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Publicly insured children needing referral to mental health (MH) services often do not access or receive services. The objective of this study was to identify gaps in communication and coordination between primary care providers (PCPs) and MH providers during the MH referral and care process for publicly insured children. Thirteen semi-structured interviews were conducted with 10 PCPs and staff from a federally qualified health center (FQHC) and 6 MH providers and staff from two local MH clinics. Interview participants identified multiple gaps in communication throughout the care process and different phases as priorities for improvement. PCPs described primary care-MH communication challenges during early phases, while MH providers described coordination challenges in transferring patients back to primary care for ongoing mental health management. Strategies are needed to improve primary care-specialty MH communication and coordination throughout all phases of the referral and care process, particularly at initial referral and transfer back to primary care. [ABSTRACT FROM AUTHOR]

Programs that serve transition-age youth with serious mental health conditions typically reside in either the child or the adult system. Good service provision calls for interactions among these programs. The objective of this research was to discover programmatic characteristics that facilitate or impede collaboration with programs serving dissimilar age groups, among programs that serve transition-age youth. To examine this "cross-age collaboration," this research used social network analysis methods to generate homophily and heterophily scores in three communities that had received federal grants to improve services for this population. Heterophily scores (i.e., a measure of cross-age collaboration) in programs serving only transition-age youth were significantly higher than the heterophily scores of programs that served only adults or only children. Few other program markers or malleable program factors predicted heterophily. Programs that specialize in serving transition-age youth are a good resource for gaining knowledge of how to bridge adult and child programs. [ABSTRACT FROM AUTHOR]

The current article aims to offer an informational basis for creating an adaptable model of spiritual support provision for Estonian health care institutions. The study addresses Estonian medical staff's knowledge about and attitudes towards spiritual support. The data originate from a quantitative research conducted in 19 Estonian hospitals during 2015-2016. The results show a good will for interdisciplinary co-operation, and pastoral caregiver is expected to be a part of the staff. The fact that spiritual support is not financed by the state budget funds raises the question about explaining the benefits of spiritual support to the hospital's or clinic's management. [ABSTRACT FROM AUTHOR]

Background: The shortage of primary care providers and the provisions of the Affordable Care Act (ACA) have spurred discussion about expanding the number, scope of practice (SOP), and independence of primary care nurse practitioners (NPs). Such discussions in the media and among professional organizations may insinuate that changes to the laws governing NP practice will engender acrimony between practicing physicians and NPs. However, we lack empirical, descriptive data on how practicing professionals view NP independence in primary care.Objective: The aim of the present study was to explore and describe the attitudes about NP independence among physicians and NPs working in primary care.Design: A qualitative study based on the principles of grounded theory.Participants: Thirty primary care professionals in Missouri, USA, including 15 primary care physicians and 15 primary care NPs.Approach: Semi-structured, in-depth interviews, with data analysis guided by grounded theory.Key Results: Participants had perspectives that were not well represented by professional organizations or the media. Physicians were supportive of a wide variety of NP roles and comfortable with high levels of NP independence and autonomy. Physicians and NPs described prerequisites to NP independence that were complementary. Physicians generally believed that NPs needed some association with physicians for patient safety, and NPs preferred having a physician readily accessible as needed. The theme "knowing your limits" was important to both NPs and physicians regarding NP independence, and has not been described previously in the literature.Conclusions: NP and physician views about NP practice in primary care are not as divergent as their representative professional organizations and the news media would suggest. The significant agreement among NPs and physicians, and some of the nuances of their perspectives, supports recommendations that may reduce the perceived acrimony surrounding discussions of NP independent practice in primary care. [ABSTRACT FROM AUTHOR]

Purpose: Outpatient commitment orders are being increasingly used in many countries to ensure follow-up care of people with psychotic disorders after discharge from hospital. Several studies have examined outpatient commitment in relation to use of health care services, but there have been fewer studies of health professionals' experiences with the scheme. The purpose of this study was to examine health professionals' experiences with patients subject to outpatient commitment.Methods: This was a focus group study using a descriptive and exploratory approach. The study was based on three focus group interviews with a total of 22 participants. Data were analysed using qualitative content analysis.Results: The study showed that health professionals had a positive attitude towards outpatient commitment and considered it necessary for patients with psychosis who lacked insight and did not collaborate on treatment. At the same time their attention to patients' lack of insight could lead to a paternalistic approach more than measures to enhance patient autonomy. This challenged their therapeutic relationship with the patient.Conclusion: Health professionals found it difficult to combine control with therapeutic care, but gave greater emphasis to patients' need for treatment and continuity of care than to their autonomy. This dilemma indicates a need to discuss whether increased attention to patients' autonomy rather than insight into their illness would improve treatment cooperation and reduce the use of coercion. [ABSTRACT FROM AUTHOR]

Collaboration involves direct and open communication and respect for different perspectives. In particular, religious literature has many references to collaboration. This study is a report of knowledge synthesis based on qualitative systematic review by content analysis. The study surveys the concept of collaboration from the Islamic point of view and intends to answer the question, 'Does the Quran deal with the use of collaboration in human activities?' This study was conducted using electronic documents from websites related to Islamic and Quran sciences, such as Howzah.net, Nashriat.ir, Tebyan.net and Google Scholar from 1950 until 2013 by focusing on the keywords, collaboration and Islam, and then retrieving the Islamic document (Quran and Hadith). The language in which the search was conducted was English and Persian. Nearly, 28 articles and 72 books related to this topic were found and after applying the search criteria, only 13 % of the references were found to be applicable. In the Quran, collaboration is equivalent to Taavon, and Muslims are requested to collaborate in their affairs and never collaborate with each other for illegal affairs. Islam asserts that everyone requires social relationship in their life. God has enacted mutual rights for people and meeting these requirements is only possible through collaboration and respecting mutual rights. [ABSTRACT FROM AUTHOR]

Background: Effective physician-nurse collaboration is an important, but incompletely understood determinant of patient and nurse satisfaction, and patient safety. Its impact on physicians has not been described. This study was undertaken to develop a fuller understanding of the collaboration experience and its outcomes.Methods: Twenty-five medical residents, 32 staff nurses, 5 physician and 5 nurse faculty wrote narratives about successful collaboration; the narratives were then qualitatively analyzed. Narrative analysis was the initial qualitative method iteratively employed to identify themes. A phenomenological approach was subsequently used to develop a framework for collaborative competence.Results: Collaboration triggers, facilitative behaviors, outcomes and collaborative competence were the themes identified. Affect was identified in the triggers leading to collaboration and in its outcomes. Practioners typically entered a care episode feeling worried, uncertain or inadequate and finished the interaction feeling satisfied, understood and grateful to their colleagues. The frequency of affective experience was not altered by gender, profession, or ethnicity. These experiences were particularly powerful for novice practioners of both disciplines and appear to have both formative and transformative potential. Collaborative competence was characterized by a series of graduated skills in clinical and relational domains. Many stories took place in the ICU and afterhours settings.Conclusions: Despite the prevailing wisdom that nursing and medicine are qualitatively different, the stories from this study illuminate surprising commonalities in the collaboration experience, regardless of gender, age, experience, or profession. Collaborative competence can be defined and its component skills identified. Contexts of care can be identified that offer particularly rich opportunities to foster interprofessional collaboration. [ABSTRACT FROM AUTHOR]

The author reflects on how the quality of hospital language services has been improved and measured. In relation to this, a program called Speaking Together: National Language Services Network has been launched by the Robert Wood Johnson Foundation. This is designed to improve the quality and availability of language services at hospitals in the U.S.

Presents a letter to the editor commenting on A. Cuschieri's article about moral and ethical challenges from advanced technology and issue for the generation of surgeons.