Identifying and addressing sexual health in serious mental illness: Views of mental health staff working in two National Health Service organizations in England.
Int J Ment Health Nurs. 2017 Nov 18;:
Authors: Hughes E, Edmondson AJ, Onyekwe I, Quinn C, Nolan F
People with serious mental illness (service users) have needs related to sexual health and sexuality, yet these have been poorly addressed in mental health services. In the present study, we report the current practice of mental health professionals in relation to sexual health. Focus groups conducted in two mental health trusts explored routine practice in relation to discussing, assessing, and planning care in relation to sexual health. A thematic analysis identified seven themes: (i) sexual health provision is a complex issue; (ii) mental health staff are aware of sexual health needs; (iii) current provision regarding sexual health is 'neglected'; (iv) barriers to sexual health provision; (v) enabling a discussion around sexual health; (vi) sexual health provision is a role for mental health professionals; and (vii) training needs. Mental health staff are aware of complex issues related to sexual health for service users, but this is mainly seen through the lens of risk management and safeguarding. We need to develop the mental health workforce to be able to incorporate sexual health into routine health care.
PMID: 29150893 [PubMed - as supplied by publisher]
Psychometric validation of the needs assessment tool: progressive disease in interstitial lung disease.
Thorax. 2017 Nov 17;:
Authors: Johnson MJ, Jamali A, Ross J, Fairhurst C, Boland J, Reigada C, Hart SP, Grande G, Currow DC, Wells AU, Bajwah S, Papadopoulos T, Bland JM, Yorke J
The inter-rater/test-retest reliability and construct validity of a palliative care needs assessment tool in interstitial lung disease (NAT:PD-ILD) were tested using NAT:PD-ILD-guided video-recorded consultations, and NAT:PD-ILD-guided consultations, and patient and carer-report outcomes (St George's Respiratory Questionnaire (SGRQ)-ILD, Carer Strain Index (CSI)/Carer Support Needs Assessment Tool (CSNAT)). 11/16 items reached at least fair inter-rater agreement; 5 items reached at least moderate test-retest agreement. 4/6 patient constructs demonstrated agreement with SGRQ-I scores (Kendall's tau-b, 0.24-20.36; P<0.05). 4/7 carer constructs agreed with the CSI/CSNAT items (kappa, 0.23-20.53). The NAT:PD-ILD is reliable and valid. Clinical effectiveness and implementation are to be evaluated.
PMID: 29150549 [PubMed - as supplied by publisher]
Differences in optimality index between planned place of birth in a birth centre and alternative planned places of birth, a nationwide prospective cohort study in The Netherlands: results of the Dutch Birth Centre Study.
BMJ Open. 2017 Nov 16;7(11):e016958
Authors: Hermus MAA, Hitzert M, Boesveld IC, van den Akker-van Marle ME, Dommelen PV, Franx A, Graaf JP, Lith JMMV, Luurssen-Masurel N, Steegers EAP, Wiegers TA, Bruin KMVP
OBJECTIVES: To compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife.
DESIGN: Prospective cohort study.
SETTING: Low-risk pregnant women under care of a community midwife and living in a region with one of the 21 participating Dutch birth centres or in a region with the possibility for midwife-led hospital birth. Home birth was commonly available in all regions included in the study.
PARTICIPANTS: 3455 low-risk term pregnant women (1686 nulliparous and 1769 multiparous) who gave birth between 1 July 2013 and 31 December 2013: 1668 planned birth centre births, 701 planned midwife-led hospital births and 1086 planned home births.
MAIN OUTCOME MEASUREMENTS: The Optimality IndexNL-2015, a tool to measure 'maximum outcome with minimal intervention', was assessed by planned place of birth being a birth centre, a hospital setting or at home. Also, a composite maternal and perinatal adverse outcome score was calculated for the different planned places of birth.
RESULTS: There were no differences in Optimality Index NL-2015 for pregnant women who planned to give birth in a birth centre compared with women who planned to give birth in a hospital. Although effect sizes were small, women who planned to give birth at home had a higher Optimality Index NL-2015 than women who planned to give birth in a birth centre. The differences were larger for multiparous than for nulliparous women.
CONCLUSION: The Optimality Index NL-2015 for women with planned birth centre births was comparable with planned midwife-led hospital births. Women with planned home births had a higher Optimality Index NL-2015, that is, a higher sum score of evidence-based items with an optimal value than women with planned birth centre births.
PMID: 29150465 [PubMed - in process]
Surgeons' Perceptions of the Causes of Preventable Harm in Arterial Surgery: A Mixed-Methods Study.
Eur J Vasc Endovasc Surg. 2017 Nov 15;:
Authors: Lear R, Godfrey AD, Riga C, Norton C, Vincent C, Bicknell CD
BACKGROUND: System factors contributing to preventable harm in vascular patients have not been previously reported in detail. The aim of this exploratory mixed-methods study was to describe vascular surgeons' perceptions of factors contributing to adverse events (AEs) in arterial surgery. A secondary aim was to report recommendations to improve patient safety.
METHODS: Vascular consultants/registrars working in the British National Health Service were questioned about the causes of preventable AEs through survey and semi-structured interview (response rates 77% and 83%, respectively). Survey respondents considered a recent AE, indicating on a 5 point Likert scale the extent to which various factors from a validated framework contributed toward the incident. Semi-structured interviews were conducted to obtain detailed accounts of contributory factors, and to elicit recommendations to improve safety.
RESULTS: Seventy-seven surgeons completed the survey on 77 separate AEs occurring during open surgery (n = 41) and in endovascular procedures (n = 36). Ten interviewees described 15 AEs. The causes of AEs were multifactorial (median number of factors/AE = 5, IQR 3-9, range 0-25). Factors frequently reported by survey respondents were communication failures (36.4%; n = 28/77); inadequate staffing levels/skill mix (32.5%; n = 25/77); lack of knowledge/skill (37.3%; n = 28/75). Themes emerging from interviews were team factors (communication failure, lack of team continuity, lack of clarity over roles/responsibilities); work environment factors (poor staffing levels, equipment problems, distractions); inadequate training/supervision. Knowledge/skill (p = .034) and competence (p = .018) appeared to be more prominent in causing AEs in open procedures compared with endovascular procedures; organisational structure was more frequently implicated in AEs occurring in endovascular procedures (p = .017). To improve safety, interviewees proposed team training programmes (5/10 interviewees); additional protocols/checklists (4/10); improved escalation procedures (3/10).
CONCLUSION: Vascular surgeons believe that AEs in arterial operations are caused by multiple, modifiable system factors. Larger studies are needed to establish the relative importance of these factors and to determine strategies that can effectively address system failures.
PMID: 29150228 [PubMed - as supplied by publisher]
Family-centered bereavement practices in Danish intensive care units: a cross-sectional national survey.
Intensive Crit Care Nurs. 2017 Nov 14;:
Authors: Egerod I, Kaldan G, Coombs M, Mitchell M
BACKGROUND: Mortality in Danish intensive care units (ICUs) continues at 27%, resulting in a large number of bereaved family members being cared for in the ICU.
OBJECTIVES: To investigate the provision of bereavement care and follow-up services for bereaved families in Danish ICUs.
METHODOLOGY: Self-administered computerized cross-sectional nation-wide survey of Danish ICUs.
RESULTS: Nurses at 46 of 48 (96%) ICUs in Denmark responded. Bereavement care at the time of patient death included viewing the patient in ICU (100%), and in the hospital mortuary (59%). Information about hospital-based follow-up for the family was provided in 72% of units, whereas only one unit provided information on community-based bereavement follow-up. Bereavement follow-up services after hospitalization were offered to families in 59% of ICUs and included an ICU visit, meeting with the staff present at the time of death, a letter of condolence, a phone call to the family, referral to a priest or clergyman, or referral to other counseling. Although many interventions were common, there were variations within the elements offered. Nurses and physicians were the most consistent health care staff involved in bereavement services.
CONCLUSION: Most ICUs in Denmark offered bereavement follow-up services, but these varied in their approach, were not evidence-based, and lacked formal evaluation. More systematic quality improvement of bereavement practices is required.
PMID: 29150180 [PubMed - as supplied by publisher]
Access to health care for persons with disabilities in rural South Africa.
BMC Health Serv Res. 2017 Nov 17;17(1):741
Authors: Vergunst R, Swartz L, Hem KG, Eide AH, Mannan H, MacLachlan M, Mji G, Braathen SH, Schneider M
BACKGROUND: Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at "triple vulnerability" - poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa.
METHODS: The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis.
RESULTS: Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age.
CONCLUSIONS: This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.
PMID: 29149852 [PubMed - in process]
Patient participation in nursing bedside handover: A systematic mixed-methods review.
Int J Nurs Stud. 2017 Oct 24;77:243-258
Authors: Tobiano G, Bucknall T, Sladdin I, Whitty JA, Chaboyer W
BACKGROUND: Numerous reviews of nursing handover have been undertaken, but none have focused on the patients' role.
OBJECTIVES: To explore how patient participation in nursing shift-to-shift bedside handover can be enacted.
DESIGN: Systematic mixed- methods review.
DATA SOURCES: Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects.
REVIEW METHODS: Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table.
RESULTS: Segregated synthesis of research of patients' perceptions revealed two contrasting categories; patient-centred handover and nurse-centred handover. Segregated synthesis of research of nurses' perceptions included three categories: viewing the patient as an information resource; dealing with confidential and sensitive information; and enabling patient participation. The segregated synthesis of QI projects included two categories: nurse barrier to enacting patient participation in bedside handover; and involving patients in beside handover. Once segregated findings were configured, we discovered that the patient's role in bedside handover involves contributing clinical information related to their care or progress, which may influence patient safety. Barriers related to nurses' concerns for the consequences of encouraging patient participation, worries for sharing confidential and sensitive information and feeling hesitant in changing their handover methods. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and involving both patients and nurses throughout the change process.
CONCLUSIONS: Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses and patient views. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects.
PMID: 29149634 [PubMed - as supplied by publisher]
Addressing the Unmet Need for Maternal Mental Health Services in Low- and Middle-Income Countries: Integrating Mental Health Into Maternal Health Care.
J Midwifery Womens Health. 2017 Nov 17;:
Authors: Lasater ME, Beebe M, Gresh A, Blomberg K, Warren N
PMID: 29149521 [PubMed - as supplied by publisher]
Compassion in Practice - evaluating the awareness, involvement and perceived impact of a national nursing and midwifery strategy amongst health care professionals in NHS Trusts in England.
J Clin Nurs. 2017 Nov 17;:
Authors: Allan H, O'Driscoll M, Liu L, Corbett K, Serrant L
AIM: To report the findings from an evaluation of the impact of the Compassion in Practice Vision & Strategy (CiPVS) (National Health Service England (NHSE), 2012) on nursing, midwifery and care staff.
BACKGROUND: The CiPVS was a programme of work to highlight the importance of compassionate care following the Francis Report in 2013 into the deficits in care in an NHS hospital trust. It was launched by NHS England in 2012 at a time when fiscal cuts were introduced by the Department of Health in England.
DESIGN AND SETTING: Mixed methods.
RESULTS: Inferential statistics were used to test whether there were significant differences between staff at different levels of seniority with regard to awareness and involvement in CiPVS and their attitudes to it. Awareness and involvement of staff in CiPVS was high amongst middle and senior management but limited at ward level. Staff were not involved in CiPVS due to a lack of awareness. Ward level staff who were aware and involved perceived a lack of support and communication from senior leadership to deliver CiPVS.
DISCUSSION: Results reveal professional anger, distress and resistance to CiPVS and a view of the programme as a top down initiative which did not sufficiently recognise structural constraints on nurses' ability to deliver compassionate care. We discuss the implications of our findings for global nursing.
CONCLUSION: Participants emphasised that compassion for patients is only sustainable where there is compassion for staff and many participants felt that they were not being treated with compassion.
RELEVANCE FOR PRACTICE: NHSE should strongly affirm that nurses and midwives in general provide compassionate care. Trust leadership should provide support for ward level staff who deliver compassionate care in difficult circumstances. This article is protected by copyright. All rights reserved.
PMID: 29149520 [PubMed - as supplied by publisher]
Registered Nurse and Midwife Experiences of Using Videoconferencing in Practice: a Systematic Review of Qualitative Studies.
J Clin Nurs. 2017 Nov 17;:
Authors: Penny RA, Bradford NK, Langbecker D
AIM: To synthesise evidence of registered nurses' and midwives' experiences with videoconferencing and identify perceptions of the appropriateness, meaningfulness and feasibility of this technology in professional and clinical practice.
BACKGROUND: Videoconferencing is a form of telehealth that can facilitate access to high quality care to improve health outcomes for patients and enable clinicians working in isolation to access education, clinical supervision, peer support and case review. Yet use of videoconferencing has not translated smoothly into routine practice. Understanding the experiences of registered nurses and midwives may provide practitioners, service managers and policy makers with vital information to facilitate use of the technology.
DESIGN: A qualitative meta-synthesis of primary qualitative studies undertaken according to Joanna Briggs Institute methodology.
METHOD: A systematic search of 19 databases was used to identify qualitative studies that reported on registered nurses' or midwives' experiences with videoconferencing in clinical or professional practice. Two reviewers independently appraised studies, extracted data and synthesised findings to construct core concepts.
RESULTS: Nine studies met the criteria for inclusion. Five key synthesised findings were identified: useful on a continuum; broader range of information; implications for professional practice; barriers to videoconferencing; and technical support, training and encouragement.
CONCLUSIONS: While videoconferencing offers benefits, it comes with personal, organisational and professional consequences for nurses and midwives. Understanding potential benefits and limitations, training and support required and addressing potential professional implications all influence adoption and ongoing use of videoconferencing.
RELEVANCE TO CLINICAL PRACTICE: Registered nurses and midwives are well placed to drive innovations and efficiencies in practice such as videoconferencing. Nursing and midwifery practice must be reframed to adapt to the virtual environment whilst retaining valued aspects of professional practice. This includes ensuring professional standards keep pace with the development of knowledge in this area and addressing the findings highlighted in this meta-synthesis. This article is protected by copyright. All rights reserved.
PMID: 29149507 [PubMed - as supplied by publisher]
Being there and reconnecting: midwives' perceptions of the impact of Mindfulness training on their practice.
J Clin Nurs. 2017 Nov 17;:
Authors: Hunter L, Snow S, Warriner S
OBJECTIVE: To ascertain how midwives perceived attending a mindfulness course impacted on their professional practice, particularly in regard to any stress they experienced at work.
DESIGN: A qualitative study using Interpretive Phenomenological Analysis. Semi-structured interviews were conducted with nine midwives.
SETTING: A large maternity Trust in the United Kingdom.
INTERVENTION: An eight-week Mindfulness course, adapted from Mindfulness-based Cognitive Therapy.
FINDINGS: Four superordinate themes were identified: 'being challenged and committing', 'containing the self', 'reconnecting', and 'moving forward with confidence'. Focusing on the present moment enabled participants better to identify the boundary between self and other. This led to an increased sense of control and a reconnection with and reframing of relationships with colleagues and the women in their care.
KEY CONCLUSIONS: Mindfulness may provide an effective way to address the high levels of stress, role dissatisfaction and workplace bullying found in Midwifery, by improving both the working environment and patient care. The pivotal role of positive workplace relationships in this process resonates with other nursing research and with contemporary philosophical thought.
RELEVANCE TO CLINICAL PRACTICE: This study adds to a body of evidence which suggests investing in the wellbeing of midwifery staff improves both job satisfaction and women's experiences of care. This article is protected by copyright. All rights reserved.
PMID: 29149499 [PubMed - as supplied by publisher]
Effect of a thermal care bundle on the prevention, detection, and treatment of perioperative inadvertent hypothermia.
J Clin Nurs. 2017 Nov 17;:
Authors: Duff J, Walker K, Edward KL, Ralph N, Giandinoto JA, Alexander K, Gow J, Stephenson J
AIMS AND OBJECTIVES: To improve the prevention, detection, and treatment of perioperative inadvertent hypothermia (PIH) in adult surgical patients by implementing a Thermal Care Bundle.
BACKGROUND: Keeping patients normothermic perioperatively prevents adverse surgical outcomes. Hypothermia leads to serious complications including increased risk of surgical bleeding, surgical site infections, and morbid cardiac events. The Thermal Care Bundle consists of three elements: 1) assess risk; 2) record temperature; and (3) actively warm.
DESIGN: A pre-post implementation study was conducted to determine the impact of the Thermal Care Bundle on the prevention, detection and treatment of PIH.
METHODS: The Thermal Care Bundle was implemented using an adapted version of the Institute of Healthcare Improvement's Breakthrough Series Collaborative Model. Data were collected from auditing medical records.
RESULTS: Data from 729 patients (pre-implementation: n=351; post-implementation: n=378) at four sites were collected between December 2014 to January 2016. Improvements were recorded in the percentage of patients with a risk assessment; at least one documented temperature recording per perioperative stage; and appropriate active warming. Despite this, the overall incidence of PIH increased post-implementation.
CONCLUSION: The Thermal Care Bundle facilitated improved management of PIH through increased risk assessment, temperature recording, and active warming but did not impact on PIH incidence. Increased temperature recording may have more accurately revealed the true extent of PIH in this population.
RELEVANCE TO CLINICAL PRACTICE: This study showed that a collaborative, context specific implementation method, such as the IHI Breakthrough Series Model, is effective at improving practices which can improve thermal care. This article is protected by copyright. All rights reserved.
PMID: 29149456 [PubMed - as supplied by publisher]
Job strain in nursing homes - Exploring the impact of leadership.
J Clin Nurs. 2017 Nov 17;:
Authors: Backman A, Sjögren K, Lövheim H, Edvardsson D
AIMS AND OBJECTIVES: This study aimed to explore the association between leadership behaviours, job strain and social support as perceived by direct care staff in nursing homes.
BACKGROUND: It is well known that aged care staff experience high levels of job strain, and that aged care staff experiencing job strain are exposed to increased risk for adverse health effects. Managerial leadership styles have been associated to job strain in the literature, however, the impact of perceived leadership behaviors' on staff job strain and social support has not been clarified within this context.
DESIGN: This study had a cross-sectional design.
METHODS: Participating staff (n=3605) completed surveys which included questions about staff characteristics, valid and reliable measures of managerial leadership behaviors, perceived job strain and social support. Statistical analyses of correlations and multiple regression analysis with interaction terms were conducted.
RESULTS: Highly rated leadership behaviors' were significantly associated to lower lever of job strain and higher level of social support. Higher levels of leadership behaviors' also moderated the impact of social support on job strain.
CONCLUSIONS: Highly rated leadership behaviours in nursing home managers seems to buffer staff job strain and potentiate social support within nursing homes. Thus, nursing home managers' leadership behaviors seem beneficial for the working situation and strain of staff.
RELEVANCE TO CLINICAL PRACTICE: Promoting a supporting work environment through a positive leadership seems to be an important implication for middle managers in nursing home care as it can influence staff perception of job strain and social support within the unit. By providing leadership, offering support and strategies towards a healthy work environment, nursing home managers may through their leadership, prevent adverse health effects among staff. This article is protected by copyright. All rights reserved.
PMID: 29148598 [PubMed - as supplied by publisher]
Psychosocial factors predicting length of hospitalization in elderly individuals with diabetes in selected hospitals of Isfahan University of Medical Sciences, Isfahan, Iran, in 2015.
ARYA Atheroscler. 2017 May;13(3):103-108
Authors: Baharlooei O, Alavi M, Adelmehraban M
BACKGROUND: Currently, researchers seek to identify factors related to length of hospital stay in elderly in order to reduce burden on the health system. The importance of either physiological or psychological factors in determining health outcomes has been well stablished; however, the possible contribution of psychosocial factors particularly in elderly patients with diabetes is also of special importance. This study aimed to know what psychosocial variables predicts length of hospital stay in elderly patients with diabetes.
METHODS: This was a cross-sectional, correlational study conducted on 150 elderly patients from July-October 2015. Convenient sampling method was used to recruit the subjects. The data was collected by a three-part questionnaire consisted of demographic and health related characteristics, 21-item depression anxiety stress scale (DASS-21) and multidimensional scale of perceived social support (MSPSS).
RESULTS: The mean ± standard deviation of length of hospital stay was 15.6 ± 7.7 days. Findings from multiple regression analysis showed that the models of predicting length of hospital stay in subgroups of both women (P = 0.001, F6,77 = 4.45) and men (P = 0.030, F6,71 = 2.43) were significant. The entered variables in subgroups of women and men accounted for 27% and 18% of total variance (R2) of the length of hospital stay, respectively. None of the psychosocial variables in women significantly predicted the lengths of hospital stay. However, one out of three predicting psychosocial variables (i.e. stress) in men significantly predicted the length of hospital stay (β = 0.39, t = 2.1, P = 0.040).
CONCLUSION: The results emphasized the importance of promoting social support of elderly patients with diabetes, particularly in patients who are women, have higher levels of stress, have higher period of disease and a history of hospitalization in the past 6 months in order to lower length of hospital stay and finally promote health status in elderly patients with diabetes. Further studies regarding the effect of each of these factors on health condition of elderly with diabetes are recommended.
PMID: 29147119 [PubMed]
Assessing quality of maternity care in Hungary: expert validation and testing of the mother-centered prenatal care (MCPC) survey instrument.
Reprod Health. 2017 Nov 16;14(1):152
Authors: Rubashkin N, Szebik I, Baji P, Szántó Z, Susánszky É, Vedam S
BACKGROUND: Instruments to assess quality of maternity care in Central and Eastern European (CEE) region are scarce, despite reports of poor doctor-patient communication, non-evidence-based care, and informal cash payments. We validated and tested an online questionnaire to study maternity care experiences among Hungarian women.
METHODS: Following literature review, we collated validated items and scales from two previous English-language surveys and adapted them to the Hungarian context. An expert panel assessed items for clarity and relevance on a 4-point ordinal scale. We calculated item-level Content Validation Index (CVI) scores. We designed 9 new items concerning informal cash payments, as well as 7 new "model of care" categories based on mode of payment. The final questionnaire (N = 111 items) was tested in two samples of Hungarian women, representative (N = 600) and convenience (N = 657). We conducted bivariate analysis and thematic analysis of open-ended responses.
RESULTS: Experts rated pre-existing English-language items as clear and relevant to Hungarian women's maternity care experiences with an average CVI for included questions of 0.97. Significant differences emerged across the model of care categories in terms of informal payments, informed consent practices, and women's perceptions of autonomy. Thematic analysis (N = 1015) of women's responses identified 13 priority areas of the maternity care experience, 9 of which were addressed by the questionnaire.
CONCLUSIONS: We developed and validated a comprehensive questionnaire that can be used to evaluate respectful maternity care, evidence-based practice, and informal cash payments in CEE region and beyond.
PMID: 29145863 [PubMed - in process]
Rehabilitation for cancer patients at Black Lion hospital, Addis Ababa, Ethiopia: a cross-sectional study.
BMC Palliat Care. 2017 Nov 16;16(1):53
Authors: Worku T, Mengistu Z, Semahegn A, Tesfaye G
BACKGROUND: In Ethiopia, there were greater than 2000 adult and 200 pediatric cancer patients annually in 2010, but the estimated number of cancer patients were increasing. Oncologic rehabilitation treatment may result in improved physical and mental impairment. There is a paucity of information about rehabilitation service utilization among cancer patients in Ethiopia. Hence, the purpose of this study was to assess the rehabilitation service for cancer patient and associated factors at Black Lion hospital, Addis Ababa, Ethiopia.
METHODS: A hospital-based cross-sectional quantitative study was conducted from March to April 2014. Convenient sampling method was employed to recruit the study participants. Interviewer administered questionnaire was used to collect data. Data were entered into EPI data version 3.1 and exported to SPSS (16.0) software for analysis. Descriptive analysis, binary and multiple logistic regression were carried out. Significance association was interpreted using adjusted odds ratio at 95% confidence interval and p-value less than 0.05.
RESULT: A sample of 423 patients aged 18 years and older were involved in the study. Breast cancer (25%), colorectal cancer (20.6%), cervical cancer (14.7%), lymphoma (7.7%), lung (7.2%), leukemia (5.4%), kidney (3.6%) and prostate cancer (2.6%) were the common forms of cancer diagnosed at cancer unit of the Black Lion Hospital. Twenty six percent of cancer patients received rehabilitation service at least once. The main rehabilitation services given were nutritional and psychological support. Unavailability of supplies, lack of professionals and cost of service were among the barriers to receiving rehabilitation services.
CONCLUSION: Only a few cancer patients received cancer rehabilitation services. Increasing the knowledge of the professionals, stocking cancer units with necessary supplies, and other comprehensive programs are needed.
PMID: 29145841 [PubMed - in process]
Care and self-reported outcomes of care experienced by women with mental health problems in pregnancy: Findings from a national survey.
Midwifery. 2017 Oct 27;56:171-178
Authors: Henderson J, Jomeen J, Redshaw M
BACKGROUND: mental health problems in pregnancy and the postnatal period are relatively common and, in pregnancy, are associated with an increase in adverse outcome. It is recommended that all women are asked about their emotional and mental health and offered treatment if appropriate.
OBJECTIVES: to describe the care received by women self-identifying with mental health problems in pregnancy, and to describe the effects of support, advice and treatment on outcomes in the postnatal period.
DESIGN: this study used cross-sectional survey data collected in 2014 which described women's experience of maternity care.
SETTING: England PARTICIPANTS: a random sample of women who had a live birth in January 2014.
MEASUREMENTS: the questionnaire asked about sociodemographic characteristics, whether women were asked about emotional and mental health in pregnancy, support and treatment offered, about postnatal wellbeing, and questions relating to attachment to their baby. Descriptive statistics and logistic regression were used to examine the associations between mental health and outcomes taking account of sociodemographic characteristics.
FINDINGS: the survey response rate was 47%. Women with antenatal mental health problems were significantly more worried at the prospect of labour and birth, had lower satisfaction with the experience of birth, worse postnatal mental health, and indications of poorer attachment to their baby. They received substantially more care than other women but they did not always view this positively. Support, advice and treatment for mental health problems had mixed effects.
CONCLUSIONS: this study describes the significant additional care provided to women self-identifying with mental health problems in pregnancy, the mixed effects of support, advice and treatment, and the poor perception of staff interaction among women with mental health problems.
IMPLICATIONS FOR PRACTICE: health care professionals may need additional training to effectively support women with mental health problems during the perinatal period.
PMID: 29145155 [PubMed - as supplied by publisher]
Attendance at prenatal care and adverse birth outcomes in China: A follow-up study based on Maternal and Newborn's Health Monitoring System.
Midwifery. 2017 Nov 13;57:26-31
Authors: Huang A, Wu K, Zhao W, Hu H, Yang Q, Chen D
OBJECTIVE: to evaluate the independent association between attendance at prenatal care and adverse birth outcomes in China, measured either as the occurrence of preterm birth or low birth weight.
DESIGN: a follow-up study.
SETTING: the data was collected from maternal and newborn's health monitoring system at 6 provinces in China.
PARTICIPANTS: all pregnant women registered in the system at their first prenatal care visit. We included 40152 registered pregnant women who had delivered between October 2013 and September 2014.
MEASUREMENTS: attendance at prenatal care was evaluated using Kessner index. χ(2) tests were used to examine the correlations between demographic characteristics and preterm birth or low birth weight. The associations between attendance at prenatal care and birth outcomes were explored using multilevel mixed-effects logistic regression models.
FINDINGS: the prevalence for preterm birth and low birth weight was 3.31% and 2.55%. The null models showed region clustering on birth outcomes. Compared with women who received adequate prenatal care, those with intermediate prenatal care (adjusted OR 1.62, 95%CI 1.37-1.92) or inadequate prenatal care (adjusted OR 2.78, 95%CI 2.24-3.44) had significantly increased risks for preterm birth, and women with intermediate prenatal care (adjusted OR 1.31, 95%CI 1.10-1.55) or inadequate prenatal care (adjusted OR 1.70, 95%CI 1.32-2.19) had significantly increased risks for low birth weight. We found very significant dose-response patterns for both preterm birth (p-trend<0.001) and low birth weight (p-trend = 0.001).
KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: This study shows that attendance at prenatal care in China has independent effects on both preterm birth and low birth weight. Appropriate timing and number of prenatal care visits can help to reduce the occurrence of preterm birth or low birth weight.
PMID: 29144978 [PubMed - as supplied by publisher]
Birthplace in Australia: Processes and interactions during the intrapartum transfer of women from planned homebirth to hospital.
Midwifery. 2017 Nov 02;57:18-25
Authors: Fox D, Sheehan A, Homer C
OBJECTIVE: the aim of the study was to explore the views and experiences of women, midwives and obstetricians on the intrapartum transfer of women from planned homebirth to hospital in Australia.
DESIGN: a Constructivist Grounded Theory approach was taken, to conceptualise the social interactions and processes grounded in the data.
SETTING: urban and regional areas in four states of south-eastern Australia.
PARTICIPANTS: semi-structured qualitative interviews were conducted with 36 women, midwives and obstetricians who had experienced an intrapartum homebirth transfer within three years prior to the interview. Interviews were audio recorded and transcribed verbatim.
FINDINGS: women who were transferred to hospital from a planned homebirth made physical and psychological journeys out of their comfort zone, as they faced the uncertainty of changing expectations for their birth. The trusting relationship between a woman and her homebirth midwife was crucial to women's sense of safety and well-being in hospital. Midwives and obstetricians, when congregating in the hospital birthing rooms of transferred women, also felt out of their comfort zones. This was due to the challenges of converging with others who possessed conflicting paradigms of safety and risk in birth that were at odds with their own, and adapting to different routines, roles and responsibilities. These differences were derived from diverse professional, social and personal influences and often manifested in stereotyping behaviours and 'us and them' dynamics. When midwife-woman partnerships were respected as an inclusive part of women's care, collaboration ensued, conflict was ameliorated, and smooth transfers could be celebrated as successes of the maternity care system.
KEY CONCLUSIONS: supporting woman centred care in homebirth transfers means acknowledging the social challenges of collaborating in the unique context of a transferred woman's hospital birthing room. Understanding the power of the midwife-woman partnership, and its value to the health and well-being of each woman and her baby, is key to facilitating a successful transfer.
IMPLICATIONS FOR PRACTICE: the midwife-woman partnership played a central role in providing the necessary support and advocacy for women transferred out of their comfort zone. When midwives worked together in an integrated system to provide the necessary care and support for women who were transferred, greater levels of collaboration emerged and women's perceptions of their quality of care was high. In practice, this meant health professionals respecting each other's roles, responsibilities and expertise, and ameliorating 'us and them' dynamics.
PMID: 29144977 [PubMed - as supplied by publisher]
Is it time to abandon care planning in mental health services? A qualitative study exploring the views of professionals, service users and carers.
Health Expect. 2017 Nov 16;:
Authors: Brooks HL, Lovell K, Bee P, Sanders C, Rogers A
BACKGROUND: It has been established that mental health-care planning does not adequately respond to the needs of those accessing services. Understanding the reasons for this and identifying whose needs care plans serve requires an exploration of the perspectives of service users, carers and professionals within the wider organizational context.
OBJECTIVE: To explore the current operationalization of care planning and perceptions of its function within mental health services from the perspectives of multiple stakeholders.
SETTINGS AND PARTICIPANTS: Participants included 21 mental health professionals, 29 service users and 4 carers from seven Mental Health Trusts in England. All participants had experience of care planning processes within secondary mental health-care services.
METHODS: Fifty-four semi-structured interviews were conducted with participants and analysed utilizing a qualitative framework approach.
FINDINGS: Care plans and care planning were characterized by a failure to meet the complexity of mental health needs, and care planning processes were seen to prioritize organizational agendas and risk prevention which distanced care planning from the everyday lives of service users.
DISCUSSION AND CONCLUSIONS: Care planning is recognized, embedded and well established in the practices of mental health professionals and service users. However, it is considered too superficial and mainly irrelevant to users for managing mental health in their everyday lives. Those responsible for the planning and delivery of mental health services should consider ways to increase the relevance of care planning to the everyday lives of service users including separating risk from holistic needs assessment, using support aids and utilizing a peer workforce in this regard.
PMID: 29144591 [PubMed - as supplied by publisher]
Relationship Between Hospital-Level Percentage of Midwife-Attended Births and Obstetric Procedure Utilization.
J Midwifery Womens Health. 2017 Nov 16;:
Authors: Attanasio L, Kozhimannil KB
INTRODUCTION: Research has shown good outcomes among individual low-risk women who receive perinatal care from midwives, yet little is known about how hospital-level variation in midwifery care relates to procedure use and maternal health. This study aimed to document the association between the hospital-level proportion of midwife-attended births and obstetric procedure utilization.
METHODS: This analysis used 2 data sources: Healthcare Cost and Utilization Project State Inpatient Database data for New York in 2014, and New York State Department of Health data on the percentage of midwife-attended births at hospitals in the state in 2014. Using logistic regression, we estimated the association between the hospital-level percentage of midwife-attended births and 4 outcomes among low-risk women: labor induction, cesarean birth, episiotomy, and severe maternal morbidity.
RESULTS: Hospital-level percentage of midwife-attended births was not associated with reduced odds of labor induction or severe maternal morbidity. Women who gave births at hospitals with more midwife-attended births had lower odds of giving birth by cesarean (eg, adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.59-0.82 at a hospital with 15% to 40% of births attended by midwives, compared to no midwife-attended births) and lower odds of episiotomy (eg, aOR, 0.41; 95% CI, 0.23-0.74 at a hospital with more than 40% of births attended by midwives, compared to no midwife-attended births).
DISCUSSION: Our results indicate that hospitals with more midwife-attended births have lower utilization of some obstetric procedures among low-risk women; this raises the possibility of improving value in maternity care through greater access to midwifery care.
PMID: 29144586 [PubMed - as supplied by publisher]
The Making of Informed Choice in Midwifery: A Feminist Experiment in Care.
Cult Med Psychiatry. 2017 Nov 15;:
Authors: MacDonald ME
This paper is about the clinical principle of informed choice-the hallmark feature of the midwifery model of care in Ontario, Canada. Drawing on ethnographic history interviews with midwives, I trace the origins of the idea of informed choice to its roots in the social movement of midwifery in North America in the late 1960s and 1970s. At that time informed choice was not the distinctive feature of midwifery but was deeply embedded what I call midwifery's feminist experiment in care. But as midwifery in Ontario transitioned from a social movement to a full profession within the formal health care system, informed choice was strategically foregrounded in order to make the midwifery model of care legible and acceptable to a skeptical medical profession, conservative law makers, and a mainstream clientele. As mainstream biomedicine now takes up the rhetoric of patient empowerment and informed choice, this paper is at once a nuanced history of the making of the concept and also a critique of the ascendant 'regime of choice' in contemporary health care, inspired by the reflections of the midwives in my study for whom choice is impossible without care.
PMID: 29143236 [PubMed - as supplied by publisher]
Prevention of Insulin Resistance by Dietary Intervention among Pregnant Mothers: A Randomized Controlled Trial.
Int J Prev Med. 2017;8:85
Authors: Goodarzi-Khoigani M, Mazloomy Mahmoodabad SS, Baghiani Moghadam MH, Nadjarzadeh A, Mardanian F, Fallahzadeh H, Dadkhah-Tirani A
Background: Chronic insulin resistance (IR) is a basic part of the pathophysiology of gestational diabetes mellitus. Nutrition significantly impacts IR and weight loss reduces insulin levels, whereas weight gain increases the concentrations. Therefore, we surveyed the effect of nutrition intervention on IR in pregnant women and whether this effect is irrespective of weight gaining in accordance with Institute of Medicine limits.
Methods: This prospective, randomized clinical trial was carried out among 150 primiparous pregnant mothers in fifteen health centers, five hospitals, and 15 private obstetrical offices in Isfahan. The nutrition intervention included education of healthy diet with emphasize on 50%-55% of total energy intake from carbohydrate (especially complex carbohydrates), 25%-30% from fat (to increase mono unsaturated fatty acids and decrease saturated and trans-fatty acids), and 15%-20% from protein during pregnancy for experimental group. The controls received the usual prenatal care by their health-care providers.
Results: This trial decreased pregnancy-induced insulin increases (P = 0.01) and IR marginally (P = 0.05). ANCOVA demonstrated that control of gestational weight gaining was more effective to decrease IR (P = 0.02) while insulin values decreased by nutrition intervention and irrespective of weight control (P = 0.06). Fasting plasma glucose (FPG) concentrations did not decrease by intervention (P = 0.56) or weight management (P = 0.15).
Conclusions: The current intervention was effective to decrease pregnancy-induced insulin increases and IR. Considering study results on FPG levels and incidence of GDM, we suggest repeat of study design in a larger sample.
PMID: 29142651 [PubMed]
Development and validation of the coping with multiple sclerosis questionnaire.
Mult Scler Relat Disord. 2017 Nov;18:49-55
Authors: Dehghani A, Nayeri ND, Ebadi A
BACKGROUND: Development of a self-report measure of coping with multiple sclerosis is required based on cultural factors, which can advance our understanding of the level of coping for care planning and improvement of coping and quality of life. The current study aimed to develop and validate the scale of coping with Multiple Sclerosis.
METHODS: This methodological study was conducted in three phases. In the first phase, the concept of coping with MS was defined by the hybrid model. In the second phase, the item pool was generated from findings of the first phase. In the third phase, psychometric properties of the scale were evaluated including face, content and construct validity as well as reliability.
RESULTS: 192 items in primary item pool were finally reduced to 35 items after evaluating the validity (face, content and construct validity) and reliability. Factor analyses revealed five factors: self-efficacy, self-regulation, accepting the current situation, treatment seeking and adherence to it, and emotional balance. Internal consistency and stability of the developed questionnaire confirmed with 0.93 and 0.96 respectively that indicated excellent reliability.
CONCLUSION: The 35-item developed questionnaire is valid and reliable for assessment of levels of coping in Iranian people with MS.
PMID: 29141821 [PubMed - in process]
Health-Related Decisions for Serious Illness Among Ethnically Diverse Older Adults.
ANS Adv Nurs Sci. 2017 Nov 14;:
Authors: Rahemi Z, Williams CL, Tappen RM, Engstrom GA
We investigated the influence of sociodemographic factors, acculturation, ethnicity, health status, and spirituality on older adults' health-related decisions when confronted with a choice between competing options. The sample included 451 participants: African Americans (15.74%), Afro-Caribbeans (25.5%), European Americans (36.36%), and Hispanic Americans (22.4%). Compared with others, European Americans and Hispanic Americans favored quality of life over a lengthy life. Sociodemographic factors, acculturation, ethnicity, health status, and spirituality accounted for variations of decisions. The variability of decisions calls for multiple care options to explore the value of different trade-offs in order to avoid predetermined clinical practice guidelines, especially in nursing.
PMID: 29140805 [PubMed - as supplied by publisher]
Understanding and meeting your legal responsibilities as a nurse.
Nurs Stand. 2017 Nov 15;32(12):52-63
Authors: Terry L, Carr G, Halpin Y
Nurses, midwives and nursing students are legally responsible for their actions. This article discusses the legal standard of care required in relation to nursing and midwifery practice and nurses' professional standards and code of conduct. It examines how courts in the UK determine if nurses have met their duty of care and how nurses must ensure they maintain competence to provide safe care. It examines why organisational knowing - understanding the organisation in which one is employed; its people, values and how it works - is important for all nurses, regardless of their level in the organisation. It also discusses workplace incivility and its adverse effects on nurses, patient care and healthcare organisations. The article explains that if nurses are uncertain why they are doing something, they should investigate this further, because the law expects nurses to be able to justify their actions, or failure to act.
PMID: 29139627 [PubMed - in process]
Adherence to a multifactorial fall prevention program following paramedic care: Predictors and impact on falls and health service use. Results from an RCT a priori subgroup analysis.
Australas J Ageing. 2017 Nov 15;:
Authors: Mikolaizak AS, Lord SR, Tiedemann A, Simpson P, Caplan G, Bendall JC, Howard K, Close J
OBJECTIVE: To identify predictors and impact of adherence to a multifactorial fall-prevention program on falls and health service utilisation.
METHODS: Randomised controlled trial with a priori subgroup analysis within intervention group according to adherence. Participants were community dwelling, (≥65 years), not transported to hospital following fall-related paramedic care. The Attitudes to Falls-Related Interventions Scale (AFRIS) was completed at baseline, adherence levels were measured (three-point scale) at six months, and falls and health service utilisation were recorded for 12 months. Multivariate logistic regression and area under the curve were calculated with 95% confidence interval (CI).
RESULTS: Attitudes to Falls-Related Interventions Scale scores (n = 85) were independent of baseline characteristics. At six months, 39 (46%) participants reported full adherence. Independent predictors of adherence were positive AFRIS (OR 4.10, 95% CI 1.48-11.39) and receiving 3+ recommendations (OR 3.36, 95% CI 1.26-9.00). Adherers experienced fewer falls (IRR 0.53, 95% CI 0.45-0.80) and fall-related health service use (emergency department presentations IRR 0.37, 95% CI 0.17-0.82) compared to non-adherers.
CONCLUSION: Older adults who adhere to recommendations benefit, regardless of fall-risk profile.
PMID: 29139599 [PubMed - as supplied by publisher]
Healthcare providers' gestational weight gain counselling practises and the influence of knowledge and attitudes: a cross-sectional mixed methods study.
BMJ Open. 2017 Nov 14;7(11):e018527
Authors: Morris J, Nikolopoulos H, Berry T, Jain V, Vallis M, Piccinini-Vallis H, Bell RC, ENRICH team
OBJECTIVE: To understand current gestational weight gain (GWG) counselling practices of healthcare providers, and the relationships between practices, knowledge and attitudes.
DESIGN: Concurrent mixed methods with data integration: cross-sectional survey and semistructured interviews.
PARTICIPANTS: Prenatal healthcare providers in Canada: general practitioners, obstetricians, midwives, nurse practitioners and registered nurses in primary care settings.
RESULTS: Typically, GWG information was provided early in pregnancy, but not discussed again unless there was a concern. Few routinely provided women with individualised GWG advice (21%), rate of GWG (16%) or discussed the risks of inappropriate GWG to mother and baby (20% and 19%). More routinely discussed physical activity (46%) and food requirements (28%); midwives did these two activities more frequently than all other disciplines (P<0.001). Midwives interviewed noted a focus on overall wellness instead of weight, and had longer appointment times which allowed them to provide more in-depth counselling. Regression results identified that the higher priority level that healthcare providers place on GWG, the more likely they were to report providing GWG advice and discussing risks of GWG outside recommendations (β=0.71, P<0.001) and discussing physical activity and food requirements (β=0.341, P<0.001). Interview data linked the priority level of GWG to length of appointments, financial compensation methods for healthcare providers and the midwifery versus medical model of care.
CONCLUSIONS: Interventions for healthcare providers to enhance GWG counselling practices should consider the range of factors that influence the priority level healthcare providers place on GWG counselling.
PMID: 29138209 [PubMed - in process]
Current status of postnatal depression smartphone applications available on application stores: an information quality analysis.
BMJ Open. 2017 Nov 14;7(11):e015655
Authors: Zhang MW, Ho RC, Loh A, Wing T, Wynne O, Chan SWC, Car J, Fung DSS
OBJECTIVES: It is the aim of the current research to identify some common functionalities of postnatal application, and to determine the quality of the information content of postnatal depression application using validated scales that have been applied for applications in other specialties.
SETTINGS AND PARTICIPANTS: To determine the information quality of the postnatal depression smartphone applications, the two most widely used smartphone application stores, namely Apple iTunes as well as Google Android Play store, were searched between 20May and 31 May. No participants were involved. The inclusion criteria for the application were that it must have been searchable using the keywords 'postnatal', 'pregnancy', 'perinatal', 'postpartum' and 'depression', and must be in English language.
INTERVENTION: The Silberg Scale was used in the assessment of the information quality of the smartphone applications.
PRIMARY AND SECONDARY OUTCOMES MEASURE: The information quality score was the primary outcome measure.
RESULTS: Our current results highlighted that while there is currently a myriad of applications, only 14 applications are specifically focused on postnatal depression. In addition, the majority of the currently available applications on the store have only disclosed their last date of modification as well as ownership. There remain very limited disclosures about the information of the authors, as well as the references for the information included in the application itself. The average score for the Silberg Scale for the postnatal applications we have analysed is 3.0.
CONCLUSIONS: There remains a need for healthcare professionals and developers to jointly conceptualise new applications with better information quality and evidence base.
PMID: 29138195 [PubMed - in process]
Experiences and shared meaning of teamwork and interprofessional collaboration among health care professionals in primary health care settings: a systematic review.
JBI Database System Rev Implement Rep. 2017 Nov;15(11):2723-2788
Authors: Sangaleti C, Schveitzer MC, Peduzzi M, Zoboli ELCP, Soares CB
BACKGROUND: During the last decade, teamwork has been addressed under the rationale of interprofessional practice or collaboration, highlighted by the attributes of this practice such as: interdependence of professional actions, focus on user needs, negotiation between professionals, shared decision making, mutual respect and trust among professionals, and acknowledgment of the role and work of the different professional groups. Teamwork and interprofessional collaboration have been pointed out as astrategy for effective organization of health care services as the complexity of healthcare requires integration of knowledge and practices from differente professional groups. This integration has a qualitative dimension that can be identified through the experiences of health professionals and to the meaning they give to teamwork.
OBJECTIVE: The objective of this systematic review was to synthesize the best available evidence on the experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings.
INCLUSION CRITERIA TYPES OF PARTICIPANTS: The populations included were all officially regulated health professionals that work in primary health settings: dentistry, medicine, midwifery, nursing, nutrition, occupational therapy, pharmacy, physical education, physiotherapy, psychology, social work and speech therapy. In addition to these professionals, community health workers, nursing assistants, licensed practical nurses and other allied health workers were also included.
PHENOMENA OF INTEREST: The phenomena of interest were experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings.
CONTEXT: The context was primary health care settings that included health care centers, health maintenance organizations, integrative medicine practices, integrative health care, family practices, primary care organizations and family medical clinics. National health surgery as a setting was excluded.
TYPES OF STUDIES: The qualitative component of the review considered studies that focused on qualitative data including designs such as phenomenology, grounded theory, ethnography, action research and feminist research.
SEARCH STRATEGY: A three-step search strategy was utilized. Ten databases were searched for papers published from 1980 to June 2015. Studies published in English, Portuguese and Spanish were considered.
METHODOLOGICAL QUALITY: Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. All included studies received a score of at least 70% the questions in the instrument, 11 studies did not address the influence of the researcher on the research or vice-versa, and six studies did not present a statement locating the researcher culturally or theoretically.
DATA EXTRACTION: Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument.
DATA SYNTHESIS: Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software.
RESULTS: This review included 21 research studies, representing various countries and healthcare settings. There were 223 findings, which were aggregated into 15 categories, and three synthesized findings: CONCLUSIONS: This review shows that health professionals experience teamwork and interprofessional collaboration as a process in primary health care settings; its conditions, consequences (benefits and barriers), and finally shows its determinants. Health providers face enormous ideological, organizational, structural and relational challenges while promoting teamwork and interprofessional collaboration in primary health care settings. This review has identified possible actions that could improve implementation of teamwork and interprofessional collaboration in primary health care.
PMID: 29135752 [PubMed - in process]
Screening Women for At-Risk Alcohol Use: An Introduction to Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Women's Health.
J Midwifery Womens Health. 2017 Nov 14;:
Authors: Shogren MD, Harsell C, Heitkamp T
A significant number of women engage in at-risk drinking behavior, or heavy alcohol use. Women are especially at risk for the negative impact of excessive alcohol consumption secondary to gender differences in body structure, chemistry, and alcohol absorption. In addition, women who drink alcohol during pregnancy risk fetotoxic effects. Screening for at-risk alcohol use is considered best practice during primary care and prenatal care visits and is an integral component of preventive care services for women. The purpose of this brief report is to introduce the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model as it applies to alcohol use and its importance in women's health care services. SBIRT resources are evidence based, allowing the clinician to screen for use of alcohol, implement a brief intervention, and conduct referral to treatment, if necessary. Implementing SBIRT improves recognition of at-risk alcohol use or alcohol use disorder, facilitates awareness and education about use, enhances the referral-to-treatment process, and decreases overall health care costs.
PMID: 29135087 [PubMed - as supplied by publisher]
Influence of stroke coordinators on delivery of acute stroke care and hospital outcomes: An observational study.
Int J Stroke. 2017 Jan 01;:1747493017741382
Authors: Purvis T, Kilkenny MF, Middleton S, Cadilhac DA
Background Stroke coordinators have been inconsistently used in various countries to support stroke care in hospital. Aim To investigate the association between stroke coordinators and the provision of evidence-based care and patient outcomes in hospitals with acute stroke units. Methods Observational study using cross-sectional data from the 2015 National Acute Services Audit Program (Australia): including a retrospective medical record audit (40 records from each hospital) and a self-reported survey of organizational resources for stroke. Multilevel random effects logistic regression for patient outcomes including complications, independence on discharge, and death. Median regression for length of stay comparisons. Results A total of 109 hospitals submitted 4060 cases; 59 (54%) had a stroke coordinator. Compared with patients from stroke unit hospitals with no stroke coordinator ( N = 33, 1333 cases), patients in stroke unit hospitals with a stroke coordinator ( N = 53, 2072 cases) were more likely to receive clinical practices including rehabilitation therapy within 48 hours of initial assessment (88 vs. 82%, p < 0.001), risk factor modification advice (62 vs. 55%, p = 0.003) and receive a discharge care plan (65 vs. 48%, p < 0.001). No differences in complications, independence on discharge, or deaths were evident. Patients from hospitals with a stroke coordinator were more likely to access inpatient rehabilitation (adjusted odds ratio 1.8, 95% confidence interval 1.1-2.8) and have a reduced length of acute stay if discharged (median 14 h, p = 0.03). Conclusion Presence of stroke coordinators was associated with reduced length of stay and improved delivery of evidence-based care in hospitals with a stroke unit.
PMID: 29134926 [PubMed - as supplied by publisher]
A Concept Analysis of Spiritual Health.
J Relig Health. 2017 Nov 13;:
Authors: Sadat Hoseini AS, Razaghi N, Khosro Panah AH, Dehghan Nayeri N
Spiritual health is an important dimension of health and forms part of a comprehensive care. This study was conducted to redefine and clarify the components of spiritual health based on different worldviews through Walker and Avant's concept analysis method. Being given a life and a soul and having beliefs are the antecedents of spiritual health. The attributes of this concept include a morality-oriented intellectual connectedness with the self, others, and the universe guided by a connection with the Transcendent and Superior being in order to create meaning in life and find its purpose in the context of culture and religion; transcendence is ultimately the consequence of spiritual heath. Using the attributes appeared in this conceptual analysis, nurses can evaluate the spiritual health of their clients and help them create positive outcome by providing appropriate interventions.
PMID: 29134438 [PubMed - as supplied by publisher]
Provision of medical abortion by mid-level healthcare providers in Kyrgyzstan: testing an intervention to expand safe abortion services to under-served rural and peri-urban areas.
Contraception. 2017 Nov 10;:
Authors: Johnson BR, Maksutova E, Boobekova A, Davletova A, Kazakbaeva C, Kondrateva Y, Landoulsi S, Lazdane G, Monolbaev K, Seuc Jo AH
OBJECTIVE: To demonstrate the feasibility and safety of training mid-level healthcare providers (midwives and family nurses) to provide medical abortion and post-abortion contraception in under-served areas in Kyrgyzstan.
STUDY DESIGN: This was an implementation study at four referral facilities and 28 Felsher Obstetric Points in two districts to train their midwives and family nurses to deliver safe and effective abortion care with co-packaged mifepristone-misoprostol and provide contraceptives post-abortion. The outcome of abortion - complete abortion, incomplete abortion, or on-going pregnancy - was the primary endpoint measured. An international consultant trained 18 midwives and 14 family nurses (with midwifery diplomas) to provide medical abortion care. Supervising gynaecologists based in the referral centres and study investigators based in Bishkek provided monthly monitoring of services and collection of patient management forms. A voluntary self-administered questionnaire at the follow-up visit documented women's acceptability of medical abortion services. All study data were cross-checked and entered into an online data management system for descriptive analysis.
RESULTS: Between August 2014 and September 2015, midwives provided medical abortion to 554 women with a complete abortion rate of 97.8%, of whom 62% chose to use misoprostol at home. No women were lost to follow-up. Nearly all women (99.5%) chose a contraceptive method post-abortion. 61% of women receiving services completed the acceptability form, of whom more than 99% indicated a high level of satisfaction with the service and would recommend it to a friend.
CONCLUSION: This study demonstrates that trained Kyrgyz midwives and nurses can provide medical abortion safely and effectively. This locally generated evidence can be used by the Kyrgyz Ministry of Health to reduce unintended pregnancy and expand safe abortion care to women in under-served peri-urban and rural settings.
IMPLICATIONS: Success in scaling up midwife/nurse provision of medical abortion in Kyrgyzstan will require registration of mifepristone-misoprostol, regulations permanently allowing midwife/nurse provision, strengthened procurement and distribution systems to prevent stockouts of supplies, pre-service training of midwives/nurses and their involvement in district level supervision, monitoring and reporting, and support from supervisors.
PMID: 29133110 [PubMed - as supplied by publisher]
A comprehensive systematic review of pharmacy perspectives on interprofessional education and collaborative practice.
Res Social Adm Pharm. 2017 Nov 02;:
Authors: El-Awaisi A, Joseph S, El Hajj MS, Diack L
INTRODUCTION: Pharmacists are key professionals in the collaborative working process and are integral members of the healthcare team. However, there is paucity of information regarding their perspectives towards interprofessional education (IPE) and collaborative practice.
AIMS: The aim of this systematic review is to synthesise, summarise and evaluate the quality of the quantitative and qualitative literature related to the perspectives of pharmacy students, pharmacy faculty and practising pharmacists toward IPE and collaborative practice. The perspectives included their views, experiences and attitudes with a special focus on their perceived benefits and challenges in relation to IPE and collaborative practice.
METHODS: An integrated mixed method systematic review was conducted. Four electronic databases were searched for articles published in English between 2000 and 2015. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the studies.
RESULTS: Twenty-nine articles were identified meeting the selection criteria from the first initial search of 8512 articles. Seventeen articles (59%) targeted pharmacy students, 11 articles (38%) focused on practising pharmacists and 1 study (3%) was related to pharmacy faculty. The majority of studies were conducted in the United States (n = 13), were published in the last five years (83%, n = 24) and employed quantitative methods (52%, n = 15). The two commonly used survey instruments to measure the perspectives were: different versions of the RIPLS (35%, n = 6) and the IEPS scale (35%, n = 6). Fourteen of the 29 studies were rated as low quality (MMAT = 25%), eight studies were rated as average quality (MMAT = 50%), four were rated as high quality (MMAT 75%) and three were rated as very poor quality (MMAT 0%). No studies were rated with 100% MMAT quality. Overall, the findings suggest that pharmacy students, practicing pharmacists and faculty valued interprofessional education and collaborative practice and had positive attitudes towards it. Five main findings have been identified from this review: heterogeneity in reporting IPE research, traditional professional image of the pharmacist, lack of longitudinal follow-up, lack of IPE research on faculty and paucity in mixed method studies in terms of quality and numbers.
CONCLUSIONS: These findings will provide an opportunity to stakeholders and policy makers to develop and implement IPE activities that are meaningful, comprehensive and unique. Sustained efforts are required not just in undergraduate curricula but also in healthcare settings to improve and promote an interprofessional culture at individual and organisational level.
PMID: 29132909 [PubMed - as supplied by publisher]
How can structured cooperation between countries address health workforce challenges related to highly specialized health care? Improving access to services through voluntary cooperation in the EU
Book. 2016 Authors: Kroezen M, Buchan J, Dussault G, Glinos I, Wismar M, Richardson E, Wismar M, Richardson E, Figueras J, Kluge H, Lessof S, McDaid D, Mossialos E, Permanand G, North J, White C
Resolving health workforce challenges and improving cooperation between health professionals makes it more likely that patients will receive high-quality specialized care in their own country. Voluntary structured cross-border cooperation can help address the health workforce challenges that currently force patients to travel to find appropriate care. Structured cooperation works at different levels (linking countries; health care or training bodies; and/or clusters of organizations and individuals) but is always influenced by the institutional framework in which it takes place and the underlying European and national legal and policy frameworks. Evaluation of different models of structured cooperation is still scarce but policy-makers can enhance the chances of structured cooperation succeeding by reviewing the five main groups of factors that can enable or block success, specifically: legal factors including differences between jurisdictions on eligibility or licensing of products and medicines; political factors and the commitment to making exchanges work; economic factors including price and wage differences and the availability of EU funding; sociocultural factors and issues like trust, communication and language barriers which influence patient preferences and impact the level and quality of knowledge and information exchange that can be achieved; and organizational factors including context, the type of delivery system and any existing (informal) networks and relations. Policy-makers at a European and national level can support structured cooperation and address health workforce challenges in highly specialized care by: Building highly specialized care capacity throughout the EU through structured postgraduate training exchanges as a cross-border cooperation activity; Tailoring all structured cooperation to the context in which it takes place; Supporting successful initiatives on a structural basis, with political and financial support from domestic authorities and/or the EU; Using the grassroots experience of structured cooperation in highly specialized health care to inform macro-level policies when appropriate; Promoting the exchange of good practices in cross-border cooperation in (highly specialized) health care, not least as a way of inspiring health system actors to overcome health workforce challenges to the benefit of patients and health professionals.