'If there were doctors who could understand our problems, I would already be better': dissatisfactory health care and marginalisation in superdiverse neighbourhoods.

How people in community settings describe their experience of disappointing health care, and their responses to such dissatisfaction, sheds light on the role of marginalisation and underlines the need for radically responsive service provision. Making the case for studying unprompted accounts of dissatisfaction with healthcare provision, this is an original analysis of 71 semi-structured interviews with healthcare users in superdiverse neighbourhoods in four European cities. Healthcare users spontaneously express disappointment with services that dismiss their concerns and fail to attend to their priorities. Analysing characteristics of these healthcare users show that no single aspect of marginalisation shapes the expression of disappointment. In response to disappointing health care, users sought out alternative services and to persuade reluctant service providers, and they withdrew from services, in order to access more suitable health care and to achieve personal vindication. Promoting normative quality standards for diverse and diversifying populations that access care from a range of public and private service providers is in tension with prioritising services that are responsive to individual priorities. Without an effort towards radically responsive service provision, the ideal of universal access on the basis of need gives way to normative service provision.

Relationship between nurse staffing levels and nurse outcomes in community hospitals, Thailand.

A growing body of research has shown an association between nurse staffing levels and a range of nurse outcomes. There is little empirical research evaluating this relationship in Thailand. This study evaluated the influence of nurse staffing levels on outcomes among nurses. A cross-sectional survey design was conducted at 92 community hospitals using a stratified random sampling design across Thailand during May and July 2012. Questionnaires included items focusing on nurse staffing levels; job dissatisfaction and emotional exhaustion, both related to nurse retention; and needlestick and sharps injuries. The study sample comprised 1412 registered nurses who provided direct patient care. The findings showed that each additional patient per nurse was associated with an additional 5% of nurses reporting dissatisfaction in their job; 8% of nurses reporting high emotional exhaustion, and 4% of nurses reporting needlestick and sharps injuries. This study provides evidence of how nurse staffing levels result in nurse outcomes. Nurses are significant healthcare providers that directly affect quality of care and patient safety in hospitals. Improvement of nurse staffing levels holds promise for improving nurse outcomes in Thailand.

Prevention of Unhealthy Weight, Disordered Eating, and Poor Body Image in Children. Perspectives From Norwegian Parents and Healthcare Professionals.

Background: Childhood obesity (ChO) and eating disorders are on the rise, with concerning effects on health. Early prevention is essential as interventions after problems arise are costly and with a low success rate. In Norway, prevention of ChO has been largely weight-centered, without desired effects. Confident Body, Confident Child (CBCC) is a universal program aimed at preventing ChO, disturbed eating, and body image problems through a health-centered intervention for parents of children between 2 and 6 years. The current study is part of a cultural adaptation and translation of CBCC into Norwegian. Methods: Focus groups with parents (n = 16) and professionals (n = 11) were held around healthy eating, activity, and body image, with an emphasis on possible barriers for prevention as well as approaches considered helpful. The interviews were analyzed using interpretative phenomenological analysis. Results: Parents and professionals described parental stress connected to high standards, conflicting information, and parental comparison. A narrowing sense of normality around healthy living was described with little flexibility resulting in "all-or-nothing" thinking. Parents were anxious to say or do the wrong thing when regulating children's food intake and when faced with comments about appearance. Parents and professionals described parental concern around children not eating enough, and professionals described an increase in parents using food as regulation. Both parents and professionals expressed that having a child with overweight was tied to a sense of failure and shame. Interventions related to overweight seemed to increase stress and shame, further complicating follow-up. As an alternative, parents and professionals expressed a desire for interventions with normalizing information around "good-enough" parenting related to food and weight. Discussion: The described fear of doing something wrong and lack of flexibility is interpreted within a stress-sensitive understanding, where stress and shame can influence parents toward mobilizing action or disengagement, presenting as dichotomous behaviors of "all-or-nothing". Conclusion: Interventions that can normalize parental concerns in a non-moralizing way may reduce stress and shame. CBCC addresses all the major concerns raised in this study, providing parents with evidence-based information they can implement into everyday life. The Norwegian cultural adaptation added extra emphasis on normalization and shame-reduction.

An exploration of key issues and potential solutions that impact physician wellbeing and professional fulfillment at an academic center.

Background. Physician wellness is a vital element of a well-functioning health care system. Not only is physician wellness empirically associated with quality and patient outcomes, but its ramifications span individual, interpersonal, organizational, and societal levels. The purpose of this study was to explore academic physicians' perceptions about their work-related wellness, including the following questions: (a) What are the workplace barriers and facilitators to their wellness? (b) What workplace solutions do theythinkwouldimprove their wellness? (c)What motivates their work? and (d) What existing wellness programs are they aware of? Methods. A multi-method design was applied to conduct a total of 19 focus group sessions in 17 clinical departments. All academic faculty ranks and career lines were represented in the 64 participating physicians, who began the sessions with five open-ended survey questions pertaining to physician wellness in their work environment. Participants entered their answers into a web-based survey program that enabled anonymous data collection. The initial survey component was followed by semi-structured focus group discussion. Data analysis of this qualitative study was informed by the general inductive approach as well as a review of extant literature through September 2015 on physician wellness, professional fulfillment, satisfaction, dissatisfaction, burnout and work-life. Results. Factors intrinsic to the work of physicians dominated the expressed reasons for work motivation. These factors all related to the theme of overall contribution, with categories of meaningful work, patient care, teaching, scientific discovery, self-motivation and matching of career interests. Extrinsic factors such as perceptions of suboptimal goal alignment, inadequate support, restricted autonomy, lack of appreciation, and suboptimal compensation and benefits dominated the risk of professional dissatisfaction. Discussion. Our findings indicate that the factors that enhance professional fulfillment and those that precipitate burnout are distinct: motivation and quality of work performed were supported by domains intrinsic to the work itself, whereas external dysfunctional work aspects resulted in frustration. Thus, it can be anticipated that optimization of physician wellness would require tailored approaches in each of these dimensions with sustained funding and support for wellness initiatives. Physicians identified the availability of resources to enable them to thrive and provide excellent patient care as their most important wellness-enhancing factor.

Exploring Physicians' Dissatisfaction and Work-Related Stress: Development of the PhyDis Scale.

Research, all over the world, is starting to recognize the potential impact of physicians' dissatisfaction and burnout on their productivity, that is, on their intent to leave the job, on their work ability, on the amount of sick leave days, on their intent to continue practicing, and last but not least, on the quality of the services provided, which is an essential part of the general medical care system. It was interest of the provincial medical board's ethical committee to acquire information about physician's work-related stress and dissatisfaction. The research group was committed to define the indicators of dissatisfaction and work-related stressors. Focus groups were carried out, 21 stressful experience's indicators were identified; we developed an online questionnaire to assess the amount of perceived stress relating to each indicator at work (3070 physicians were contacted by e-mail); quantitative and qualitative data analysis were carried out. The grounded theory perspective was applied in order to assure the most reliable procedure to investigate the concepts' structure of "work-related stress." We tested the five dimensions' model of the stressful experience with a confirmatory factor analysis: Personal Costs; Decline in Public Image and Role Uncertainty; Physician's Responsibility toward hopelessly ill Patients; Relationship with Staff and Colleagues; Bureaucracy. We split the sample according to attachment style (secure and insecure -anxious and avoidant-). Results show the complex representation of physicians' dissatisfaction at work also with references to the variable of individual difference of attachment security/insecurity. The discriminant validity of the scale was tested. The original contribution of this paper lies on the one hand in the qualitative in depth inductive analysis of physicians' dissatisfaction starting from physicians' perception, on the other hand, it represents the first attempt to analyze the physicians' dissatisfaction with reference to attachment styles, which is recognized as being a central variable of individual difference supporting caregiving practices. This study represents an original and innovative attempt to address physicians' dissatisfaction and job satisfaction. The PhyDis scale has been developed and, in line with international findings, our results indicate that role uncertainty and loss of social esteem are the most dissatisfying factors.

A measure of treatment response: patient and physician satisfaction with traditional NSAIDs for osteoarthritis control.

PURPOSE: The clinical response to traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) varies substantially. The objective of this study was to describe physicians' and patients' perceptions of response to tNSAIDs as measured by satisfaction with control of patients' osteoarthritis (OA). PATIENTS AND METHODS: A cross-sectional survey was undertaken in 2009 in Germany, Spain, and the UK. Linked physician and patient questionnaires collected data on OA management, degree of pain and disability, and satisfaction with OA control. RESULTS: The study included 363 treating physicians and 713 patients receiving tNSAIDs. Patient mean (standard deviation) age was 65.5 (11.0) years (range 36-94 years); 60% were women; 86% were white; and one-quarter were obese. Dissatisfaction with control of patients' OA was expressed by physicians or their patients, or both, for 51% of patients, including 208 patients (31%) with mild OA and 478 patients (60%) with moderate or severe OA. Overall, 37% of patients reported dissatisfaction and 34% had a physician who reported dissatisfaction. Patient and physician assessments were the same in 70% of cases; Cohen's κ coefficient was 0.34 (95% confidence interval 0.26-0.41), indicating fair agreement. Of those reporting dissatisfaction, most physicians (79%) and patients (64%) believed that the current control was the best that could be achieved. The most common reasons for which physicians reported dissatisfaction were inadequate response (56%), side effects (11.1%), and poor tolerance (7.8%). CONCLUSION: One-half of patients or their treating physicians were dissatisfied with the control of OA provided by tNSAID therapy; moreover, most believed it was the best control that could be achieved.