Search

Chronic pain is a common feature of hypermobile Ehlers–Danlos Syndrome (hEDS), yet how patients assess and communicate their pain remains poorly understood. The objective of the present study was to explore the use of numeric pain assessment in individuals with hEDS, from a patient-centered perspective. Our analysis is based on in-depth qualitative interviews. The interviews were conducted over the phone. Our participants were patients living with hEDS (N = 35). Interviews were recorded, transcribed, and analyzed to identify factors related to their use of these pain assessment instruments. Three primary themes emerged from these data, namely, (1) confusion around the quantification of multidimensional pain, (2) the subjectivity of pain experience, and (3) a strategic use of assessments for practical purposes beyond the accurate representation of pain. These results demonstrate the need for caution in relying exclusively on numeric pain assessment instruments. We conclude with a brief proposal for a clinical communication strategy that may help to address the limitations of numeric pain assessment that were identified in our interviews. Chronic pain is a common feature of hypermobile Ehlers–Danlos Syndrome (hEDS), yet how patients assess and communicate their pain remains poorly understood. Clinicians should be aware that patients have difficulties with the Numeric Rating Scale (NRS) for at least three reasons: (1) confusion around the quantification of multidimensional pain, (2) the subjectivity of pain experience, and (3) a strategic use of assessments for practical purposes beyond the accurate representation of pain. Clinicians should use caution in relying exclusively on NRS instruments. Clinicians may benefit from using clinical communication strategies outlined in our paper, which may help to address the limitations of the NRS that were identified in our interviews. [ABSTRACT FROM AUTHOR]

This paper reports findings from a qualitative study on the triggers of hospital social workers' moral distress at a large southern U.S. health system. Moral distress occurs when ethical conflict cannot be resolved in a way that aligns with an individual's personal and professional values and ethics. Participants indicated that moral distress derives from both individual interactions and the culture and climate of health systems. For example, participants expressed how sources of moral distress derived from client-centered decisions, such as end-of-life care and patient autonomy; interpersonal dynamics, including team or supervisory conflict; structural issues, such as insurance barriers or internal hospital policies; and organizational values, such as perceptions of institutional support and validation. Implications of this research suggest that health systems need to foster positive ethical environments that nurture clinicians' health and mental health through programs that aim to increase moral resilience, promote empowerment, and foster wellness. [ABSTRACT FROM AUTHOR]

This paper presents findings of a study that explored the challenges and coping strategies of parents of children with mental disorders. In-depth interviews were conducted with 35 parents of children with mental disorders at the Psychiatric Unit of the Komfo Anokye Teaching Hospital in Kumasi. Data were analyzed using thematic content analysis. Findings indicated that financial constraints, inability to secure permanent employment, and stigma were the challenges of the parents. Having faith in God and accepting their children's condition were the coping strategies adopted by the parents. However, lack of effective support system makes coping difficult for the parents. [ABSTRACT FROM AUTHOR]

This paper explores the lived experiences of older surgical patients' (aged 74 years and older) experienced challenges during a brief admission to hospital. Age, gender, polypharmacy, and the severity of illness are also factors known to affect the hospitalization process. For an ethnographic study using participant observation and interviews, surgical cancer patients (n=9, aged 74 years and older) were recruited during admission to a Danish teaching hospital. Using ethnographic strategies of participant observation and interviews, each patient was followed through the course of 1 day during their stay at the hospital. Interviews were carried out with all patients during this time. Three areas of concern were identified as prominent in the patients' experiences and challenges during their short hospital stay: teeth and oral cavity, eating in a hospital setting, and medication during hospitalization. Short-term hospitalization requires focused collaboration between staff and patient concerning individual challenges from their teeth and oral cavity as support of nutritional needs during surgical treatment for cancer. [ABSTRACT FROM AUTHOR]

To explore the experiences of being a family with one member suffering from severe traumatic brain injury (STBI) up to 7 years earlier through narrative family interviews. There are few studies where a family as a unit, including persons with STBI, are interviewed together. This study used a family systems research approach following a qualitative interpretative design. Therefore, 21 families with a total of 47 family members were interviewed. Qualitative content analysis was used to reveal categories with sub-categories and a theme. "From surviving STBI towards stability, through the unknown, into a new everyday life and a new future as a family" characterized the implicit message. The results revealed two categories both with three subcategories. The first category characterized the rapid change from a normal everyday life to one of uncertainty and finally to one of stability, and the second category described how it is to adapt as a family after STBI. Long-term experiences of STBI show the importance for the whole family of belonging to a context, having a job, and having something to belong to as a way to achieve stability. Families' feelings of loneliness and lack of treatment and support are challenges for professionals when trying to involve families in care and rehabilitation. A sense of belonging, having a purpose and a social network are important within families. Professionals can provide information and can help to eliminate misunderstandings for individuals with severe traumatic brain injury and their families. It is important for rehabilitation professionals to undertake a thorough family assessment. This assessment will support families become involved in the process of rehabilitation. [ABSTRACT FROM AUTHOR]

This study aimed to understand the experiences of bilingual nurses asked to interpret in the Emergency Department (ED), and the subsequent impact on safety climate. Australian ED clinicians assess and treat high numbers of linguistically diverse patients, many with limited English proficiency. New South Wales Health policy mandates the use of accredited interpreters when collecting personal and health information, and when obtaining consent for medical procedures. Semi-structured interviews with 12 nurses (representing 12 languages) from two metropolitan EDs were audio-recorded and analysed using qualitative content analysis, guided by Glendon & Stanton's model of organisational climate and culture. Analysis revealed widespread underlying assumptions that engaging interpreters is difficult, time-consuming and costly. Bilingual ED nurses with variable language fluency were used across organisations as the first choice due to clinical urgency, task urgency, and hospital workflow pressures. While the use of nurse interpreters facilitated timely assessment for the benefit of patients, it equally led to increased nurse workload, missed or misinterpreted information and subsequent perceived clinical risk. These practices were supported and facilitated by unit level managerial and multidisciplinary team practices, physician pressure and the nurses' own values and beliefs. While some, (but not all) participants were aware of the interpreter policy, they were torn between their acknowledgement of risky translation practices and their desire to support their colleagues to provide timely, culturally-competent assessment and care. Findings suggests a 'top-down' approach to translation policy has failed to influence the local safety culture and practices and does not address a climate created by clinical urgency and workflow. Formal training and accreditation of bilingual nurses, and/or embedded interpreters for common language groups may reduce risks for non-English speaking patients. [ABSTRACT FROM AUTHOR]

The present study was conducted to determine the extent of observation of patients' privacy by physicians and nurses and its relationship with patient satisfaction. This descriptive correlational study was conducted on 600 patients selected by convenience sampling. Based on the patients' points of view, the level of observation of patients' privacy and its dimensions, especially the psychosocial dimension, were reported to be higher in nurses than in physicians. Pearson's correlation coefficient showed a direct and significant relationship between the observation of privacy by the nurses and physicians and different dimensions of patient satisfaction. [ABSTRACT FROM AUTHOR]

Burnout among hospital personnel is frequent and has impacts on the quality of care. Monitoring is important, but there is a lack of specificity for individual patterns of burnout syndromes. This study aimed to identify specific burnout profiles in a hospital setting. Using job satisfaction data from a survey of 4793 hospital personnel, we performed a latent class analysis on the work-related items of the Copenhagen Burnout Inventory (CBI). Total burnout score, job satisfaction and work-related variables were compared across classes. Five latent work-related burnout profiles were revealed, including a high-risk class (9.5% of participants) and two classes with similar total CBI scores: a high-fatigue class (6%), including young administrative personnel who reported less pleasure at work but a better work–life balance, and an emotional-exhaustion class (13.1%), including older healthcare personnel who were more satisfied at work and could use their skills appropriately. Finally, personnel in the high-risk class were younger healthcare professionals, reporting lower job satisfaction, poorer working conditions and less respect from their direct hierarchy. The risk and type of burnout depended on personnel's characteristics and their social and work environments. Tailored interventions should be used to address these different profiles. [ABSTRACT FROM AUTHOR]

Phenomenon: Universities offer a variety of voluntary faculty development to ensure quality education, but face inconsistent faculty participation. Therefore, all Dutch universities require all faculty to obtain a teaching qualification certificate. Yet, like other medical centers, University Medical Center Utrecht continued to struggle with faculty nonparticipation. It has been postulated that clinician teachers may face unique challenges with responsibilities for patient care in addition to teaching and research, challenges that cannot be overcome by merely mandating faculty development or a teaching certificate. This project was conducted to gain insight into factors that hinder faculty participation and better understand what is needed to enhance faculty engagement in their professional development as teachers. Approach: UMC Utrecht has had a teaching certificate requirement for over 20 years. In 2015-2016, we conducted a local needs assessment, gathering faculty perspectives about the teaching certification process. To convey seriousness of purpose and promote commitment to change, we formally engaged key stakeholders from the outset, obtained grant funding for the needs assessment, and had an outside consultant lead the project. Faculty who were stalled or never started were questioned via semi-structured interviews. A focus group with those actively in the process of obtaining their certificate discussed perceived challenges in the process and recommended solutions. Faculty who obtained their teaching certificate completed an anonymous evaluation form. All evaluation comments and transcripts were thematically analyzed using open and axial coding. A literature review was performed to contextualize our findings and identify potential solutions. We compared our initial themes to these findings and found key challenge/solution categories, which we subsequently developed into a novel framework. Findings from the study and literature review were organized using this framework and shared with different stakeholders, all of whom engaged in problem-solving. Ideas and potential solutions were incorporated into a final report with recommendations for improving faculty support and provided to the institutional leadership. Findings: Of 23 faculty teachers approached, 8 (34.8%) agreed to be interviewed; 7 of 25 (28.0%) participated in the focus group; and 83 of 156 (53.2%) completed the evaluation. From the transcripts and evaluation comments, three themes emerged related to context and barriers: (a) skill development versus certification; (b) workplace priorities and culture, and (c) visibility and feasibility of the teacher's role. Triangulation of these themes with the literature revealed four challenge/solution categories – Competence, Context, Community, and Career. This 4-C framework facilitated communication of findings, structured the development of an action plan in response to the findings, and assured implementation of new initiatives for faculty support beyond competence development. Insights: Simply adopting requirements for faculty development may be insufficient and even invoke resistance. Improving faculty participation in faculty development and the quality of education requires institutional attention to not just faculty Competence needs, but also the factors of Context, Community, and Career that together comprise the culture experienced by faculty teachers. With institutional buy-in and commitment to change, the 4-C framework can help focus institutional attention on existing gaps in all four domains and guide the development of comprehensive solutions. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to explore personal experiences of pain in people with motor neuron disease. Materials and methods: Sixteen participants were individually interviewed on one occasion concerning their experiences of presentation, consequences, and management of pain. Qualitative content analysis with researcher triangulation was used to synthesize and interpret data. Results: Four themes emerged as the result of the analysis: (1) The multiple faces of pain, (2) The thin line between experience of pain and no pain, (3) The negative effects of pain on role functioning (4) Successful coping with pain requiring personal effort and competent engagement. The important findings were the experiences of unpredictability of pain breakthroughs, the efforts required to manage pain, consequences for activity and quality of life, and the suffering induced by diminishment and neglect of pain from both patients and staff. Conclusions: Pain in motor neuron disease seems to have certain and multiple characteristics, which is why there is a need to develop and implement pain assessment methods adapted to this population. Such methods may help make pain more predictable, and increase the possibilities to provide effective and individually tailored pain treatment. Pain is a common, but often neglected, ailment in motor neuro disease, which deserves more attention from health care. Staff should provide information about the pain being possible to treat successfully with medication, by contrast to the possibility of curing the disease itself. Pain assessments should be implemented during the entire course of the disease, covering a time frame long enough to cover characteristic fluctuations of pain. Whenever possible, facilitate the performance of painful activities of daily living as much as possible to make room for engagement in other personally valued activities of importance for individual quality of life. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed awareness and availability of assistive facilities in a Nigerian public university. Methods: Study was conducted in Obafemi Awolowo University (OAU), Ile Ife Nigeria using a mixed methods approach. Fifty two students with disability (SWD) were interviewed with a semistructured, self-administered questionnaire. A checklist was used to assess assistive facilities on campus while in-depth interviews (IDI) were conducted with university officials, to assess their perspectives about the availability and use of assistive facilities in the university. Results: Almost three-thirds (57.7%) of SWD were male while more than two-thirds were aged between 21 and 30 years. About seven in 10 (71.1%) respondents, had mobility impairment, while two-fifth had visual impairment (40.8%) and a few had hearing impairment. Only the university's administrative building had a functioning elevator. Slightly more than half (54.5%) of the lecture theatres have public address systems, while only two have special entrances and exits with ramps for SWD. Almost all respondents were unaware of facilities that aid learning (96.2%) and facilities for library use (90.4%). University officials were aware of assistive facilities for SWD but do not know the actual number of SWD. Conclusion: Assistive facilities for SWD on campus are limited. More assistive facilities need to be provided alongside increased awareness about these facilities and a disability register should be open for students on campus. Assistive facilities to aid learning and make SWD more comfortable are required. Universities should have an official policy on students with disabilities and implement it, such a policy should address special considerations for disabled students, such as having an updated register for students with disability, having examination questions in large fonts for students with visual disabilities, giving them extra time for examinations and providing special counselling services for students with disabilities. Awareness about assistive facilities in tertiary institutions for students with disability should be increased so that they can utilize the ones available and demand for such if non-existent. The design of buildings on university campus should be made disability friendly. A disability register should be open for SWD on campus. [ABSTRACT FROM AUTHOR]

Objective: Emergency care takes place in a complex work environment that is characterized by critically ill patients, short hospital stays, and a wide variety of different healthcare professionals. Studies of occupational therapists' (OTs) experiences of working within emergency care have shown that they often experience difficulties in explaining the essence of occupational therapy and have to justify their approaches. Much effort has been made in Sweden to help OTs dispel the notion that occupational therapy is difficult to explain, and the aim of this study was to describe how Swedish OTs perceive their work in emergency care. Method: A qualitative descriptive approach was taken, and 14 interviews were conducted with OTs working in emergency care. Qualitative content analysis was used to analyse the data. Results: The overall theme that emerged was 'Feeling established through deliberate occupation-based work'. The underlying categories showed different strategies used by the OTs to provide occupational therapy in an emergency care context. Deliberate strategies were used to demonstrate the effectiveness of occupational therapy and its approaches to patients and other health care professionals, and this resulted in the OTs feeling both established and needed. Unlike the OTs in previous studies, the Swedish OTs experienced no difficulties in explaining occupational therapy and could make convincing arguments for their interventions. Parallel to their clinical work, the OTs worked with on-going development to find ways to improve their approaches. Conclusions: In summary, these Swedish OTs seem to have been provided with a professional language and the knowledge required to establish themselves in an emergency care setting. [ABSTRACT FROM AUTHOR]

Aims:To understand GP trainees' experience of out-of-hours (OOH) training in England; whether it is achieving educational aims, and to highlight potential improvements. Additionally to explore factors that influence the decision to work in OOH care.Methods:An online survey was sent to 1091 GP trainees in England. Odds ratios were calculated for factors correlating with intention to work in OOH, or confidence and effectiveness in OOH work. Free text responses were coded and organised thematically.Results:Trainees' experience of OOH care influences the decision to work there once qualified. Although this experience has positively influenced over three-quarters of trainees, it can be improved. Training is not achieving competencies in managing psychiatric emergencies and personal safety. Half of trainees received formal teaching in OOH skills; 3% receiving assessments in telephone triage. Only a quarter of trainees had worked with their usual GP trainer. Influential features of training included trainer enthusiasm and continuity, familiarity with the workplace, and confidence in OOH skills. Financial and lifestyle considerations were also important.Conclusion:OOH training in England has an impact on the future workforce and could be improved. The planned transition to a 4-year GP training structure offers an opportunity to address this. [ABSTRACT FROM AUTHOR]

Background: The transition from hospital to home has been described as a distinct rehabilitation phase for individuals with brain injury. As most research to date has quantitatively measured outcomes or used a sample with mixed brain injury diagnoses, less is known about the experience of transition following traumatic brain injury (TBI). Aims: This study aimed to examine the lived experiences of individuals with TBI during the first 6 months following discharge from hospital. Design: A qualitative investigation was conducted with 16 individuals with TBI using semi-structured interviews. Data analysis: Data were analysed thematically using a Framework approach. Results: Transition experiences were characterized by a desire to return to normality and a changed perspective on life, by accepting change or altering priorities. The process of transition was dynamic as individuals experienced the dominant themes in cyclical patterns. Conclusions: Research has highlighted the significant adjustment for individuals with TBI, particularly in relation to identity change, appraisal and coping. The themes of wanting normality and changing life perspective which were dominant in the current study highlight the significance of the transition phase in the process of adjustment and that transition is characterized by adapting to a new normality. [ABSTRACT FROM AUTHOR]

Health workers in general, and midwives and nurses in particular, experience high levels of stress/distress due to the nature of their work and workplaces; and, their socialization into ways of working that minimizes the likelihood of self-care. Increasing interest in the development of resilient workers has meant an enormous growth in interest in the role of holistic practices such as mindfulness meditation. Kabat-Zinn's mindfulness-based stress reduction (MBSR) is one of the most commonly used by those seeking to practise, theorize or research mindfulness across multiple contexts. The primary aim of this study was to pilot the effectiveness of an adapted mindfulness-based stress reduction intervention on the psychological wellbeing of nurses and midwives. More specifically, we sought to test the acceptability and feasibility of a modified MBSR intervention to inform a future randomized controlled trial (RCT). The pilot study used a pre and post intervention design. Twenty midwives and 20 nurses participated in a one-day workshop, undertook to meditate daily for 8 weeks and completed pre and post intervention measures: general health questionnaire (GHQ-12); sense of coherence (SOC) - orientation to life and the depression, anxiety and stress scale (DASS). A subgroup took part in interviews or focus group discussions of their experiences of the program and their ongoing mindfulness practice. The quantitative findings included significant improvements on the GHQ-12, SOC and the stress subscale of the DASS. Qualitative findings support the acceptability of the intervention, and highlighted a number of issues related to feasibility of any future RCT. In conclusion, mindfulness practice holds promise for increasing individual and workplace resilience, however, meaningful research evidence from carefully constructed studies will be required to engage and motivate participation and organizational support. [ABSTRACT FROM AUTHOR]

The purpose of this phenomenological exploration was to describe the lived experiences of persons diagnosed with advanced cancer who receive Medicaid. Themes emerged from the transcribed interviews of 10 participants in accordance with the cancer trajectory. Before diagnosis, participants were uninsured or underinsured and had more severe symptoms prior to late diagnosis. Upon diagnosis, they desired hopeful, respectful communication and experienced strong emotional reactions. There was also an abrupt change in the use of health care resources. During cancer treatment, they experienced social isolation from family and friends while receiving strong psychosocial support from the health care team. Throughout the cancer trajectory, they focused on living, reclaiming normalcy, and expressed resiliency and spirituality. Findings support the need to recognize the “fighting spirit” of patients regardless of prognosis or socioeconomic status; the impact of hopeful, respectful communication; and the value of oncology social work assistance when navigating the cancer experience. Lack of health care coverage prior to severe symptoms prevented earlier diagnosis and contributed to poor physical outcomes. Medicaid eligibility enabled these patients to receive quality health care and focus on living beyond cancer. [ABSTRACT FROM PUBLISHER]