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Background: Health care professionals (HCPs) historically exhibit high rates of stress, burnout, and low rates of service utilization from Employee Assistance Programs (EAPs) and Professional Health Programs (PHPs). New and magnified stressors that accompanied COVID-19 exacerbated HCPs' risk of burnout. Purpose: During the pandemic, this study examined Ohio HCP's utilization of EAPs and PHPs, knowledge of available services, barriers to accessing services, and likelihood of future service utilization. Conditions needing to change to increase likelihood of future utilization were also explored. Methods: A one-time survey was administered in July and August of 2021 to HCPs from 13 licensing boards in Ohio. This study used a subset of data to examine the extent of convergence between quantitative results—analyzed using frequency calculations—and results from thematic analysis of corresponding open-ended survey items. Qualitative results supported and elaborated the quantitative findings. Results: Fewer than 25% of respondents (N = 12,807) utilized EAPs or PHPs to address mental health concerns. Obstacles impeding service utilization included issues around awareness, time commitment, and confidentiality—a concern encompassing issues of stigma and fear of employment repercussions. Noting multiple obstacles to accessing EAPs and PHPs, HCPs in Ohio reported low rates of support service utilization and low likeliness to use services in the future despite their experiences of extreme stress and burnout. Conclusions: Addressing the time commitment and confidentiality concerns could increase the likelihood of accessing services. Employers of HCPs should explore additional support mechanisms such as comprehensive wellness programs and innovative, brief intervention strategies to combat burnout, especially during viral outbreaks and other high-stress events. [ABSTRACT FROM AUTHOR]

Background: Moral distress is a problem and negative experience among health-care professionals. Various instruments have been developed to measure the level and underlying reasons for experienced moral distress. The moral distress thermometer (MDT) is a single-tool instrument to capture the level of moral distress experienced in real-time. Aim: The aim of this study was to translate the MDT and adapt it to the Swedish cultural context. Research design: The first part of this study concerns the translation of MDT to the Swedish context, and the second part the psychometric testing of the Swedish version. Participants and research context: 89 healthcare professionals working at a hospital in northern Sweden participated. Convergent validity was tested between MDT and Measure of Moral Distress-Healthcare Professionals (MMD-HP), and construct validity was tested by comparing MDT scores among healthcare professionals. MDT was compared with responses to the final questions in MMD-HP. One-way ANOVA, Welch's ANOVA, Games–Howell post-hoc test and Pearson's correlation analysis were done. Ethical considerations: The study was approved by the Swedish Ethics Review Authority (dnr 2020-04120) in accordance with Helsinki Declaration. Results: The translated Swedish version of MDT was described as relevant to capture the experience of moral distress. The mean value for MDT was 2.26, with a median of 2 and a mode value of 0. The result showed moderate correlations between the MDT and MMD-HP total scores. There was a significant difference when comparing MDT and healthcare professionals who had never considered leaving their present position with those who had left and those who had considered leaving but had not done so, with the latter assessing significantly higher moral distress. Conclusion: The MDT is an easily available instrument useful as an extension to MMD-HP to measure the real-time experience of moral distress among healthcare professionals in a Swedish context. [ABSTRACT FROM AUTHOR]

Introduction: The development of cultural sensitivity is essential for health care professionals but there are few tools to measure this quality in Japan. The purpose of this study was to develop a scale of cultural sensitivity for Japanese health care professionals and examine its reliability and validity. Method: A draft scale was created through conceptual analysis and a questionnaire was completed by 515 health care professionals and 1,322 college students. Exploratory and confirmatory factor analyses were used to determine suitable scale items and examine model fitness. Results: The four-factor 18-item scale showed acceptable model fitness. Cronbach's α coefficient exceeded.90 and correlation coefficients for criterion-related validity were over.29. Construct validity was confirmed by the significantly higher score of the cross-culturally experienced groups. The intraclass correlation coefficient was.642 (professionals) and.722 (students). Discussion: This reliable and valid scale for Japanese health professionals and college students may be used to evaluate training programs to increase their cultural sensitivity. [ABSTRACT FROM AUTHOR]

Shortages of satisfied and well-trained health care professionals are an urgent threat for health systems worldwide. Although numerous studies have focused on retention issues for nurses and physicians, the situation for the allied health workforce remains understudied. We conducted a rapid review of the literature on allied health workers to investigate the main reasons for leaving their profession. 1,305 original research articles were retrieved from databases MEDLINE, CINAHL, PsycInfo, and Epistemonikos, of which 29 were eligible for data extraction. Reviewed studies featured mainly pharmacists, psychologists, dietitians, physical therapists, emergency medical professionals, and occupational therapists. We categorized 17 typical factors of the intent to leave as organizational, psychological, team and management, and job characteristics. The relative importance of each factor was assessed by measuring its prevalence in the selected literature. By revealing common themes across allied health professions, our work suggests actionable insights to improve retention in these vital services. [ABSTRACT FROM AUTHOR]

Background: Psychosis is a mental disorder that, despite its low prevalence, causes high disease and economic burden. Inadequate knowledge, lack of confidence and stigmatising attitudes of healthcare professionals (HCPs) may lead to suboptimal care. Aim: To review the literature exploring HCPs' knowledge, confidence and attitudes in relation to psychosis care. Method: A systematic search was undertaken across three databases (MEDLINE, Embase, PsycINFO) using a search strategy encompassing the concepts: 'healthcare professionals', 'knowledge, attitude, and confidence in care' and 'psychotic illnesses and symptoms' to identify relevant records published from 1st January 2002 to 18th March 2022. Results were screened against predetermined inclusion and exclusion criteria by title and abstract, followed by full text. Data were extracted into tables and synthesised narratively. Results: Initially, 7,397 studies were identified. Following two-stage screening, 24 studies were eligible for inclusion. Of these studies, 16 explored attitudes, four explored knowledge and attitudes, one explored knowledge, one explored confidence, one explored attitudes and confidence in care and one explored all three constructs. Most HCPs in the included studies demonstrated stigmatising attitudes towards people with psychosis. Furthermore, certain HCPs, including nurses and general practitioners, demonstrated low levels of knowledge, while psychiatrists, occupational therapists, psychologists and nurses had low levels of confidence in caring for people with psychosis. Conversely, positive attitudes were also observed in some HCPs resulting from having acquaintances with lived experience of psychosis. The need for additional education and training to improve HCPs' knowledge and confidence in relation to caring for people living with psychosis was identified. Conclusions: Most attitudes identified were negative and stemmed from stigma, while some were positive due to HCPs' compassion and familiarity with psychosis. The level of knowledge and confidence identified were mostly suboptimal, and so further research is required to develop and evaluate tailored interventions to address this gap. [ABSTRACT FROM AUTHOR]

Background: Moral distress has been extensively studied in developed economies; however, not much in terms of studies has been carried out in developing economies. Objective: To review the literature reporting the experience of moral distress in nurses in health care settings in developing economies. Design: An integrative literataure review was used. Method: Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online Cochrane and Psych INFO were searched to retrieve titles and abstracts of papers on the experience of moral distress in nurses in developing economies. Results: Sixteen articles reporting the experience of moral distress in nurses in developing economies published between 1984 and March 2019 were used for the review. Analysis of the findings revealed seven themes, nurses' experience of moral distress, inadequate material and human resources, end-of-life challenges, cultural and religious beliefs as a source of moral distress, perceived inactions of medical and nursing staff, impact of moral distress on nurses in developing economies and coping strategies. Conclusion: There is paucity of empirical studies on moral distress in nurses in developing economies. More qualitative studies are needed in various cultural settings to enhance its understanding in nurses working in developing economies. [ABSTRACT FROM AUTHOR]

Burnout is a mental, emotional, and physical exhaustion that affects many healthcare workers. However, there is a lack of information in Ethiopia. Therefore, this study aimed to assess the prevalence of burnout syndrome and identify the associated risk factors among healthcare professionals in Dessie Comprehensive Specialized Hospital, Ethiopia. A cross-sectional study was conducted on randomly selected 251 health workers at Dessie Comprehensive Specialized Hospital. The Maslach Burnout Inventory-Human Service Survey was used to assess burnout (MBIHSS). A multivariable logistic regression analysis was used to explore the potential determinants of burnout syndrome among the participants. A total of 251 healthcare professionals were included in this study making a response rate of 99.2%. The prevalence of burnout syndrome among healthcare professionals was 15.1% (95% CI [10.8, 19.9]). Being male (AOR = 3.22:95% CI [1.17, 8.87]), lack of interest in their profession (AOR = 2.66, 95% CI [1.84, 6.02]), experiencing physical violence (AOR = 3.52, 95% CI [1.32, 9.36]), unsatisfied with their job (AOR = 4.17, 95% CI [1.46, 11.90]) were variables found to be significantly associated with burnout syndrome. Burnout is a major problem among working in Dessie Comprehensive Specialized Hospital healthcare professionals. Being male, having no interest in their job, having physical violence, and not being satisfied with their job contributed to burnout syndrome. Interventions to increase interest in there in their job, improve physician-patient relationships, provide safer workplace environments, and increase job satisfaction may be promising strategies to reduce burnout syndrome. Plain Language Summary: Abstract Background: Burnout is a mental, emotional, and physical exhaustion that affects many healthcare workers. However, there is a lack of information in Ethiopia. Therefore, this study aimed to assess the prevalence of burnout syndrome and identify the associated risk factors among healthcare professionals in Dessie Comprehensive Specialized Hospital, Ethiopia. Methods: A cross-sectional study was conducted on randomly selected 251 health workers at Dessie Comprehensive Specialized Hospital. The Maslach Burnout Inventory-Human Service Survey was used to assess burnout (MBIHSS). A multivariable logistic regression analysis was used to explore the potential determinants of burnout syndrome among the participants. Results: A total of 251 healthcare professionals were included in this study making a response rate of 99.2%. The prevalence of burnout syndrome among healthcare professionals was 15.1% (95% CI [10.8, 19.9]). Being male (AOR = 3.22:95% CI [1.17, 8.87]), lack of interest in their profession (AOR = 2.66, 95% CI [1.84, 6.02]), experiencing physical violence (AOR = 3.52, 95% CI [1.32, 9.36]), unsatisfied with their job (AOR = 4.17, 95% CI [1.46, 11.90]) were variables found to be significantly associated with burnout syndrome. Conclusion: Burnout is a major problem among working in Dessie Comprehensive Specialized Hospital healthcare professionals. Being male, having no interest in their job, having physical violence, and not being satisfied with their job contributed to burnout syndrome. Interventions to increase interest in there in their job, improve physician-patient relationships, provide safer workplace environments, and increase job satisfaction may be promising strategies to reduce burnout syndrome. [ABSTRACT FROM AUTHOR]

Background: Despite a strong international standpoint against female genital mutilation, the prevalence of female genital mutilation in Somalia is extremely high. Objectives: This study assessed the knowledge, attitude, and practice of female genital mutilation among female health care service providers in order to formulate appropriate policies and programs to eliminate this harmful practice. Design: Facility-based cross-sectional survey conducted in 2019 among female doctors and nurses working in Banadir Hospital, Mogadishu, Somalia. Methods: A total of 144 female health care service providers were randomly selected, and data were collected through a pre-tested, semi-structured questionnaire. Quantitative data were analyzed by using the statistical software SPSS (Version 21), and qualitative data were analyzed thematically in accordance with the objectives of the study. Results: The study found that about three-fifths of the respondents had undergone some forms of female genital mutilation during their life. An overwhelming majority believed that female genital mutilation practices were medically harmful, and a majority of them expressed their opinion against the medicalization of the practice of female genital mutilation. The study also observed a significant association between participants' age and their negative attitudes regarding the legalization of female genital mutilation. Conclusion: Health care service providers' effort is critical to eliminating this harmful practice from the Somalian society. Strong policy commitment and a comprehensive health-promotion effort targeting the parents and community leaders are essential to avert the negative impact of female genital mutilation. [ABSTRACT FROM AUTHOR]

Background: Stigma toward those with non-medical substance use may present as anticipated, perceived, enacted, or internalized stigma. Objective: The purpose of the study was to describe the role of stigma on health care professionals with non-medical substance use, from the perspective of treatment providers. Soliciting information about stigma from treatment providers is a unique perspective lacking in current literature. Methods: A qualitative descriptive design was used with semi-structured interviews of treatment providers (N = 16) in Colorado. Inductive content analysis was used to identify concepts and themes across interviews. Results: Findings showed that stigma is a major concern and a barrier for health care professionals seeking substance use treatment. Nurses and physicians demonstrate shame and guilt (internalized stigma) around their substance use. These professionals also experience fear around their reputation (perceived stigma) and challenges around re-entry to the workforce after treatment (anticipated stigma). Conclusions: The awareness of existing stigma as well as internalized stigma impacts how health care professionals approach treatment, recovery, and returning to work. [ABSTRACT FROM AUTHOR]

Introduction: Preterm neonates require Non-invasive Respiratory Support (NiRS) because of underdeveloped lungs to administer pressurized oxygen for a long duration. The interface used to deliver NiRS can cause pressure injury at the nasal surface, septum, and bridge. Preterm neonates are more vulnerable to such injuries due to immature skin and septum. It is the responsibility of Health Care Professionals (HCPs) to prevent nasal injury through the implementation of evidence-based practices and innovative techniques to secure nasal interfaces. Objectives: (1) To find out the barriers and facilitators related to nasal injury among preterm neonates in selected neonatal units of a Tertiary Care Centre, in North India. (2) To seek the remedial measures suggested by HCPs to prevent nasal injury. Methodology: After obtaining permission from the head of the department of neonatology, covert participatory observations related to existing practices were made using an observation checklist. Focused Group Discussions (FGDs) were conducted with HCPs (Nursing Officers-43 and Physicians-10) and audio-recorded. Out of the total of eight FGDs, three were conducted with physicians in a group of 2–4 members and the remaining five with nursing officers in a group of 8–9 members, each of 15–20 min duration. FGD guide was used as a tool to guide the discussion. The qualitative data were analyzed by using Van Manen's approach. Result: The barriers identified were related to supplies, staff, and administration. Supplies include limited hospital supply of RAM cannula, reuse of hard ethylene oxide sterilized RAM cannula, lack of adequate size head caps; staff includes lack of awareness regarding the implications and effect of nasal injury among healthcare professionals, variable documentation of nasal injury; administration: no standard guidelines and lack of regular audits to prevent nasal injury. The facilitator suggested were motivated healthcare professionals. Suggested remedial measures were the availability of appropriate size RAM cannula, stockinette head caps, self-motivation, frequent inspection and early identification of nasal injury, staff education, and standard protocol of measures for nasal injury prevention. Conclusion: There are concrete barriers and limited facilitators. There is a need to incorporate the suggested remedial measures to address barriers to preventing nasal injury among preterm neonates. [ABSTRACT FROM AUTHOR]

Background: Ethics of care provides a framework for health care professionals to manage ethical dilemmas and moral resilience may mitigate stress associated with the process and outcomes of ethical reasoning. This review addresses the empirical study of ethics of care and moral resilience, published in the health care literature, and identifies potential research gaps. Methods and procedure: Arksey O'Malley's framework was adopted to conduct this scoping review. A literature search was conducted across six databases: CINAHL Plus with full text, PubMed, PsycINFO, EMBASE, Scopus and MEDLINE. We collected and synthesised information on the nature of studies including study design, methods and key findings. Results: While there is an abundance of literature describing the potential strengths of an ethics of care approach to ethical reasoning and growing interest in the role of moral resilience in protecting against moral distress, both concepts have received little empirical attention. A total of six relevant publications were selected for review. No studies explored the relationship between ethics of care and moral resilience. However, studies focused upon ethics of care approach as a facilitator of patient-practitioner professional relationships and effective ethical decision making in health care practice. Current evidence explores key characteristics consistent with moral resilience in health care professionals. Conclusion: This review identified a dearth of research in ethics of care and moral resilience in healthcare practice. Further empirical investigation may provide a deeper understanding of the translation of ethics of care and moral resilience to health care practice to facilitate workplace culture. [ABSTRACT FROM AUTHOR]

The aim of our study was to identify burnout profiles among pediatric nurses and physicians, and their specificities concerning sociodemographic characteristics, occupational stress, stress specific to pediatric caregivers, and coping. Conducted on a sample of 195 French pediatric health care professionals, a cluster analysis showed 2 endpoint profiles (Engagement, Burnout) and 3 intermediate profiles (Overextended, Disengaged, Ineffective). The Burnout profile showed the highest median scores on hours worked per week, occupational stress, stress related to working conditions, and relationships with colleagues and superiors. The Overextended profile reported more stress related to working conditions than did other intermediate profiles. The Disengaged profile showed the second lowest median score on stress related to relationships with colleagues and superiors and less social support–seeking than other profiles. The Ineffective profile used less problem-focused coping than the Engagement and intermediate profiles. Intervention for the well-being of these professionals should focus primarily on improving their working conditions. [ABSTRACT FROM AUTHOR]

Objective: Persons with chronic obstructive pulmonary disease (COPD) require complex follow-up by healthcare professionals (HCPs) and may experience several health literacy (HL) needs. This study aimed to explore such needs in people with COPD and the HCPs who care for them. Methods: From October 2016 to August 2017 a qualitative study with four focus groups (FG) were performed in people with COPD (n = 14) and three in multidisciplinary HCPs (n = 21). An inductive thematic analysis was used to investigate HL needs. Results: Four HL needs emerged: 1) strengthening the feeling of security; 2) combating the burden of insufficient knowledge on COPD and lack of informational flow; 3) supporting motivation for endurance and self-management; and 4) strengthening dignity. Discussion: This study highlights a gap between people with COPD who express important HL needs and HCPs' capabilities to care for these needs. For HCPs to increase HL in such cases, HCPs need to improve their own HL. It is essential to find solutions on how to improve HL in HCPs who care for people with COPD and to increase the availability of interventions that increase HL in COPD. Education programs, health organizations, and governments should be aware of HL needs in such situations. [ABSTRACT FROM AUTHOR]

Intimate partner abuse (IPA) affects women's health, requiring accurate questions to identify the abuse. We investigated the accuracy of three questions about fear of an intimate partner in identifying exposure to IPA. We compared the sensitivity and specificity of these questions with the Composite Abuse Scale (CAS) using secondary data analysis of four existing studies. All studies recruited adult women from clinical settings, with sample sizes ranging from 1,257 to 5,871. We examined associations between demographic factors and fear through multivariate logistic regression, and analysis of the sensitivity and specificity of the questions about fear and IPA (CAS), generating a receiver operating curve (ROC). The prevalence of lifetime fear of a partner ranged from 9.5% to 26.7%; 14.0% of women reported fear in the past 12 months; and current fear ranged from 1.3% to 3.3%. Comparing the three questions, the question "afraid of a partner in the past 12 months" was considered the best question to identify IPA. This question had the greatest area under the ROC (0.80, 95% confidence interval (CI) = [0.78–0.81]) compared with "are you currently afraid" (range 0.57–0.61) or "have you ever been afraid" (range 0.66–0.77); and demonstrated better sensitivity (64.8%) and specificity (94.8%). Demographic factors associated with "fear of a partner in the past 12 months" included being divorced/separated (odds ratio [OR] = 8.49, 95% CI = [6.70–10.76]); having a low income (OR = 4.21, 95% CI = [3.46–5.13]); and having less than 12 years of education (OR = 2.48, 95% CI = [2.04–3.02]). The question "In the last 12 months did you ever feel frightened by what your partner says or does?" has potential to identify a majority of women experiencing IPA, supporting its utilization where more comprehensive measures are not possible. [ABSTRACT FROM AUTHOR]

Background: There is a growing need for palliative care for patients near the end of life and their caregivers. Palliative and end-of-life care (EoLC) education are recommended for all health care (e.g., physicians, nurses, and allied health practitioners) and social care professionals (e.g., social workers) to ensure the quality of services. However, less attention has been afforded to generic, in contrast to specialized, EoLC education. This study evaluated the effectiveness of a series of short-term generic EoLC educational programs for health and social care professionals. Method: A pre-post survey design was adopted, focusing on different EoLC core competences. Results: Significant improvement was observed in all perceived competences after the educational programs, regardless of participants' occupation or EoLC experience. Perceived competence in self-care was rated significantly higher than all other competences prior to the programs. Healthcare professionals rated significantly higher on competence in symptom management than social workers. Scores on communication skill and self-care competences were significantly higher following longer (i.e., 16-24 hours) than shorter (i.e., 4-8 hours) programs. Conclusion: Generalist palliative/EoLC educational programs may enable health and social care professionals to refresh and extend their knowledge and skills and enhance their perceived competence in providing EoLC. Further research on generalist palliative/EoLC education is needed to examine the impact of continuing training on professionals' actual practice in EoLC and palliative care. [ABSTRACT FROM AUTHOR]

HIV stigma among health care providers in the Arab world is understudied due to a lack of valid and reliable measures. Data from 352 Egyptian physicians was used to validate an Arabic version of the Health Care Provider HIV/AIDS Stigma Scale (HPASS). Exploratory factor analysis (n = 1 9 4) suggested a 3 -factor structure. Confirmatory factor analysis (n = 1 5 8) validated the three-factor solution with 18 items, which explained 5 3 .3 6% of the variance. All items loaded on their designated constructs, which ranged from 0 .58 to 0 .82 (prejudice) to 0 .58 to 0 .66 (stereotypes) and 0 .52 to 0 .91 (discrimination). The prejudice, stereotypes, and discrimination subscales consisted of seven, five, and six items, respectively. The internal consistency (α = 0 .9 0) and the test-retest reliability demonstrated (r = 0 .9 5) were excellent. The cultural adaptation of the Arabic version of HPASS suggests that it is a suitable scale for assessing HIV stigma among Arab health care providers. [ABSTRACT FROM AUTHOR]

Prenatal ultrasound use is skyrocketing despite limited evidence of improved outcomes. One factor driving this trend is the widely recognized psychological appeal of real-time fetal imaging. Meanwhile, considering imperfect safety evidence, U.S. professional guidelines dictate that prenatal ultrasound—a screening test—should be governed by expected clinical benefits—an opportunity for intervention. However, when women's healthcare professionals themselves are pregnant, their access to ultrasound technology permits informal, personal use that may deviate from standard-of-care, e.g., for reassurance. Highlighting a poignant case wherein a pregnant obstetrician's personal ultrasound use had unforeseen negative consequences, we explore this issue within context of professional ethics and informal medical care. We discuss how women's health professionals' self-care may influence and inform prenatal care at large. We advocate curtailing informal prenatal ultrasound use, but also potentially broadening accepted indications for or relaxing proscriptions against ultrasounds for patients. Further research and updated, evidence-based, ethically-sound guidelines are needed. [ABSTRACT FROM AUTHOR]

Female genital mutilation/cutting (FGM/C) remains a global problem. We aimed to explore Kenyan health care professionals' (HCPs) perceptions of FGM/C abandonment and, in particular, those focused on those serving Maasai communities who continue to practice FGM/C. Using a grounded theory Straussian approach, 18 interviews were conducted with HCPs in Kajiado County, Kenya, to understand perceptions of FGM/C as a cultural practice, identify barriers and facilitators to abandonment, and explore attitudes to medicalization (FGM/C conducted by HCPs) and alternatives of FGM/C. Within a substantive theory, one core category ("FGM/C persists but can be abandoned") comprised two subcategories: "exploring the influencers of persistence" and the "roadmap to abandonment." HCPs believed collaborative multilateral efforts were necessary to support successful abandonment and that "enlightening" the community needed to focus on changing the perception of FGM/C as a social norm alongside a health risk educational approach. Future effective intervention is needed to support the abandonment of FGM/C in Kenya. [ABSTRACT FROM AUTHOR]

Background: Home palliative care services have played an essential role during the first wave of the SARS-CoV-2 outbreak by providing symptom control, drug procurement, and psychological support for frail patients and their families unable to leave their homes. Aim: To understand how home palliative care professionals were affected by the outbreak, describing changes and challenges in their daily work as well as their reactions to the Covid-19 pandemic in Italy. Design: Qualitative study conducted using telephone semi-structured interviews, with thematic analysis. Setting/participants: Thirty home care professionals working for an Italian non-profit organization which provides home palliative care for cancer patients and their families. Results: Three main themes were identified. The first theme showed both patient-related and practice-related challenges participants faced in their daily work, requiring the implementation of different communication methods and patient and family education on risk prevention. The second theme showed the perception of increased responsibility and being the only landmark for family played a decisive role in participants' positive attitude. The third theme highlighted the participants' perception of the critical role of a home care setting in this emergency situation. Conclusions: The first wave of the Covid-19 pandemic brought many challenges and stressors for home palliative care professionals. On the other side, they reported a satisfaction with their critical role in carrying out their work with patients at risk. [ABSTRACT FROM AUTHOR]

Learning about the historical and current context of Indigenous peoples' lives and building campus communities that value cultural safety remains at the heart of the Canadian educational agenda and have been enacted as priorities in the Manitoba Collaborative Indigenous Education Blueprint. A participatory approach informed by forum theater and Indigenous sharing circles involving collaboration between Indigenous and non-Indigenous health care professionals (n = 8) was employed to explore the above priorities. Through the workshop activities, vignettes were created and performed to an audience of students and educators (n = 7). The findings emerging from the workshop illuminated that Indigenous people in nursing and higher education face challenges with negotiating their identity, lateral violence and struggle to find safe spaces and people due to tokenism and a paucity of physical spaces dedicated to Indigenous students. This study contributed to provoking a greater understanding of Indigenous experiences in higher education and advancing reconciliation. [ABSTRACT FROM AUTHOR]

India is considered the epicenter of the global antimicrobial resistance crisis, with unprecedented antimicrobial consumption, production, and "misuse." But the story of resistance in India is complicated—emerging from intersections of industrial pharmaceutical development, rationing/purchasing of health care, policy infrastructure, and dynamics of disadvantage. What looks like rampant, escalating antimicrobial misuse and a need for tighter controls over drugs and "prescribers," emerges as a complex social problem. These dimensions reach the bedside, although variously, with doctors in India dealing with precarious infectious disease landscapes, threats of multidrug-resistant organisms, and (pan) national imperatives for "more judicious" practices. Drawing on 24 semi-structured interviews with doctors in Hyderabad, we explore their perspectives on resistance (literal and figurative) in everyday practice, and how practices articulate intersections of power, influence, and governance. This offers broader context to reframe resistance in India as multifactorial, enacted through cultural/local practices, and irreducible to singular problems of control or regulation. [ABSTRACT FROM AUTHOR]

Comprehending professionals' emotional challenges when addressing child abuse can help to improve identification, protection, and care for exposed children. This study presents an interpretive description analysis of qualitative interviews with ten child protective services workers and nine child mental health services psychologists in Norway. The participants described intense negative reactions due to addressing child abuse during assessments and investigations. We identified five main themes: (a) facing children's suffering caused by adults, (b) feeling mean, (c) doubting one's ability and skills, (d) feeling that one is betraying children, and (e) being obstructed by heavy workload and dysfunctional structure. To improve professionals' capacity to help exposed children, it is necessary to change the organizational structure and culture. In addition, professionals would benefit from systematic training in handling complexity and in efficient emotion regulation. Finally, we strongly suggest that institutions responsible for investigating child abuse facilitate and prioritize deliberate practice for their staff. [ABSTRACT FROM AUTHOR]

Background. There is a notable lack of education on nutrition and physical activity guidelines in medical schools and postgraduate training. The purpose of this study is to assess the nutrition and exercise knowledge and personal health behaviors of physicians in the Department of Medicine at a large academic center. Methods. We conducted a survey study in the Department of Medicine at the University of Florida in 2018. The survey instrument included questions on demographics, medical comorbidities, baseline perception of health and fitness, and knowledge of nutrition concepts. The Duke Activity Status Index assessed activity/functional capacity and the validated 14-point Mediterranean Diet Survey evaluated dietary preferences. Data were analyzed using descriptive statistics and the χ2 test was used to perform comparisons between groups. Statistical significance was determined at P <.05. Results. Out of 331 eligible physicians, 303 (92%) participated in the study. While all respondents agreed that eating well is important for health, less than a fourth followed facets of a plant-based Mediterranean diet. Only 25% correctly identified the American Heart Association recommended number of fruit and vegetable servings per day and fewer still (20%) were aware of the recommended daily added sugar limit for adults. Forty-six percent knew the American Heart Association physical activity recommendations and 52% reported more than 3 hours of personal weekly exercise. Reported fruit and vegetable consumption correlated with perceived level of importance of nutrition as well as nutrition knowledge. Forty percent of physicians (102/253) who considered nutrition at least somewhat important reported a minimum of 2 vegetable and 3 fruit servings per day, compared with 7% (3/44) of those who considered nutrition less important ("neutral," "not important," or "important, but I don't have the time to focus on it right now"; P <.0001). Conclusions. This study highlights the need for significant improvement in education of physicians about nutrition and physical activity and need for physicians to focus on good personal health behaviors, which may potentially improve with better education. [ABSTRACT FROM AUTHOR]

Background: Ebola virus disease is an acute and life-threatening illness, which, if untreated, is fatal. It was first discovered in 1976, which aware the world with sporadic outbreaks of Ebola in some parts of Africa. According to Centers for Disease Control and Prevention (CDC), the natural reservoir for Ebola virus remains unknown; however, it is yet to be affirmed that the natural habitat is animal-borne where bats are most likely to carry over this virus. Therefore, the aim of this study was to estimate awareness of health care professionals as they serve as the integral part of our health care system. Methods: A cross-sectional survey was conducted among 149 health care workers (HCWs) in Civil Hospital of Karachi from June 2015 to August 2015. The study participants were randomly selected individuals who were students of and/or were working in the university's affiliated tertiary care hospital in Karachi, Pakistan. Results: Baseline characteristics of the study participants are shown in Table 1. Median age of the participants is 21 (range: 17-24) years. Female preponderance was found to be higher (104; 69.8%) as compared with the males (45; 30.2%). Discipline of majority of the study participants was medical technology (80; 53.7%), followed by nurses (38; 25.5%) and doctors (31; 20.8%). Majority of the study respondents were undergraduate medical students (60; 75%) as compared with medical technologist and the nurses (17; 24.6%) with a P value <.001 as shown in Figure 1. The mean for correct responses was 8.43 ± 4.08 (range: 3-17). Appropriate knowledge was observed in 84 (56.4%) responders and inappropriate knowledge was observed in 65 (43.6%) of the study respondents. Conclusion: Our study concludes that there is an unsatisfactory knowledge about Ebola virus disease among health care professionals. Moreover, public health authorities should signify the importance of prevention against Ebola virus disease not only among the health care professionals but also into the communities through mass media and awareness campaigns which can thus halt the panic and incidence of Ebola virus outbreaks in coming decades. [ABSTRACT FROM AUTHOR]

Background. Two decades after "patient education" was defined by the World Health Organization, its integration in health care practices remains a challenge. Perceptions might shed light on these implementation difficulties. This systematic review aims to investigate links between perceptions and patient education practices among health care professionals, paying particular attention to the quality of practices in order to highlight any associated perception. Method. PubMed, PsycINFO, and Scopus were searched using the following search terms: "perceptions," "patient education," "health care professionals," and "professional practices." PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used. Results. Twenty studies were included. Overall findings supported the existence of links between some perceptions and practices. Links were either correlational or "causal" (generally in a single direction: perceptions affecting practices). Four types of perceptions (perceptions of the task including patient education, perceptions about the patient, perceptions of oneself as a health care professional, and perceptions of the context) were identified as being linked with educational practices. Links can although be mediated by other factors. Results concerning links should, however, be considered with caution as practices were mostly assessed by prevalence measurements, were self-reported and concerned exclusively individual education. When analyzing the quality of practices, the two retained studies highlighted their changing nature and the central role of perceptions with respect to the individual patient. Conclusions. This literature review led us to specify the quality criteria for further research: covering the entire spectrum of patient education, operationalizing variables, exploring specific practices, measuring the quality of practices, developing designs that facilitate causation findings, and considering a bidirectional perspective. [ABSTRACT FROM AUTHOR]

BACKGROUND: Members of the lesbian, gay, bisexual, and transgender (LGBT) community suffer from disproportionate rates of physical and mental illness. This population experiences enhanced vulnerability to illness as a result of societal marginalization, known as minority stress, which is compounded by insufficient LGBT education for health care professionals and stigmatizing experiences within medical institutions. AIMS: The aims of this study were to review the literature on LGBT cultural competence interventions; evaluate the effect of a 4-hour pilot workshop, "Converging Cultures," on the development of cultural competence; and make recommendations for best practices in developing LGBT cultural competence among health care providers. METHOD: The study used a repeated-measures pre-/posttest design among a sample of 130 hospital employees and undergraduate nursing students. The GAP (Gay Affirmative Practice scale) scale, a measure of LGBT-affirmative practice beliefs, and an objective Knowledge Quiz were administered before and directly following the training. The posttest included three open-ended questions to elicit self-reflection and capture the development of cultural competence according to Campinha-Bacote's theory, the process of cultural competence in the delivery of healthcare services. RESULTS: Paired sample t tests revealed significant improvement on the GAP and Knowledge Quiz. Open-ended responses reflected the five constructs of Campinha-Bacote's theory. CONCLUSIONS: Self-reflection is an essential component of LGBT cultural competence education to uncover personal biases that affect clinical behavior. Future educational efforts for sexual and gender minorities should strive to avoid inadvertent marginalization of LGBT people through integration of concepts with existing curricula and workplace training. [ABSTRACT FROM AUTHOR]

Introduction: The changing proportion of older adults in society necessitates the need to determine the attitudes of health care professionals toward older adults. The purpose of this study was to explore attitudes of ageism and its correlates among health care professionals working with older adults. Method: This descriptive study was conducted in seven hospitals in five cities in Turkey. A total of 628 health care professionals participated in this study. The Fraboni Scale of Ageism (FSA) was used to collect data. Descriptive statistics, student's t test, one-way analysis of variance and multivariate linear regression were used for data analysis. Results: The mean total score from the FSA was 56.9 (SD = 8.0). Education (β = −.18, p < .001) and difficulty with the care of older adults (β = −.10, p < .05) were statistically significant predictors of the FSA score. Conclusions: The attitudes of health care professionals toward older adults were generally positive and affected by difficulty in providing care and the educational status of the health care professionals. [ABSTRACT FROM AUTHOR]

Understanding the challenges of professionals in addressing child adversity is key to improving the detection, protection, and care of exposed children. We aimed to synthesize findings from qualitative studies of professionals’ lived experience of addressing child adversity. Through a systematic search, we identified eight qualitative studies and synthesized them using metaethnography. We generated three themes, “feeling inadequate,” “fear of making it worse,” and “facing evil,” and one overarching metaphor, “walking children through a minefield.” The professionals felt that they lacked the means necessary to explore child adversity, that they were apprehensive of worsening the child’s situation, and that their work with child adversity induced emotional discomfort. This metasynthesis indicated that the professionals’ efficiency in exploring abuse relied upon their ability to manage emotional and moral distress and complexity. To support children at risk, we propose developing professionals’ ability to build relationships, skills in emotion regulation, and proficiency in reflective practice. [ABSTRACT FROM AUTHOR]

This study describes the state of end-of-life discussions in Finland. A qualitative descriptive study with thematic interviews was conducted. Data were gathered from palliative care unit nurses, physicians and social workers. Inductive content analysis was used. According to interviewees (n = 33), the state of end-of-life discussion included three main categories. First, optimal end-of-life discussion time included early end-of-life discussion, end-of-life discussion at different phases of severe illness, and flexibility and challenges in scheduling end-of-life discussion. Second, end-of-life discussion initiators included both healthcare professionals and non-healthcare professionals. Third, social care and healthcare professionals’ experiences of end-of-life discussion consisted of the importance and challenge of end-of-life discussion, end-of-life communication skills development in multiprofessional care context, and end-of-life communication in multi-cultural care context. The results can be used to justify the need of a national strategy and systematic implementation on Advance Care Planning (ACP), considering the multiprofessional, multicultural and internationalizing operating environment. [ABSTRACT FROM AUTHOR]

This qualitative inquiry explored the processes and practices of collaboration as experienced by a group of Australian multidisciplinary Aboriginal and non-Aboriginal health workers. Each worker had participated, for a period of 2 to 5 years, in an Australian Government–funded project in which a range of health initiatives led to improved access to cancer services by Aboriginal communities in a rural region of South Eastern Australia. Initiatives which addressed high rates of mortality from cancer, poor access to cancer screening, and engagement with cancer treatment were developed through the formation of close working relationships between Aboriginal and non-Aboriginal health workers. These relationships were regarded as personally and professionally transformative. Through the sharing of knowledge, skills, and experiences, new ways of knowing, being, and doing emerged. Developing a deeper understanding of cross-cultural collaboration is one way of addressing complex health problems and building the capacity of the health workforce. [ABSTRACT FROM AUTHOR]

This study looks to describe health care professionals' knowledge regarding patient safety. A quantitative study using questionnaires was conducted in three multi-disciplinary hospitals in Western Lithuania. Data were collected in 2014 from physicians, nurses, and nurse assistants. The overall results indicated quite a low level of safety knowledge, especially in regard to knowledge concerning general patient safety. The health care professionals' background factors such as their profession, education, the information about patient safety they were given during their vocational and continuing education, as well as their experience in their primary speciality seemed to be associated with several patient safety knowledge areas. Despite a wide variation in background factors, the knowledge level of respondents was generally found to be low. This requires that further research into health care professionals' safety knowledge related to specific issues such as medication, infection, falls, and pressure sore prevention should be undertaken in Lithuania. [ABSTRACT FROM AUTHOR]

This paper provides an overview of the evidence on the perspective of health care professionals (HCPs) in relation to advance care planning (ACP) for people with dementia, residing in long-term care settings. A narrative approach was adopted to provide a comprehensive synthesis of previously published literature in the area. A systematic literature search identified 14 papers for inclusion. Following review of the studies four themes were identified for discussion; Early integration and planning for palliative care in dementia; HCPs ethical and moral concerns regarding ACP; Communication challenges when interacting with the person with dementia and their families and HCPs need for education and training. Despite evidence, that HCPs recognise the potential benefits of ACP, they struggle with its implementation in this setting. Greater understanding of dementia and the concept of ACP is required to improve consistency in practice. Synthesising the existing evidence will allow for further understanding of the key issues, potentially resulting in improved implementation in practice. [ABSTRACT FROM AUTHOR]

Abortion providers work in an environment characterized by the stresses of the helping professions as well as by the marginalization and devaluation that accompany work in a stigmatized field. We created the Providers Share Workshop (PSW), a five-session workshop carried out at seven abortion care sites around the United States, to support workers and better understand the complexities of working in abortion care. Qualitative analysis suggests that the experience of participating in the workshop fosters connection, and that the group process creates unique data about the abortion care team. Taken together, these results show that PSW fulfills the dual role of a supportive group intervention—helping create connections and foster resilience—and a research tool, producing rich, multi-perspective narratives of the abortion provision team. This method provides useful insight into supporting abortion care workers specifically, and may also prove useful in the study and support of other stigmatized workers generally. [ABSTRACT FROM AUTHOR]

While an increasing number of researchers are using online discussion forums for qualitative research, few authors have documented their experiences and lessons learned to demonstrate this method’s viability and validity in health services research. We comprehensively describe our experiences, from start to finish, of designing and using an asynchronous online discussion forum for collecting and analyzing information elicited from care coordinators in Patient-Centered Medical Homes across the United States. Our lessons learned from each phase, including planning, designing, implementing, using, and ending this private online discussion forum, provide some recommendations for other health services researchers considering this method. An asynchronous online discussion forum is a feasible, efficient, and effective method to conduct a qualitative study, particularly when subjects are health professionals. [ABSTRACT FROM AUTHOR]

We used thematic analysis to investigate factors affecting decision making about gastrostomy and noninvasive ventilation (NIV) by people with Amyotrophic Lateral Sclerosis (ALS) from the viewpoint of the health care professionals (HCPs) supporting them. We conducted 20 in-depth interviews with 19 HCPs nominated by people with ALS who had made a decision to accept or decline NIV or gastrostomy. We found the main themes influencing decision making were patient-centric, caregiver-related or related to HCPs’ own beliefs, perspectives, and actions. HCPs felt patients should be, and were, in control of decision making, although caregivers and HCPs played a role. The patient’s evaluation of quality of life, the desirability of prolonging life, and acceptance of the disease and its progression by both patient and caregiver were the most important factors identified by HCPs. HCPs should be aware of the importance of multiprofessional discussions, and the potential influences (identified above) that might require discussion with patients and caregivers. [ABSTRACT FROM AUTHOR]

Patients who present with medically unexplained illnesses or medically unexplained symptoms (MUI/S) tend to be higher utilizers of health care services and have significantly greater health care costs than other patients, which add stress and strain for both the patient and provider. Although MUI/S are commonly seen in primary care, there is not sufficient information available regarding how providers can increase their level of confidence and decrease their level of frustration when working with patients who present with MUI/S. The goal of this article is to present findings from a qualitative phenomenology study, which highlights medical residents’ experiences of caring for patients with MUI/S and the personal and professional factors that contributed to their clinical approaches. Results from these studies indicate that residents often experience a lack of confidence in their ability to effectively treat patients with MUI/S, as well as frustration surrounding their encounters with this group of patients. [ABSTRACT FROM AUTHOR]

Introduction: Siblings of children with cancer experience psychosocial distress during the illness and after bereavement, but often stand outside the spotlight of attention and care. This study explored bereaved siblings' advice to health care professionals (HCPs) working with children with cancer and their families. Materials and Methods: In a nationwide Swedish survey of bereaved siblings, 174/240 (73%) participated. Of these, 108 answered an open-ended question about what advice they would give to HCPs working with children with cancer and their families. In this study, responses to this single question were analyzed using content analysis. Results: The most common advice, suggested by 56% of siblings, related to their own support. One third suggested giving better medical information to siblings. Some siblings wanted to be more practically involved in their brother's/sister's care and suggested that HCPs should give parents guidance on how to involve siblings. Other common advice related to psychosocial aspects, such as the siblings' wish for HCPs to mediate hope, yet also realism, and the importance of asking the ill child about what care they wanted. Conclusion: Information, communication, and involvement should be emphasized by HCPs to support siblings' psychosocial needs in both the health care setting and within the family. [ABSTRACT FROM AUTHOR]

Background Seven wards from three Norwegian mental health care institutions participated in a study in which regular ethics reflection groups focusing on coercion had been implemented and evaluated (2011–2015). This article presents (1) a thematic overview of the ethical challenges identified based on a systematic qualitative analyses of 161 ethics reflection groups and (2) some general observations on these ethical challenges. Results The ethical challenges are divided into four main thematic categories: (1) formal coercion, (2) informal coercion, (3) uncertainty related to the Norwegian legislation on coercion and (4) professional role and identity. Some ethical challenges did not fit into these categories. Only 36% of the ethical challenges were related to the use of formal coercion or the interpretation of the health law. Conclusion Even within coercion regulated by law, weighing different moral values remains important to reflect upon the appropriateness of the possible use of coercion. [ABSTRACT FROM AUTHOR]

The recognition and assessment of organizational social context (culture, climate and morale) is particularly valuable in primary health care. Both culture and climate have been shown to be associated with work morale and to predict job satisfaction, organizational commitment and voluntary turnover of employees in nursing. This study aims to describe the social contexts of primary health care centers from the viewpoint of health care professionals. A descriptive study using an organizational social context instrument for data collection was undertaken. From 29 teams in 18 public primary care centers of one Lithuanian county, 344 health care professionals participated. The results of the study show that different organizational cultures, climates and levels of morale existed in primary health care centers, at both team and organizational levels. The differences between teams were significant in terms of culture rigidity and resistance. Climate differences were found at both team and organization levels in regard to stress and functionality. A variance of about 7% in work morale was seen in teams and organizations. Managers should recognize the different kinds of social contexts in which teams work, in order to enable them to co-work efficiently in evidence-based primary care settings. [ABSTRACT FROM AUTHOR]

The importance of consulting children in health care situations is acknowledged but not always put into action. Health care professionals have difficulties with facilitating children's participation and children are not pleased with their amount of involvement. The aim of this study was to explore health care professionals' reflections on being in care situations with children. A qualitative design with workshops and content analysis was used. The participants (n=29) represented various health care professions. The findings show that health care professionals understand being in care situations with children as an ambiguous challenge since each situation depends on the participants involved: the child, the parents and the professionals. The findings can be used for integrating theory and practice to broaden professionals' awareness of the child's perspective in care situations. This will encourage professionals to question procedures which are taken for granted and facilitate children's participation. [ABSTRACT FROM AUTHOR]

The aim of this investigation was to conduct a comprehensive examination of communication between parents and health care professionals (HCPs) in the pediatric intensive care unit (PICU). A secondary analysis was performed on data from 3 previous qualitative studies, which included 30 physicians, 37 nurses, and 38 parents in France and Quebec (Canada). All three studies examined a mix of cases where children either survived or died. All data referring to communication between parents (and patients when applicable) and HCPs were examined to identity themes that related to communication. Thematic categories for parents and HCPs were developed. Three interrelated dimensions of communication were identified: (1) informational communication, (2) relational communication, and (3) communication and parental coping. Specific themes were identified for each of these 3 dimensions in relation to parental concerns as well as HCP concerns. This investigation builds on prior research by advancing a comprehensive analysis of PICU communication that includes (a) cases where life-sustaining treatments were withdrawn or withheld as well as cases where they were maintained, (b) data from HCPs as well as parents, and (c) investigations conducted in 4 different sites. An evidence-informed conceptual framework is proposed for PICU communication between parents and HCPs. We also outline priorities for the development of practice, education, and research. [ABSTRACT FROM AUTHOR]

Mercury, one of the most toxic heavy metals, is ubiquitous in environment. The adverse health impact of mercury on living organisms is well known. The health care facilities are one of the important sources of mercury release into the atmosphere as mercury items are extensively used in hospitals. To assess the awareness about mercury toxicity and the knowledge of proper handling and disposal of mercury-containing items in health care set–up, a questionnaire-based survey was carried out amongst doctors (n = 835), nurses (n = 610) and technicians (n = 393) in government hospitals, corporate hospitals and primary health care centres in the Indian states of Delhi, Uttar Pradesh and Haryana. The study was conducted using a tool-containing pretested structured multiple-choice questionnaire. Analysis of the results using STATA 11.1 software highlighted that overall awareness was more in corporate sector. However, percentage range of knowledge of respondents irrespective of health care sector was only between 20 and 40%. Despite the commitment of various hospitals to be mercury free, mercury containing-thermometer/sphygmomanometer are still preferred by health professionals. The likely reasons are availability, affordability, accuracy and convenience in use. There is an urgent need for source reduction, recycling and waste minimization. Emphasis must be laid on mercury alternative products, education and training of health personnel and public at large, about correct handling and proper clean up of spills. [ABSTRACT FROM AUTHOR]

A multitude of factors can influence the uptake and implementation of complex interventions in health care. A plethora of theories and frameworks recognize the need to establish relationships, understand organizational dynamics, address context and contingency, and engage key decision makers. Less attention is paid to how theories that emphasize relational contexts can actually be deployed to guide the implementation of an intervention. The purpose of the article is to demonstrate the potential role of qualitative research aligned with theory to inform complex interventions. We detail a study underpinned by theory and qualitative research that (a) ensured key actors made sense of the complex intervention at the earliest stage of adoption and (b) aided initial engagement with the intervention. We conclude that using theoretical approaches aligned with qualitative research can provide insights into the context and dynamics of health care settings that in turn can be used to aid intervention implementation. [ABSTRACT FROM AUTHOR]

Researchers often discuss patient-related outcomes of the shift from the paternalistic physician-to-patient model to those of patient participation, yet little is known about the impact of patient participation on physicians’ professional identity. In this study, we explored the context of counterprofessional patient requests in which patient participation conflicts with medical professionalism. We interviewed 34 physicians, of whom 14 were family physicians and pediatricians, and 20 were specialists in various fields. Data were analyzed by a grounded theory approach. Our findings indicate that physicians experienced conflicts between their identities as clinical experts, caretakers, service providers, and resource allocators. To cope with the resulting tension, physicians used the strategies of hierarchy setting, integrating, incorporating the patient, and changing the meaning of an identity or the event. All strategies were implemented by cognitive and relational tactics. [ABSTRACT FROM AUTHOR]

Collaborative inquiry involves a group of people in iterative examination of a shared experience, action to address identified concerns, and reflection. We describe our attempt to conduct a collaborative inquiry into the roles and experiences of health professionals designated as recovery champions within a mental health service. Our linked goals were to work with champions to support the desired shift in approach to care and implementation of recovery practices, and to gather data to develop our own understanding of the service culture. The inquiry opened up a communicative space in which robust discussion elucidated the complexities of implementing ‘recovery’ within a highly governed and scrutinised environment. Numerous problems and some opportunities for practice improvement were identified but with too little time and emotional space to engender group identity and work through ambiguity inherent in collaborative inquiry, no actions were implemented. However, champions came to appreciate substantial progress made and understand the service as one ‘in recovery’. They developed a sense of themselves as agents of change and agreed to continue the process independently. Review of the process sheds light on successes and limitations, drawing attention to the importance of context and realistic planning when considering such an inquiry. [ABSTRACT FROM AUTHOR]

Background. Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. Design and Methods. Tripartite study. First part of this study evaluates health care providers' (physicians and nurses) perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. Expected Impact for Public Health. The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients. [ABSTRACT FROM AUTHOR]

The “gift of life” metaphor is used to promote organ donation where commercialization is prohibited. In this article, we explore how multiple parties involved in organ transfer procedures think of gift terminology by drawing on interview data with transplantation specialists, organ transplant recipients, living directed donors and living nondirected donors. The interviews took place across New Zealand between October 2008 and May 2012, in participants’ homes and hospital workplaces. The interviews were transcribed verbatim, coded manually, and thematically analyzed. Although gift language is often viewed as clear-cut, the gift trope has multiple meanings for different constituent and cultural groups, ranging from positive descriptors to obscuring and romanticizing the complexities of transplantation processes. To account for these multiple perspectives, we suggest new ethical models to capture the nuanced phenomenon of organ transfer in ways that recognize the full range of donation and reception experiences. [ABSTRACT FROM AUTHOR]

A growing body of research indicates that the way health care professionals conceptualize mental health might have important clinical implications. We adopted a discursive psychology approach to explore clinical psychologists’ accounts of mental health and its effects. Semistructured interviews were conducted with 11 clinical psychologists in the East Midlands region of the United Kingdom. The participants constructed mental health through building up biological factors and psychosocial aspects as opposite ends of the same spectrum, and then positioned themselves as distant from these extremes to manage issues of stake and accountability. A discourse of moral concern for service users was used to negotiate the implications of having different views of mental health from service users, enabling clinicians to manage issues of accountability and demonstrate their ability to be helpful. This suggests that clinicians should be mindful of the effects of their use of language and make the contingent nature of their knowledge explicit. [ABSTRACT FROM PUBLISHER]

The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda. [ABSTRACT FROM PUBLISHER]

In this article, we provide an overview of social network research in health care, with a focus on social interactions between professionals in organizations. We begin by introducing key concepts defining the social network approach, including network density, centrality, and brokerage. We then review past and current research on the antecedents of health care professionals’ social networks—including demographic attributes, professional groups, and organizational arrangements—and their consequences—including satisfaction at work, leadership, behaviors, knowledge transfer, diffusion of innovation, and performance. Finally, we examine future directions for social network research in health care, focusing on micro–macro linkages and network dynamics. [ABSTRACT FROM AUTHOR]