Search

Globally, the nursing profession constitutes the largest proportion of the health workforce; however, it is challenged by widespread workforce shortages relative to need. Strategies to promote recruitment of the nursing workforce are well-established, with a lesser focus on strategies to alleviate the burden on the existing workforce. This burden may be exacerbated by the impact of low-value health care, characterised as health care that provides little or no benefit for patients, or has the potential to cause harm. Low-value health care is a global problem, a major contributor to the waste of healthcare resources, and a key focus of health system reform. Evidence of variation in low-value health care has been identified across countries and system levels. Research on low-value health care has largely focused on the medical profession, with a paucity of research examining either low-value health care or the de-implementation of low-value health care from a nursing perspective. The objective of this paper is to provide a scholarly discussion of the literature around low-value health care and de-implementation, with the purpose of identifying implications for nursing research. With increasing pressures on the global nursing workforce, research identifying low-value health care and developing approaches to de-implement this care, is crucial. [ABSTRACT FROM AUTHOR]

In this review article we will cover the management of both primary and secondary postpartum haemorrhage. Detailed national guidance on the management of primary PPH has been in place since 1998. Despite this, multiple MBRRACE-UK reports have consistently found significant scope for improvement in the care delivered to women. The recurrent nature of the themes highlighted in the reports is equally sobering, which suggests a failure to learn from these tragic cases. The first part of this paper will provide practical steps that can be taken to embed the learning from successive MBRRACE-UK reports into our day-to-day clinical practice. The second part of this paper will provide an overview of the literature on secondary postpartum haemorrhage. Secondary PPH is associated with significant maternal morbidity. Despite this, there is a lack of randomised controlled trials to inform the management of these women, and the long-term sequalae associated with both the condition and its management is unknown. [ABSTRACT FROM AUTHOR]

Due to the rise of the nurse practitioner (NP) role in long-term care settings, it is important to understand the underlying structures and processes that influence NP and physician care models. This scoping review aims to answer the question, "What are the structures, processes, and outcomes of care models involving NPs and physicians in long-term care (LTC) homes?" A secondary aim was to describe the structural enablers and barriers across care models. Seven databases were searched. Studies that described NPs and physicians working in LTC were identified and included in the review. We stratified the findings by care model and synthesized using the Donabedian model, which evaluates health care quality based on 3 dimensions: structure, process, and outcome. We then categorized macro, meso, and micro structural enablers and barriers. Sixty papers were included in the review. The main structural influencers within 5 care models included policies on scope of practice, clarity of role description, and workload. A limited number of papers referred to the process of enabling the development of a working relationship. Thirty-five (49%) studies described resident, staff, and health system outcomes. Although structural characteristics of NP and physician care models are described in-depth, there is less detail on the processes that occur within the NP and physician care models. We highlight structural barriers and enablers within the care models, allowing for recognition of the importance of organizational influence on the NP and physician relationship. Future work should focus on the processes of the relationships in the models by identifying the drivers and initiators of collaboration between NPs and physicians and how these relationships influence outcomes. [ABSTRACT FROM AUTHOR]

• Numerous barriers to service provision exist for young people with complex needs. • Strategies for service engagement are required at the practitioner and system level. • Practitioner-level strategies included relational and structural approaches. • System-level strategies included flexible and collaborative approaches. • Young people appear to benefit most from services adapted to their needs. Young people with complex needs often have a range of co-occurring challenges that require the support of multiple government agencies and services. Increasingly, government agencies are working with young people who present with co-occurring and comorbid complex needs requiring co-ordinated multi-agency responses. However, agencies and services are often faced with multiple obstacles and challenges to meeting the needs of these young people, placing them at increased risk of poor outcomes during their adolescence and into adulthood. The objective of this Rapid Evidence Assessment (REA) was to provide practice insights as they relate to service engagement for young people with complex needs to highlight ways in which service delivery can be enhanced. Published academic literature as well as relevant material from the grey literature on young people aged 10–25 was synthesized to identify: (a) the principal barriers to service provision, and (b) strategies that facilitate service engagement. A total of 18 papers met the eligibility criteria for review. Papers were assessed using the critical appraisal skills programme (CASP). Individual and system level barriers were identified, including the characteristics of young people and the nature and structure of services. Strategies were identified at the practitioner level (e.g., benefits of relational, structural and empowerment approaches), and the system level (e.g., flexible services, collaborative approaches and improved staffing and resources). The review highlighted the importance of creating a service environment that is structured around the needs of young people rather than one which requires vulnerable young people to adapt to services. [ABSTRACT FROM AUTHOR]

Government decentralisation also called 'government devolution' (GD) can provide an alternative to the 'build in' accountability mechanism of markets by influencing both the choice as well as the perceived quality of public versus private health care. To test this hypothesis, this paper exploits the gradual decentralisation of the political stewardship of the Spanish National Health System (NHS) using a difference-in-differences design. We find that GD (abandoning centralised governance) increases the choice and quality of (measured by the preference for, perceptions of, and satisfaction with) public health care (NHS) compared to private health care. Consistently, we also find that the GD reduces the uptake of private health insurance among higher income and education groups. These effects are mainly driven by improvements in health care quality as well as policy innovation and diffusion. [ABSTRACT FROM AUTHOR]

• Trauma-informed practice is being trialled in response to extra-familial risks and harms. • An institutional ethnography found sources of knowledge impact this innovation. • Professionals may say young people are 'known-to-services' but be distant from them. • Being proximal to young people and advocating for their needs helps to know them. • To be trauma-informed, professionals must relationally know those they support. Efforts to shift from criminal justice to welfare-based responses to exploitation and other forms of extra-familial risks and harms, have centred relational approaches. In particular, the role that relationships between professionals and young people can play in providing a sense of safety as well as a route to wider support services when young people come to harm beyond their families is under consideration. In parallel, trauma-informed practice is increasingly promoted as a tool for creating service conditions in which relational practice can thrive. In this paper we present data from an institutional ethnography of two social care organisations in the UK which are endeavouring to adopt trauma-informed responses to extra-familial risks and harms. We use observation, focus group, and case file data collected in two time periods, to illustrate a relationship we identified between the nature and source of knowledge that guided professional responses, the ability of professionals to form relationships with young people affected by extra-familial risks and harms, and the capacity for their organisations to be trauma-informed. In doing so we trouble an established discourse in many social care organisations, that young people subject to intervention are 'known-to-services' and call for more responses in which young people are 'known-by-professionals' who are supporting them. Far from being a matter of semantics, we discuss how these two ways of knowing about young people, and the situations they face, potentially facilitate or undermine key pillars of trauma-informed practice, and the relational approaches that make such practice possible. [ABSTRACT FROM AUTHOR]

The evolution of knowledge and information has changed the practices of health services over the years. The use of Information systems (IS), with the underlying Information Technology (IT), plays a vital role in managing medical information and associated resources, always to provide a better quality of health care. IS/IT is increasingly developing globally, with new features and tasks greatly expanded, leaving paper records and voluminous files behind. The ubiquitous information and computing resources increasingly allow the sharing of all types of data between various entities. New IS/IT will have to be thought to correspond to the new types of monitoring and analysis of biomedical data. This work intends to explore the IS/IT in health and its evolution over the last few years. [ABSTRACT FROM AUTHOR]

The effect of introducing or increasing user fees for health services in low- and middle-income countries is controversial. While user fees are advocated as an effective means of generating revenue and enabling health service quality improvement, they constitute a financial barrier to access health services for the poorer. This paper contributes to the literature on the demand-side financing in health by providing evidence on the medium-term effects of introducing user fees on the utilisation of family planning, antenatal care, and delivery care services, women's access to health care, and child health status in a middle-income country setting. Using a difference-in-differences identification strategy to establish causality, we find that the introduction of user fees in Egypt had no negative effect on the utilisation of family planning and delivery care services. Further, fees did not hinder women's access to care and did not harm child health outcomes. Positive effects were even observed with respect to the utilisation of antenatal care services. Our findings are compatible with the hypothesis that the potential decrease in demand due to the user fee imposition might have been offset by an increased willingness to pay for a quality of health care that could be, at least partly, perceived as higher. • User fees do not necessarily deter utilisation of and access to health services. • Positive effects of user fees on antenatal care utilisation are observed. • Services with fees may be perceived of higher quality, raising willingness to pay. [ABSTRACT FROM AUTHOR]

Value-based payment aims to shift the focus from traditional volume-driven arrangements to a system that rewards providers for the quality and value of care delivered. Previous research has shown that it is difficult for providers to change their medical and organizational practices to adopt value-based payment, but the role of actors in these reforms has remained underexposed. This paper unravels the motives of non-clinical and clinical professionals to maintain institutionalized payment practices when faced with value-based payment. To illuminate these motives, a case study was conducted in a Dutch hospital alliance that aimed to implement value-based payment to incentivize the transition to novel interventions in a prostate cancer care pathway. Data collection consisted of observations and interviews with actors on multiple levels in the hospital (sales departments, medical specialist enterprises (MSEs) and physicians). On each actor level, motives for maintaining currently prevailing institutional practices were present. Regulative maintenance motives were more common for sales managers whereas cultural-cognitive and normative motives seemed to play an important role for physicians. An overarching motive was that desired transitions to novel interventions proved possible under the currently prevailing institutional logic, dismissing an urgent need for payment reform. Our analysis further revealed that actors engage in diverse institutional maintenance work, and that some actor groups' institutional work carries more weight than others because of the dependency relationships that exist between hospitals, MSEs and physicians. Physicians depend on MSEs and sales departments, who act as gatekeepers and buffers, to decide whether the value-based payment reform is either adopted or abandoned. • Physicians depend on other hospital actors for pursuing value-based payment reform. • Payment reform prompts actors to assess flaws of current payment practices. • Current payment practices persist due to perceived lack of payment reform necessity. • It is important to look beyond the insurer–provider nexus during payment reform. [ABSTRACT FROM AUTHOR]

Instead of diminishing with the spectacular advancement of medical expertise in the country , unqualified biomedical practice in India has been strengthened by the growth of the pharmaceutical production in the twenty first century. In public health discourse, the view that the informal health practitioners have to be punished and abolished has been countered by the recommendation that they could be trained and incorporated in primary health care where public health amenities are inadequate. The quality of care provided by the informal health care practitioners has also been subject to clinical assessment based on standardized patient vignettes. Based on a sociological approach, this paper examines the time line of chronically ill patients under lived conditions to arrive at an understanding of the role of informal health practitioners in long term treatment and highlights the setbacks. This paper draws on 253 household surveys from two villages in Madhya Pradesh, in depth interviews with four unqualified practitioners in the area, twenty five unstructured interviews of chronic patients, twenty five structured interviews on the cases of untimely death and FGDs with health workers in 2021. Informal health care practitioners offer consultation cum dispensing of medicines and are the primary source of biomedical care in the remote study area without any public transport. But they are 'for profit' economic actors who are ill-equipped to handle chronic diseases. What sets them aside from the qualified private doctors in the town is their social obligation to balance their profit motive with the ethics of proximity and neighborly ties with the villagers amidst whom they reside. These features of the market and community place the informal health care practitioners at the cusp of economy and society and defy simple binaries that they are either crooks or assets. • Unqualified health practitioners provide medical care in India where none is available. • Assessing their practices, clientele and exact role is crucial to health care policy. • One point standardized patient vignettes are used to assess their quality of care. • Their treatment of chronically and severely ill patients over time also has to be examined. • They are 'for profit' economic actors, but embedded in the community. [ABSTRACT FROM AUTHOR]

A rising emphasis on patient involvement in clinical research and healthcare improvement has led to the steady incorporation of patients and caregivers into this work. However, interactional factors shaping recruitment processes are not well understood. In this paper, we present a qualitative analysis of interviews with twenty-six patients, family members, engagement staff and healthcare providers who are engaged in healthcare improvement work in the United States. We focus on how stakeholders account for recruitment decisions to participate in healthcare improvement work. We find that expressions of and judgments about patients' and caregivers' cultural health capital shape providers' decisions to extend invitations to participate in healthcare improvement work. These findings extend current conceptualizations of cultural health capital beyond the clinical encounter to reveal factors shaping patient recruitment into healthcare improvement work. In theorizing how cultural health capital shapes action in this new setting, we found that healthcare providers, engagement staff, and patients/caregivers attended to different aspects of cultural health capital when accounting for why they extended or received a recruitment pitch. We further found that participating in healthcare improvement work led to a boost in cultural health capital for patients and caregivers, which they could use to develop transmissible forms of cultural health capital for less centrally involved patients and caregivers. Finally, we describe how participants in healthcare improvement collaboratives account for a lack of diversity among partners. These findings help us hypothesize the consequences of recruitment processes that rely on displays and judgments of cultural health capital and identify possibilities for change. Using the case of healthcare improvement work in Collaborative Learning Health Systems, our findings advance past work on cultural health capital in medical sociology by theorizing the role of cultural health capital in recruitment processes. • Providers recruit patients for healthcare improvement work with subjective criteria. • Providers often recruit high-resourced, privileged patients that they "vibe" with. • Partners build cultural health capital from doing healthcare improvement work. • Recruiting for cultural health capital may exclude patients from diverse backgrounds. • The role of recruitment should be considered to improve partner representation. [ABSTRACT FROM AUTHOR]

To meet the growing needs of a diverse population, it is critical that healthcare service provision is underpinned by innovative, cost-effective, and sustainable services and solutions. The role of the nurse practitioner creates an opportunity to meet the increasing demands of complex care and enables greater access to high quality care. Understanding how best to support nurse practitioner candidates to develop into the nurse practitioner role will create greater opportunities to transform service delivery and improve healthcare outcomes. To identify key factors that support and positively impact the implementation of nurse practitioner candidacy programs and candidate experiences. A scoping review of research and grey literature was conducted using Joanna Briggs Institute methodology. For the research literature, eight electronic databases (Embase, Medline, CINAHL, Web of Science, Cochrane Library, Joanna Briggs Institute, PubMed and PsycINFO) were searched followed by a hand search of the reference lists of published systematic reviews and relevant topical papers. A review of national and international grey literature sources was completed. Identification of a service gap, developing and promoting a clear role for the nurse practitioner candidate, integration into a multi-disciplinary team with strong mentorship/preceptorship support, continuing professional development, and evaluation of the program were identified as key factors in the research and grey literature. A well-designed candidacy program can facilitate transition of the candidate into an autonomous, fully independent nurse practitioner. Recommendations to support the implementation of these roles into the clinical setting have been generated. Tweetable abstract : Key to nurse practitioner candidate programs: Identification of a service gap, clear role, integration, mentorship, training and evaluation [ABSTRACT FROM AUTHOR]

Interactions between healthcare users and providers are an essential but often problematic element in therapeutic processes. In many settings worldwide, there has been a general recognition of the importance of adopting care approaches that understand patients as active agents, moving away from traditional paternalistic forms of interaction. Research shows that improving the quality of communication in therapeutic encounters fosters mutual understanding and cooperation in healthcare processes, helping to create the grounding conditions for building trusting relationships. But what are the communicative mechanisms through which trust in healthcare providers is cultivated? Going beyond the traditional 'doctor-patient' dyad analysis, and using data from a mixed-method study on medicine use in Maputo, Mozambique, this paper explores healthcare users' experiences and interpretations of their interactions with public healthcare professionals (medical doctors and prescribing nurses) and community pharmacy workers (pharmacists, technicians and other attendants). The analysis evolves around various communicative and relational aspects, emphasised by users as meaningful and underpinning different qualities of care, competence, integrity and trustworthiness. These attributes were assessed based on a combination of verbal conversation and information exchange, together with the use of other (non-verbal) situationally valued artefacts such as biomedical tools and communicative rituals performed by providers. This study shows that despite healthcare providers' different attributes of competence and authority, it is mainly their communicative performances during interactions that influence whether (symbolic) trust has the space to evolve or crystallise. Moreover, while performing certain rituals may be an effective form of communication, the lack of other (verbal and non-verbal) communicative elements during the interaction may compromise patient trust in what is being prescribed or advised. Efforts to improve the quality and responsiveness of healthcare services centred around citizens' needs should take users' perspectives into account and pay particular attention to these communicative and relational dimensions. • Care, competence and trustworthiness are assessed verbally and non-verbally. • Prescribers' communicative performances shape how users' symbolic trust manifests. • Using situationally valued biomedical techniques may be a way of communicating care. • Continuity of care allows repeated reassessments of providers' trustworthiness. • Medicines packaging can become a material basis of communicative trust. [ABSTRACT FROM AUTHOR]