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6.
7.
JAMA Netw Open ; 3(1): e1913202, 2020 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-31922555

RESUMO

Importance: Improving health care in low- and middle-income countries (LMICs) requires a workforce with positive job morale. However, the level of job morale in this population remains unclear. Objective: To analyze studies measuring the job morale of physicians and dentists working in LMICs, using levels of job burnout, job satisfaction, and job motivation as indicators of job morale. Data Sources: A comprehensive search of Scopus, PubMed, PsycINFO, EMBASE, Web of Science, and the Cochrane Library, from database inception to October 30, 2018, and gray literature was performed. Study Selection: Studies were eligible if at least 50% of the sample were qualified physicians and/or dentists working in public health care settings in LMICs. Three indicators of job morale in this population were used: job burnout, job satisfaction, and job motivation. Of 12 324 records reviewed, 79 studies were included in the systematic review and 59 were eligible for the meta-analysis. Data Extraction And Synthesis: Data were extracted independently by several investigators in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Random-effects meta-analyses, planned subgroup analyses, and metaregression were performed. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess bias. Main Outcomes and Measures: Levels of job burnout, job satisfaction, and job motivation as indicators of job morale. Results: Overall, 12 324 records were identified. Of them, 80 records, representing 79 studies and involving 45 714 participants across 37 LMICs, met the inclusion criteria for the review; however, only 3 were from low-income countries. In 21 studies with 9092 participants working mainly in middle-income countries, 32% (95% CI, 27%-38%; I2 = 95.32%; P < .001) reported job burnout, and in 20 studies with 14 113 participants, 60% (95% CI, 53%-67%; I2 = 98.21%; P < .001) were satisfied with their job overall. Sufficient data were not available for a meta-analysis of job motivation. Conclusions and Relevance: The findings suggest that, among physicians and dentists working mainly in middle-income countries, more than half reported having positive job morale. Positive job morale among physicians and dentists may help with recruitment and retention and thus support programs for improving health care in LMICs.


Assuntos
Esgotamento Profissional/epidemiologia , Odontólogos/psicologia , Moral , Médicos/psicologia , Local de Trabalho/estatística & dados numéricos , Adulto , Estudos de Coortes , Estudos Transversais , Países em Desenvolvimento , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Motivação , Estudos Observacionais como Assunto , Local de Trabalho/psicologia
9.
Eur J Gen Pract ; 25(4): 236-242, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31373254

RESUMO

Background: The implementation of primary care for mental health is often insufficient, which leaves its mark on staff. A team-based approach of mental healthcare prevents poor staff morale. A community health centre (CHC), therefore, set up a project promoting interprofessional collaboration with a mental health team (MHT).Objectives: This study aimed to understand how an MHT would influence staff morale in a primary care setting, aiming to formulate some recommendations for future projects.Methods: In 2017, interviews and a focus group discussion were conducted among the staff of a CHC. Using a qualitative approach, we aimed to unravel contextual factors and mechanisms that determine the effect of an MHT on staff morale.Results: The project relieved the burden of the patient encounters and staff members felt more valuable to patients. Underlying mechanisms were recognition, altered attitudes towards patients and role clarity. Facilitating factors were intercultural care mediators and a positive team atmosphere, whereas inhibiting factors were inefficient time management and communicative issues.Conclusion: Our study elucidated mechanisms and the contextual factors by which an MHT in general practice improves staff morale.[Box: see text].


Assuntos
Pessoal de Saúde/psicologia , Relações Interprofissionais , Transtornos Mentais/terapia , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Comportamento Cooperativo , Grupos Focais , Humanos , Entrevistas como Assunto , Moral , Assistência ao Paciente/métodos , Assistência ao Paciente/psicologia
10.
Nurs Manag (Harrow) ; 26(1): 22-25, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31468751

RESUMO

Intentional rounding was introduced in the UK in 2012 to improve direct nursing care. Liverpool Women's NHS Foundation Trust (LWFT) introduced intentional nursing rounds, called comfort rounds, in 2013. These are carried out and documented by nursing staff who check the patients in their care every two hours, particularly in relation to pain management, nutritional needs, hygiene and toilet needs, and overall comfort. In September 2015, LWFT introduced daily matron ward rounds (MWRs) following a directive from the trust's chief executive to provide assurance that comfort rounds were completed and that patient feedback was acted on in a timely manner. This article presents findings from an evaluation of the initiative and describes how daily MWRs improve patient experience and staff morale but are resource intensive. Further qualitative research of their effect on staff morale and well-being, as well as patient experience, is recommended.


Assuntos
Unidades Hospitalares/organização & administração , Moral , Recursos Humanos de Enfermagem no Hospital/psicologia , Satisfação do Paciente/estatística & dados numéricos , Visitas com Preceptor , Humanos , Pesquisa em Avaliação de Enfermagem , Medicina Estatal , Reino Unido
12.
Br J Community Nurs ; 24(7): 315-322, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31265338

RESUMO

As the world's population ages, efforts to improve quality of life (QOL) in old age are gaining public attention. In this study, a programme was conducted for older people with the aim of clarifying their life goals related to QOL and the meaning of their existence, and the effect of the programme in improving QOL was evaluated. Participants were randomly assigned to the intervention or control group after registration. The program consisted of four 90-minute classes. The primary outcome was the Philadelphia Geriatric Center Morale Scale score (PGC), and changes in outcomes were compared between groups. The intervention group had significantly improved PGC scores (P<0.003). Further, the scores of PGC subscales 'Acceptance of one's own ageing' and 'Lonely dissatisfaction' showed significant improvements after the intervention (P<0.001). The findings suggest the effectiveness of the developed program in improving QOL in people aged ≥65 years.


Assuntos
Envelhecimento/psicologia , Objetivos , Solidão , Tutoria/métodos , Satisfação Pessoal , Qualidade de Vida , Idoso , Feminino , Humanos , Japão , Masculino , Moral
13.
BMJ ; 365: l4344, 2019 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-31235472
14.
Occup Med (Lond) ; 69(5): 336-341, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31207611

RESUMO

BACKGROUND: Falling retention in UK general practice is a well-described problem but there has been little previous research into its underlying causes. Poor psychosocial work conditions may help explain falling workforce morale and early retirement from the profession. AIMS: To explore the impact upon morale and retirement decisions of changes in psychosocial aspects of UK general practice over the course of a career. METHODS: Biographical narrative interviewing method (BNIM) was used to obtain and analyse career narratives of 12 London general practitioners (GPs), aged 55-65, half of whom had retired. Findings were theorized using the Job Demands-Control-Support (JDCS) model. RESULTS: A spontaneous, consistent theme was evident across all 12 interviews: changes in the psychosocial work environment had contributed to a steady decline in morale. Sequential, multilayered reductions in autonomy were the most commonly cited causes for reduced enthusiasm. Increasing demands in the form of both a rising workload as well as a complaints culture drained energy and morale. The GPs described increasingly fragmented teams and therefore reduced social support for the role. Nonetheless, retirement decisions were not straightforward, provoking complex emotions. CONCLUSIONS: The combination of increasing demands with reduced autonomy puts practitioners under intense strain, diminishing the satisfaction they derive from their work and affecting retirement decisions. The Job Demands-Control-Support (JDCS) model is an empirically tested model that could be used to inform improved work design in general practice.


Assuntos
Clínicos Gerais/psicologia , Estresse Ocupacional/psicologia , Aposentadoria/psicologia , Idoso , Tomada de Decisões , Feminino , Medicina Geral/organização & administração , Humanos , Satisfação no Emprego , Londres , Masculino , Pessoa de Meia-Idade , Moral , Autonomia Profissional , Apoio Social , Carga de Trabalho
16.
Br Dent J ; 226(8): 559-561, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31028319

RESUMO

With the evolution of humanising patient-dentist interaction within healthcare has come an equal need to humanise staff interaction in order to optimise patient care. There is growing evidence to support the need to invest in enhancing team morale, given that its impact, when low, results in reduced quality of patient care. This paper endeavours to reflect on dental teams' wellbeing and morale and propose a strategy for change to enhance these aspects of team interactions. The theme throughout is to focus on staff wellbeing, in order to initiate a change in work ethic which should in turn initiate a positive work environment. The two strategies discussed are leadership changes conducive to a servant leadership style and a mentorship/buddy programme focusing on reducing stress among dental professionals. Both strategies have their merits and faults, but the purpose of the paper is to prompt food for thought as to how to raise team morale in dental practice.


Assuntos
Moral , Equipe de Assistência ao Paciente , Odontólogos , Humanos , Liderança , Local de Trabalho
17.
Tijdschr Psychiatr ; 61(2): 84-91, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-30793268

RESUMO

BACKGROUND: Demoralisation is a multidimensional concept, with helplessness and hopelessness as its key elements. Many patients, both in somatic and in mental health care, suffer from demoralisation. In the process of recovery, remoralisation constitutes a first step.
AIM: To investigate demoralisation in alcohol-dependent inpatients with co-occurring psychiatric disorders.
METHOD: Included in this study were 159 alcohol-dependent inpatients admitted to clinics for dual diagnosis. Demoralisation was assessed at treatment entry and again one month later.
RESULTS: A strong level of demoralisation was found, particularly in the co-occurrence of depression, anxiety and personality disorders. At treatment entry, 92% of patients was clinically demoralised and, one month later, this was 89%. In patients with co-occurring depression, mood and personality disorders, a significant decrease of demoralisation was found after one month, whereas in patients with developmental and psychotic disorders this was not the case. In 11% of patients there was clinically relevant improvement and in 7.5% there was clinically relevant deterioration; the latter mainly in patients with co-occurring developmental and psychotic disorders.
CONCLUSION: At start of treatment, these alcohol-dependent patients were strongly demoralised, especially in the co-occurrence of psychiatric disorders. Although there was a significant improvement in demoralisation after one month of treatment, patients remained strongly demoralised. In one in ten patients there was clinically relevant remoralisation. As a first step in the process of recovery, clinicians should pay more attention to remoralisation. Targeted interventions, aimed at this specific population, are necessary.


Assuntos
Alcoolismo/psicologia , Adulto , Idoso , Alcoolismo/epidemiologia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Comorbidade , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moral , Transtornos da Personalidade/psicologia , Adulto Jovem
18.
Educ Prim Care ; 30(3): 145-151, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30747043

RESUMO

The World Health Organisation policy of improving retention of rural health care practitioners recommended that continuing medical education (CME) programmes addressing their needs should be accessible and delivered where they live and work. This cross-sectional study involved a self-administered anonymous questionnaire completed by GPs attending CME small groups (CME-SGL) in Ireland. All GPs attending CME-SGL in a one-month period were invited to complete the questionnaire which examined demographic details, distance to travel to educational meetings/nearest regional hospital, barriers to accessing continuing education, whether CME-SGL met their educational needs, morale and professional isolation. A total of 1,686 responses were collected, of which 332 (19.6%) were from rural GPs. Of these, 289 (87%) reported that their educational needs were fully or mostly met by attending CME-SGL. Compared to urban doctors, rural GPs had further to travel to CME-SGL meetings, were further from the nearest regional hospital, and reported increased barriers to accessing continuing education. Rural GPs reported lower morale and greater levels of professional isolation. Despite considerable barriers to accessing continuing education, rural GPs reported that CME-SGL meets their educational needs. Future research should focus on the potential positive impact this may have on professional isolation and morale.


Assuntos
Educação Médica Continuada/métodos , Clínicos Gerais/educação , Adulto , Estudos Transversais , Feminino , Clínicos Gerais/psicologia , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Moral , População Rural , Inquéritos e Questionários , Viagem
19.
Hu Li Za Zhi ; 66(1): 48-59, 2019 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-30648245

RESUMO

BACKGROUND: Terminally ill patients often experience demoralization, which negatively impacts their spiritual well-being. However, studies on the relationship between demoralization and levels of spiritual well-being in Taiwan are still at an early stage. Thus, more research is required to verify and support the correlation between demoralization and spirituality and to establish methods to care for and treat demoralization. PURPOSE: The purposes of this study were to investigate the demoralization and spiritual-well-being status of terminally ill patients and to determine the value of demographic data, disease characteristics, demoralization in predicting spiritual well-being. METHODS: A cross-sectional research design was used to evaluate terminally ill patients who were currently receiving hospice care at a teaching hospital in southern Taiwan. Data were collected using a structured questionnaire that included a demographic datasheet and the Chinese demoralization and spiritual well-being scale. Pearson product-moment correlation and hierarchical multiple regression were performed to analyze the relationship between the target variables and spiritual well-being. RESULTS: Of the 82 participants surveyed, 81.7% had high levels of demoralization. The average spiritual well-being score for the participants was 31.7 (moderate). A significant and negative correlation was found between degree of demoralization and level of spiritual well-being (r = -.600, p < .01). Regression analysis showed that, after controlling for demographic characteristics, disease characteristics, and other variables, demoralization scores were shown to predict the spiritual-well-being score, explaining 12.7% of total variance (ß = -.41, p < .001). In other words, higher demoralization was associated with lower spiritual well-being. CONCLUSIONS: Demoralization is a common problem in people with terminal illnesses and is an important factor affecting spiritual well-being in this patient population. In clinical practice, early assessment and identification of demoralization in patients as well as establishing relevant models of care for demoralization are necessary to help patients attain spiritual well-being at the end of life.


Assuntos
Moral , Espiritualidade , Doente Terminal/psicologia , Estudos Transversais , Humanos , Inquéritos e Questionários , Taiwan
20.
Br J Gen Pract ; 69(679): e146-e153, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30642907

RESUMO

BACKGROUND: In the context of the biggest GP workforce crisis since the NHS began, the alleged negative portrayal of UK general practice in the media is often cited as a reason for falling recruitment. AIM: To explore how general practice and GPs are depicted in UK national newspapers. DESIGN AND SETTING: A thematic analysis of all newspaper articles mentioning GPs or general practice published in the UK from late October 2016 to early October 2017 was undertaken, along with a sample of articles on hospital medicine. METHOD: Articles were identified through the Lexin UK search engine; relevant titles were tabulated and data extracted. A preliminary coding scheme was developed through discussion and used to categorise data; additional codes and categories were added iteratively as the analysis progressed. RESULTS: In total, 403 articles on general practice or GPs were identified, and 100 on hospital specialists or specialties were sampled. Articles depicted UK general practice as a service in crisis, with low morale and high burnout, and leaving gaps in patient care. The traditional family doctor service was depicted as rapidly eroding through privatisation and fragmentation, with GPs portrayed as responsible for the crisis and the resulting negative impact on quality of care. Hospital specialties were also illustrated as under pressure, but this crisis was depicted as being the fault of the government. GP leaders interviewed in the press were usually defending their specialty; hospital doctors were usually sharing their expertise. CONCLUSION: Newspaper portrayals of general practice are currently very negative. Efforts to influence the media to provide a more balanced perspective of general practice should continue.


Assuntos
Assistência à Saúde/normas , Medicina Geral , Clínicos Gerais , Medicina Estatal/normas , Pesquisa Empírica , Medicina Geral/normas , Reforma dos Serviços de Saúde , Humanos , Moral , Jornais como Assunto , Relações Médico-Paciente , Política , Reino Unido , Recursos Humanos
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