Culture Change in Older Adult Care Settings: A Bibliometric Review.

BACKGROUND AND OBJECTIVES: We systematically analyzed research on the culture change movement, in the context of global efforts to transform the provision of older adult care in institutional settings. RESEARCH DESIGN AND METHODS: Using Web of Science and Scopus publications relevant to person-centered care, culture change, or older adult care settings, we built bibliometric networks for keywords and terms extracted from titles and abstracts. Overlays depicted corresponding authors' countries, publication recency, funding, scientific impact, and concept use. RESULTS: The keyword network for 337 publications revealed variability in culture change settings and study indexing. Term network overlays showed geographical and chronological research variation. Corresponding authors from 14 countries contributed publications, mostly from the United States (69% of publications), Canada (9%), and Australia (5%). Social environment and person-centeredness studies, particularly in dementia care settings, were more recent than studies on physical environment, quality, organizational culture, turnover, and staffing. Scholars listed funding sources for 38% of publications; funding and scientific impact did not always overlap. Well-cited studies on standards of care and policy were funded at a lower rate than topics of lower impact. Over 60% of titles, abstracts, or keywords referred to quality and person-centeredness. DISCUSSION AND IMPLICATIONS: Originating in the 1990s in the United States, culture change quickly became an international phenomenon, drawing researchers' attention. Change research has deep roots in quality improvement and person-centered philosophy. We offered practical strategies for querying this hard to access literature. With some database-related limitations, empirical data on scientific impact can be used to allocate research funding.

Psychological empowerment and job crafting among registered nurses working in public health: A quantitative study.

BACKGROUND AND OBJECTIVES: The researchers examine the relationship between two variables related to work meaningfulness and engagement - psychological empowerment and job crafting - among Ontario registered nurses working in public health. RESEARCH DESIGN AND METHODS: This quantitative, cross-sectional study was conducted in Ontario, Canada with registered nurses (n = 238) from six randomly selected health units. Registered nurses provided quantitative ratings of their psychological empowerment and job crafting behaviours in an online, confidential, anonymous survey. Data analyses included descriptive statistics, correlations, multiple and hierarchical regressions, and independent samples t-tests. RESULTS: Significant, positive relationships were observed between overall scores for psychological empowerment and job crafting (r = 0.50, n = 238, p < .01) and for each of their dimensions. Region, age, job, and public health experience explained 26 % of the variance in overall psychological empowerment; job crafting accounted for an additional 24 % of variance. Region and public health experience moderated the relationship between psychological empowerment and job crafting. DISCUSSION AND IMPLICATIONS: Registered nurses working in public health experience empowerment when they engage in job crafting. Nurse managers and educators can support and promote job crafting by nurses who are willing to engage and make their jobs more meaningful. What is already known about this topic?

Crowdsourcing homemade facemasks: 772 U.S. health facilities' responses to personal protective equipment shortages in the first half of 2020.

PURPOSE: We examined 772 U.S. health facilities' responses to Personal Protective Equipment (PPE) shortages in the first half of 2020, as they crowdsourced face coverings from volunteer makers to be used as respiratory protection during crisis surge capacity. The purpose was to examine facemask specification requests from health facilities and develop a framework for crowdsourcing last resort PPE. DESIGN/METHODOLOGY/APPROACH: Homemade facemask donation requests from health facilities in 47 states systematically recorded in a public database maintained by public health graduate students at a major U.S. university were analysed. Open coding was used to content analyse facemask types and specifications, intended uses, delivery logistics and donation management strategies. FINDINGS: Our analysis revealed information gaps: Science-based information was scarce in 2020, leading to improvised specifications for facemask materials and designs. It also revealed the emergence of a crowdsourcing structure: Task specifications for volunteer facemasks makers, delivery logistics, and practical management of donations within the pandemic context. In anticipation of future pandemics and localised PPE shortages, we build on this empirical evidence to propose a framework for crowdsourcing science-informed facemasks from volunteers. Categorised within (a) logistics and workflow management, (b) task specifications and management, and (c) practical management of contributions functional areas, the framework outlines the required tasks and specifications for crowdsourcing. ORIGINALITY: A novel empirically derived framework for crowdsourcing homemade facemasks is proposed, based on empirical analysis and crowdsourcing system design strategies. Our findings and the framework may be used for refining crisis capacity guidelines, as part of strategic planning and preparation for future pandemics that disrupt supply chains and cause shortages in protective equipment.

Job crafting in registered nurses working in public health: A qualitative study.

BACKGROUND AND OBJECTIVES: Job crafting is proactively adjusting and redesigning one's own job to make it more meaningful. This is accomplished by changing the activities (task crafting), altering the way one thinks about the job (cognitive crafting), and using discretion about with whom one chooses to work (relational crafting). We examined self-reported behavioral manifestations of job crafting among Ontario registered nurses working in public health. RESEARCH DESIGN AND METHODS: This qualitative, descriptive, cross-sectional study was conducted with registered nurses (n = 238) from six randomly selected health regions in Ontario, Canada. Registered nurses completed surveys to provide quantitative ratings and qualitative reports of their job crafting behaviours. Data analyses included descriptive statistics and a content analysis of written comments to summarize common job crafting behaviours. RESULTS: Registered nurses in public health are actively job crafting by emphasizing and initiating tasks that are based on strengths and passions. Examples included training students and new staff, participating in workgroups and committees, and being involved in projects. Nurses proactively modified the processes of the tasks to better meet client needs and improve quality of care. Job crafting facilitators and barriers included availability of opportunities, support from management, experience/level of skill of the nurse, limitations in the role, and heavy workload/insufficient staffing. The ability to continually modify tasks at the point of care, using evidenced-based approaches and utilizing education and professional development facilitated job crafting. Nurses reported that improving work meaningfulness was a driver of job crafting. Nurses also described a willingness to take on other tasks, being enriched by nurse-client and collegial relationships, and that their service to clients superseded their service to the organization. DISCUSSION AND IMPLICATIONS: Public health registered nurses are actively involved in their own, bottom-up job redesign and managers are instrumental in facilitating or hindering the job crafting process. Managers can support nurses by allowing them to make changes on the job, providing professional development, managing workload and creating environments that support collegial relationships. Overall, the study contributes new knowledge about job crafting. It draws attention to the importance of registered nurses' involvement in designing their jobs. Lastly, managers and educators should promote and support job crafting.

Health Services to Meet Physical, Mental, and Social Needs of 126 Females Who Survived Boko Haram Abduction and Captivity: Providers' Perspective.

We explore the challenges faced by survivors of Boko Haram abduction and human trafficking after their release by interviewing survivors' care providers and analyzing electronic medical records at the American University of Nigeria Health Center. Our report details the physical, mental, and social challenges the survivors faced in captivity and how providers managed those challenges using a holistic health care model.

Nursing staff member experiences with household model implementation in a nursing home setting.

This qualitative study used conventional content analysis of interview data to examine nursing staff members' experiences with Household Model implementation in a nursing home setting. Staff members were recruited from the skilled nursing center post implementation and completed individual interviews (N=16). Participants described the impact of implementation in relation to three categories: antecedents, explicit reactions and change consequences. Participants described barriers and facilitators to implementation as well as outcomes such as role strain, feelings of isolation and harder working conditions. This study provides opportunities for further examination of nursing staff members' experiences with person centered care models in nursing homes, how those experiences may relate to effectiveness of implementation and the need for support of nursing home staff.

Bibliometric Analysis and Visualization of Catholic Health Care Research: 1973-2019.

A multi-dimensional construct of Catholic health care is examined using a bibliometric analysis of 181 scientific studies from the Web of Science database. Medical ethics, religion, and health services research by 418 authors from 26 countries reveals developments in the Catholic health care domain since 1973. Using VOSviewer, we map keyword clusters to reveal the structure of research on Catholic health care that transcends religious and secular literatures. The clusters mostly reflect clinical and ethical issues of reproductive health and the end of life, as well as the essence and the future of the Catholic identity from the theological and empirical perspectives.

Sources of variability in hospital administrative data: Clinical coding of postoperative ileus.

BACKGROUND: Multiple studies have questioned the validity of clinical codes in hospital administrative data. We examined variability in reporting a postoperative ileus (POI). OBJECTIVE: We aimed to analyse sources of coding variations to understand how clinical coding professionals arrive at POI coding decisions and to verify existing knowledge that current clinical coding practices lack standardised applications of regulatory guidelines. METHOD: Two medical records (cases 1 and 2) were provided to 15 clinical coders employed by a midsize nonprofit hospital in the northwest region of the United States. After coding these cases, the study participants completed a survey, reported on the application of guidelines, and participated in a focus group led by a health information management regulatory compliance expert. RESULTS: Only 5 of the 15 clinical coders correctly indicated no POI complication in case 1 where the physician documentation did not establish a link between the POI as a complication of care and the surgery. In contrast, 13 of the 15 study participants correctly coded case 2, which included clear physician documentation and contained the clinical parameters for the coding of the POI as a complication of care. Clinical coder education, credentials, certifications, and experience did not relate to the coding performance. The clinical coders inconsistently prioritised coding rules and valued experience more than education. CONCLUSION AND IMPLICATIONS: The application of International Classification of Diseases, Ninth Revision, Clinical Modification; coding conventions; Centers for Medicare and Medicaid Services coding guidelines; and American Hospital Association coding clinic advice was subject to the clinical coders' interpretation; they perceived them as conflicting guidance. Their reliance on subjective experience in dealing with this conflicting guidance may limit the accuracy of reporting outcomes of clinical performance.

Primary Care and Public Health Collaboration Reports: A Qualitative Review of Integration Aims, Participants, and Success Determinants.

This qualitative review of 57 published case reports aimed to analyze primary care and public health integration efforts in 45 states to summarize collaboration aims, participants, and systemic, organizational, and interactional success determinants. Chronic disease management, maternal and child health, and wellness and health promotion were the most commonly reported aims of collaboration between primary care and public health entities in the United States. Typical participants were government public health structures, health delivery systems, communities, academia, state professional medical associations, and employers and businesses. Systemic, organizational, and interactional determinants included adequate funding, multiple stakeholder engagement, leadership, data and information sharing, capitalization on collaborator resources, community engagement, steering committees, effective communication, regular meetings, shared mission, vision, and goals, previous positive relationships, collaborations, and partnerships. The present study contributes to the body of knowledge of when, where, and under what contextual circumstances collaboration and integration have been perceived as effective. Future research could extrapolate which determinants are more essential than others and focus on how systemic, organizational, and interactional factors are interrelated. To advance the practice of successful integration between primary care and public health entities, longitudinal research is needed to examine the degree of integration and sustainability.

Prioritization of inpatient hospital services to prisoners: a method for justifying care and costs.

As a response to rising health care costs and substantial cuts in state funding for correctional health care in Texas, we developed and applied a process framework for systematically prioritizing the provision of inpatient hospital services to prisoners. Specifically, all inpatient services provided from September 2009 through August 2011 at the University of Texas Medical Branch/Texas Department of Criminal Justice Hospital were sorted according to levels of care consistent with those previously defined by the Oregon Department of Corrections and the Federal Bureau of Prisons. Nearly all inpatient services (94%) were deemed medically mandatory (Level 1) or medically necessary (Level 2). These services must be funded to ensure an adequate level of care, and capitated-funding mechanisms may not be sufficiently flexible to cover their costs. Correctional health care systems may adapt the framework used here to inform state policymakers regarding provision of inpatient services and funding requirements.

Developing health information literacy: a needs analysis from the perspective of preprofessional health students.

OBJECTIVE: The research identified the skills, if any, that health preprofessional students wished to develop after receiving feedback on skill gaps as well as any strategies they intended to use to address these gaps. METHODS: A qualitative approach was used to elicit students' reflections on building health information literacy skills. First, the students took the Research Readiness Self-Assessment instrument, which measured their health information literacy, and then they received individually tailored feedback about their scores and skill gaps. Second, students completed a post-assessment survey asking how they intended to close identified gaps in their skills on these. Three trained coders analyzed qualitative comments by 181 students and grouped them into themes relating to "what skills to improve" and "how to improve them." RESULTS: Students intended to develop library skills (64% of respondents), Internet skills (63%), and information evaluation skills (63%). Most students reported that they would use library staff members' assistance (55%), but even more respondents (82%) planned to learn the skills by practicing on their own. Getting help from librarians was a much more popular learning strategy than getting assistance from peers (20%) or professors (17%). CONCLUSIONS: The study highlighted the importance of providing health preprofessional students with resources to improve skills on their own, remote access to library staff members, and instruction on the complexity of building health literacy skills, while also building relationships among students, librarians, and faculty.

Dirt cheap and without prescription: how susceptible are young US consumers to purchasing drugs from rogue internet pharmacies?

BACKGROUND: Websites of many rogue sellers of medications are accessible through links in email spam messages or via web search engines. This study examined how well students enrolled in a U.S. higher education institution could identify clearly unsafe pharmacies. OBJECTIVE: The aim is to estimate these health consumers vulnerability to fraud by illegitimate Internet pharmacies. METHODS: Two Internet pharmacy websites, created specifically for this study, displayed multiple untrustworthy features modeled after five actual Internet drug sellers which the authors considered to be potentially dangerous to consumers. The websites had none of the safe pharmacy signs and nearly all of the danger signs specified in the Food and Drug Administration s (FDA s) guide to consumers. Participants were told that a neighborhood pharmacy charged US$165 for a one-month supply of Beozine, a bogus drug to ensure no pre-existing knowledge. After checking its price at two Internet pharmacies-$37.99 in pharmacy A and $57.60 in pharmacy B-the respondents were asked to indicate if each seller was a good place to buy the drug. Responses came from 1,914 undergraduate students who completed an online eHealth literacy assessment in 2005-2008. Participation rate was 78%. RESULTS: In response to "On a scale from 0-10, how good is this pharmacy as a place for buying Beozine?" many respondents gave favorable ratings. Specifically, 50% of students who reviewed pharmacy A and 37% of students who reviewed pharmacy B chose a rating above the scale midpoint. When explaining a low drug cost, these raters related it to low operation costs, ad revenue, pressure to lower costs due to comparison shopping, and/or high sales volume. Those who said that pharmacy A or B was "a very bad place" for purchasing the drug (25%), as defined by a score of 1 or less, related low drug cost to lack of regulation, low drug quality, and/or customer information sales. About 16% of students thought that people should be advised to buy cheaper drugs at pharmacies such as these but the majority (62%) suggested that people should be warned against buying drugs from such internet sellers. Over 22% of respondents would recommend pharmacy A to friends and family (10% pharmacy B). One-third of participants supplied online health information to others for decision-making purposes. After controlling for the effects of education, health major, and age, these respondents had significantly worse judgment of Internet pharmacies than those who did not act as information suppliers. CONCLUSIONS: At least a quarter of students, including those in health programs, cannot see multiple signs of danger displayed by rogue Internet pharmacies. Many more are likely to be misled by online sellers that use professional design, veil untrustworthy features, and mimic reputable websites. Online health information consumers would benefit from education initiatives that (1) communicate why it can be dangerous to buy medications online and that (2) develop their information evaluation skills. This study highlights the importance of regulating rogue Internet pharmacies and curbing the danger they pose to consumers.

Explaining and forecasting attrition in the Army pharmacy technician course.

The Army pharmacy technician (68Q) course trains--260 students per year, with a mean graduation rate of 71.3%. In support of this course, a research team conducted a study using multiple analytical methods to evaluate, to explain, and potentially to forecast failures, because the 28.7% of students who do not graduate are associated with both opportunity and real costs. Results of this study indicated that largely uncontrollable population demographic characteristics, such as rank and enrollment status, along with controllable Armed Services Vocational Aptitude Battery skilled technical test scores, were related to graduation rates. The results of this study may be used to assist individuals at risk of failure or to establish additional admission criteria to increase the likelihood of success.

Mentoring junior healthcare administrators: a description of mentoring practices in 127 U.S. hospitals.

A survey instrument about mentoring junior healthcare administrators was mailed to 485 senior-level executives-chief executive officers, hospital administrators, and presidents. Completed surveys were returned by 127 senior executives (26 percent response rate). On average, the respondents were 53 years old, had nine years of organizational tenure in their current position, and had 16.5 years of career tenure as a senior healthcare executive. The mean age of when the respondents first had a mentor was 28 years old. The average length of the respondents' relationship with their mentor was 3.56 years. Although healthcare executives believed mentoring benefits the healthcare industry as a whole, they reported that the benefits were even greater for the hospital where mentoring was done. Personal satisfaction was cited as the primary reason for serving as a mentor. In the 127 organizations represented by the respondents, informal mentoring programs were more prevalent than formal mentoring programs. Our findings suggest that healthcare executives in formal mentoring programs may be more likely to support mentoring than individuals who entered informal mentoring relationships. Those who reported being mentors or engaging in mentoring-supportive activities had a longer job tenure and career tenure than did individuals who had not served as mentors. The study suggests that mentoring--in particular, informal mentoring--is a popular activity in U.S. hospitals and is carried out by experienced healthcare executives whose primary motivation is personal satisfaction.

Health information literacy and competencies of information age students: results from the interactive online Research Readiness Self-Assessment (RRSA).

BACKGROUND: In an era of easy access to information, university students who will soon enter health professions need to develop their information competencies. The Research Readiness Self-Assessment (RRSA) is based on the Information Literacy Competency Standards for Higher Education, and it measures proficiency in obtaining health information, evaluating the quality of health information, and understanding plagiarism. OBJECTIVE: This study aimed to measure the proficiency of college-age health information consumers in finding and evaluating electronic health information; to assess their ability to discriminate between peer-reviewed scholarly resources and opinion pieces or sales pitches; and to examine the extent to which they are aware of their level of health information competency. METHODS: An interactive 56-item online assessment, the Research Readiness Self-Assessment (RRSA), was used to measure the health information competencies of university students. We invited 400 students to take part in the study, and 308 participated, giving a response rate of 77%. The RRSA included multiple-choice questions and problem-based exercises. Declarative and procedural knowledge were assessed in three domains: finding health information, evaluating health information, and understanding plagiarism. Actual performance was contrasted with self-reported skill level. Upon answering all questions, students received a results page that summarized their numerical results and displayed individually tailored feedback composed by an experienced librarian. RESULTS: Even though most students (89%) understood that a one-keyword search is likely to return too many documents, few students were able to narrow a search by using multiple search categories simultaneously or by employing Boolean operators. In addition, nearly half of the respondents had trouble discriminating between primary and secondary sources of information as well as between references to journal articles and other published documents. When presented with questionable websites on nonexistent nutritional supplements, only 50% of respondents were able to correctly identify the website with the most trustworthy features. Less than a quarter of study participants reached the correct conclusion that none of the websites made a good case for taking the nutritional supplements. Up to 45% of students were unsure if they needed to provide references for ideas expressed in paraphrased sentences or sentences whose structure they modified. Most respondents (84%) believed that their research skills were good, very good, or excellent. Students' self-perceptions of skill tended to increase with increasing level of education. Self-reported skills were weakly correlated with actual skill level, operationalized as the overall RRSA score (Cronbach alpha = .78 for 56 RRSA items). CONCLUSIONS: While the majority of students think that their research skills are good or excellent, many of them are unable to conduct advanced information searches, judge the trustworthiness of health-related websites and articles, and differentiate between various information sources. Students' self-reports may not be an accurate predictor of their actual health information competencies.