff and their own health status determined their digital use.ConclusionThe potential of digital feedback was recognised but implementation should take local contexts, different patient groups and organisational leadership into account. Patient involvement in change and adaptation of the intervention was important in enhancing the embedding of digital methods in routine feedback. NPT allowed for a in-depth understanding of actions and interactions of both staff and patients.

Nurses' views on workload, care rationing and work environments.

The article examines nurses' experiences to institutionally enforced choices they must make regarding what patient care will be left undone. Cognitive dissonance theory is used to discuss how missed care is reconciled with the nurses' sense of professionalism and feelings of compassion. Research into missed nursing care and care rationing is increasing, with an awareness that it impacts on nurses' coping ability. In-depth video and telephone interviews were conducted with four experienced nurses who were asked to describe how they made choices regarding required patient care and how they managed care under workload pressures. Thematic analysis of interview narratives revealed four key themes describing the experiences of nurses managing their work: compromising care; incongruity between professional standards and organisational resources; emotional exhaustion; and depersonalization. Nurses expressed concerns that their professional values regarding patient care are being lost in a quest to achieve financial targets. It raises questions regarding ethical and psychological dilemmas created for workers by work intensification. Financial effectiveness negatively impacts on nurses' emotional and clinical well-being cannot be easily dismissed, given that cognitive dissonance arises from attempting to provide quality care of patients whilst meeting organisational financial targets.

Work–life satisfaction in academia: myth or reality?

In India, there is an increasingly demanding work culture in engineering colleges. Teachers perform multiple roles which may expand and intrude into their personal lives and cause work–life imbalance. Initially, this work has compared WLS conditions among different groups of engineering and non-engineering faculty and recognized that problems at work were on the rise, upsetting personal lives of engineering faculty. There are clues of extended work schedules, relatively more workload and subsequent pressure making them tired and miss quality time to spend with their loved ones. In general, engineering faculty perceive both WFC and FWC. In particular, engineering professors perceive relatively less support and more WFC as they see more responsibilities in their careers. But, engineering assistant professors and PhDs perceive relatively more FWC as they see more responsibilities in their family lives. Predictive analyses show that SWLS and WFC are predictors of both engineering and non-engineering faculty WLS, having significant positive and negative impact, respectively. Recent study substantiates that job and family satisfaction of academicians in higher education decreases and increases due to work–family conflict and work–family facilitation, respectively (Murugan and Jayanth in Curr Psychol 36:193–202, 2017a. https://doi.org/10.1007/s12144-015-9400-4; Curr Psychol 36:812–822, 2017b. https://doi.org/10.1007/s12144-016-9470-y). Data were collected through personally administered questionnaire forms comprised of four constructs, viz. support for work–life satisfaction (SWLS), work-to-family conflict (WFC), family-to-work conflict (FWC) and work–life satisfaction (WLS). This study performed comparative and predictive analyses of the opinions supplied by a random sample of 931 faculty members working in engineering colleges in Krishna District of Andhra Pradesh. Implications were discussed at the end, which may help reduce work–family conflicts and enhance faculty functioning.

Barriers and Strategies to Boost Soil Carbon Sequestration in Agriculture

The Paris Agreement calls for limiting global warming below 2°C. The “4 per 1,000 Initiative: Soils for food security and climate” was launched in 2015 to increase soil organic carbon sequestration with three objectives: mitigation of climate change, adaptation to climate change and improved food security. One of the challenges of the Initiative relates to its feasibility in contrasted biophysical, social and economic environments, questioning the adoption rate of required new practices. We conducted participatory multi-stakeholder workshops in France and Senegal to collect knowledge and perception of farmers, NGOs, agro-industries, administrations, donors and researchers on barriers and coping strategies for 4 per 1,000 innovations. Results in both countries reveal the predominance of social and economic barriers such as lack of knowledge or training, increased difficulties of fieldwork, workload, risk handling, funding and social pressure. Biophysical constraints such as limited potential of soil organic matter storage or rainfall scarcity and variability appear more important in Senegal. Identified actions to foster the sequestration of soil carbon call for an improved policy context leading to innovations in land planning, stakeholder communication, demonstration facilities, capacity building or financial support. Fewer constraints and coping strategies mention technical issues, showing that fostering agricultural soil carbon sequestration is more a question of enabling environment than technical innovations or farmers' willingness for change. We conclude that actions to support the 4 per 1,000 Initiative need to include a variety of stakeholders such as extension services, private sector, civil society, local institutions, policy makers, consumers, and not only farmers.

A Study on Potential Leadership Approaches to Address Gender-Based Constraints Effective Preparedness for Disasters in Nepal

Introduction: Nepal is known for its cultural diversity and ethnicity. Despite its unique characteristics, Nepalese society has marked visible social and gender divisions that constrain the overall growth of the nation. Low decision-making power, poor control over assets, long working hours, inadequate membership to community institutions, poor access to credit services, and lack of access to appropriate information are some key indicators. However, it was also worth mentioning that places where there is effective leadership to address the gender-based constraints, the outcomes are more promising in attaining growth, dignity, self-confidence, and respect, answering to some of the common constraints. Methods: This research relies on literature review, expert interviews, Focus Group Discussions (FGD), simulations, and Key Informant Interviews. The expert interviews were conducted in-person to get detailed information on some of the organization-based interventions. Results: The study showed that since the 2015 earthquake in Nepal, the workload pressure has increased especially for women. It also increased the exposure to some of the common risks such as gender-based violence, women &amp; child trafficking, abuses, stress, family tension, health care issues, fear, and other challenges. However, leaderships shown by organizations, communities, and individuals have positive impact on reducing gender-based violence. Also, reduction of other constraints such as long walking to fetch water, long working hours, restricted movements, decision making for self-improvement, lack of recognition, and seeking permission to attend social events has been addressed by community level and individual leaderships. The places where such constraints of the women have been addressed, their engagement in disaster preparedness activities are more promising. Conclusion: The research study concluded that there is potential leadership among women groups, family members, and community-based organizations to ensure the reduction of gender-based constraints, and it is helping women for productive engagement.

COVID-19 and telemedicine: Immediate action required for maintaining healthcare providers well-being

The well-being of the health care workforce is the cornerstone of every well-functioning health system. As a result of the pandemic, medical healthcare providers are under an enormous amount of workload pressure along with increased total health expenditures. The overwhelming burden of COVID-19 illness could lead to caregiver burnout. Direct-to-consumer telemedicine can enable patients to connect with their healthcare provider at a distance. This virtual platform could be used by smartphones or webcam-enabled computers and allows physicians to effectively screen patients with early signs of COVID-19 before they reach to hospital.

The Impact of Employee’s Job Stress on Staff’s Job Performance at Administrative Office in Bahagian Samarahan, Sarawak

Job performance refers to an employee’s proficiency to perform well in achieving goals and behaviors which involve deliberate arts that are useful to the organization. Job performance can be improved if the employees manage to handle their job stress. This study investigates the significant effects and the relationships between job stress factors and job performance among the staffs at Pejabat Residen, Bahagian Samarahan, Sarawak. This study utilizes Job Demands-Control (JDC) Model by Karasek, which focuses on job demand and job control groups. Job demand consists of two dimensions; workload and time pressure while job control incorporates skill discretion and decision authority. One hundred questionnaires were conveniently distributed, and only 91 were returned and considered usable. This study used correlation and Multiple Linear Regression (MLR) analysis using SPSS version 25. The results show that job demand, job control, workload and time pressure had a significant relationship towards job performance. When the candidates had adequate time, decision-making empowerment and task-related skills, the employees could perform better. Among the predictors investigated, workload and skill discretion showed a significant effect on job performance. The recommendation for future research was also discussed and highlighted.

Communicative challenges among physicians, patients, and family caregivers in cancer care: An exploratory qualitative study in Ethiopia.

BackgroundCancer is a growing concern in Ethiopia. Though communication is essential for the treatment process, few studies have looked at communication in Ethiopian cancer care. Due to the large number of patients and scarcity of resources, it is vital to understand how to manage consultations in order to effectively help as many patients as possible in this challenging work environment. Thus, research is needed to analyze and understand the communicative challenges experienced by physicians, patients, and family caregivers, in order to successfully handle patient care in practice.ObjectiveWe explore communication in Ethiopian cancer care and present the main challenges faced by physicians, patients, and family caregivers.MethodsThis explorative qualitative study was conducted at the Oncology Department of the Tikur Anbessa (Black Lion) Specialized Teaching Hospital (TASH) in Addis Ababa, Ethiopia. A triangulation of data collection methods was used: 91 audio-recorded, semi-structured interviews and 21 video-recordings of authentic interactions during hospital rounds. The aim was to obtain as complete a picture as possible of communication from the perspectives of physicians, patients, and family caregivers. The interviews were analyzed using thematic content analysis and the identified themes were supported by excerpts from the transcribed recordings.ResultsEight themes emerged from the data. Workload and time pressure, in combination with restricted space for privacy, limited the possibilities for physicians to deliver detailed information and provide emotional support. Furthermore, patient literacy levels, in combination with no or little cancer awareness, financial problems, reliance on traditional and religious treatments, the stigma of cancer, and a fatalistic attitude, resulted in delays in patients seeking care and participating in positive health behaviors, and, subsequently, often resulted in an unwillingness to openly discuss problems with physicians and adhere to treatment. The study also illustrates the paramount role of family in physician-patient communication in Ethiopia. Though family caregivers provide a valuable interpreting support when patients have limited language skills, they can also prevent patients from sharing information with physicians. Another important finding is that family caregivers were often responsible for making decisions about treatment and avoided telling patients about a poor prognosis, believing that conveying bad news may upset them. All of these themes have important implications for the role of ethically acceptable communication in patient-centered care.ConclusionsThis study has identified a number of serious challenges for successful and ethically acceptable health communication in Ethiopian cancer care. The study contributes to our understanding of the complexity around the role of family, combined with patients’ dependency on family members for communication, support, and access to care, which creates particular ethical dilemmas for the medical staff. The questions raised by this study concern how to organize consultations to achieve patient-centered health communication, while maintaining a constructive alliance with the family and not jeopardizing the patient’s continued access to care. The integration of communication training for medical students in Ethiopia, with a focus on ethical guidelines for family-centered patient consultation suitable for these circumstances, would be an essential step.