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1.
J Nurs Educ ; 61(5): 264-267, 2022 May.
Article in English | MEDLINE | ID: mdl-35522772

ABSTRACT

BACKGROUND: Understanding of the lived experience is an important educational strategy for improving attitudes toward stigmatized patient groups. This study evaluated the influence of a personal story intervention on nursing students' attitudes toward people who use opioids and measured attitudinal change from students' regular mental health and addictions curriculum. METHOD: This study used a single-group longitudinal design. Stigma outcomes were measured using the Opening Minds Provider Attitudes Toward Opioid Use Scale. Mean scores were analyzed for four time periods: control, social contact intervention, curricular component, and 3-month follow-up. Qualitative feedback also was collected. RESULTS: Stigma scores improved significantly from pre- to postsocial contact intervention. No differences were observed for curricular content, control period, or follow-up. Qualitative findings suggest the personal story was associated with positive student-reported attitudes. CONCLUSION: Integrating personal story interventions with traditional curriculum elements is a promising educational approach for improving perceptions and behaviors of nursing students toward people who use drugs. [J Nurs Educ. 2022;61(5):264-267.].


Subject(s)
Students, Nursing , Substance-Related Disorders , Attitude of Health Personnel , Curriculum , Humans , Social Stigma , Students, Nursing/psychology
2.
Wiad Lek ; 75(3): 605-610, 2022.
Article in English | MEDLINE | ID: mdl-35522865

ABSTRACT

OBJECTIVE: The aim: This study aimed to evaluate the effect of positive reappraisal intervention model in changing nursing students' attitudes toward nursing profession. PATIENTS AND METHODS: Materials and methods: A quasi-experimental study design (one group pretest-posttest) to achieve the study objectives.The emotional regulation questionnaire (ERQ-10) and the students' attitudes scale were used pre and post applying the positive reappraisal intervention in a random sample of 165 undergraduate nursing students, male and female, in their sophomore level to senior level. The process of collecting student's data took place in July 2020 - February, 2021. RESULTS: Results: A statically significant difference in students' appraisal (t = -26.320, p < .0005) and their attitudes towards nursing (t = -15.460, p < .0001) were registered after applying (compared to the results before) the positive reappraisal intervention. CONCLUSION: Conclusions: The positive reappraisal coping intervention is proved as an easy model to apply and is highly effective in terms of changing students' cognitive appraisal, which in turns changes their attitudes toward nursing. This assumption is concluded, basing on the significant increase in the level of appraisal and attitudes of nursing students after applying the intervention model; their levels are increased to about (96%) positive appraisal and about (94%) positive attitude level.


Subject(s)
Education, Nursing, Baccalaureate , Students, Nursing , Adaptation, Psychological , Attitude of Health Personnel , Education, Nursing, Baccalaureate/methods , Female , Humans , Male , Students, Nursing/psychology , Surveys and Questionnaires
3.
PLoS One ; 17(5): e0267347, 2022.
Article in English | MEDLINE | ID: mdl-35511810

ABSTRACT

Evidence-based practice (EBP) is the application of the best scientific evidence for clinical decision-making in professional patient care. In Ethiopia, the majority of nursing care is based on experience, tradition, intuition, common sense, and untested hypotheses. Evidence-based clinical practice has the potential to increase the quality of healthcare services while also lowering costs and increasing clinical outcomes. An institutional-based concurrent study design method of quantitative and qualitative research was conducted from Feb. 30 to Apr. 20, 2020. Systematic random sampling and purposive sampling techniques were used to select the study participants for the quantitative and qualitative analyses, respectively. To collect quantitative data, a pretested, structured, and self-administered questionnaire was used, and to collect qualitative data, an in-depth interview guided by questions was used. EBP was found to be significantly associated with educational level (AOR = 2.15, CI (1.15-4.02)), administrative support for EBP (AOR = 1.89, CI (1.22-2.91)), attitude toward EBP (AOR = 1.80, CI (1.24-2.62)), and preference of available information sources (AOR: 2.32, CI (1.58-3.39). The four main themes that emerged from the conventional content data analysis were the advantages of EBP application, barriers to EBP implementation, enabling factors for EBP, and evidence sharing. According to the findings of this study, only a few nurses used EBP at a high level. The implementation of EBP was positively associated with educational level, attitude toward EBP, administrative support, and the availability of information resources, as confirmed by the qualitative study. There must be an intervention program to facilitate the implementation of evidence in nursing practice by stakeholders to improve and increase the efficacy of practicing EBP.


Subject(s)
Attitude of Health Personnel , Point-of-Care Systems , Cohort Studies , Ethiopia , Evidence-Based Practice/education , Hospitals, Special , Humans , Surveys and Questionnaires
4.
J Neurosci Nurs ; 54(3): 136-142, 2022 Jun 01.
Article in English | MEDLINE | ID: mdl-35532331

ABSTRACT

ABSTRACT: BACKGROUND: Nurses play an important role in providing holistic care and effective pain management, which is significantly associated with their knowledge and attitudes. Limited evidence is available from Vietnamese nursing studies evaluating the knowledge and attitudes of nurses toward pain management. The objectives of this study were to evaluate the knowledge and attitudes of Vietnamese nurses and identify factors associated with pain management. METHODS: This study used a descriptive and cross-sectional design and was conducted at a national hospital in Vietnam from May to June 2021. Nurses working in all clinical units were surveyed to collect demographic data and assessed using the structured Knowledge and Attitudes Survey Regarding Pain (KASRP) scale. Multiple linear regression analysis was conducted to identify factors associated with knowledge and attitudes. RESULTS: Two hundred seventy-nine nurses completed the survey, including 152 (54.5%) who read books or journals about pain, 25 (9.0%) who reported the use of unit-based pain guidelines, and 77 (27.6%) who used a numeric rating tool. The mean number of correct answers on the KASRP was 23.34 (mean KASRP correct percentage of 54.9%), and only 16 nurses (5.7%) had passing scores. Having a bachelor's degree or higher, reading books or journals about pain, using a numeric rating tool, and using unit-based pain guidelines were significantly associated with higher KASRP scores (P < .01) among nurses. CONCLUSIONS: The knowledge and attitudes of nurses regarding pain management were far from satisfactory. Regular pain management training, access to pain-related reading materials, and the frequent use of a numeric tool to assess pain intensity are recommended to enhance the quality of care for patients provided by clinical nurses.


Subject(s)
Nursing Staff, Hospital , Pain Management , Attitude of Health Personnel , Cross-Sectional Studies , Health Knowledge, Attitudes, Practice , Hospitals , Humans , Pain , Surveys and Questionnaires , Vietnam
5.
BMJ Open ; 12(5): e057062, 2022 May 09.
Article in English | MEDLINE | ID: mdl-35534057

ABSTRACT

OBJECTIVES: To assess the attitude of medical students towards cultural diversity aiming to elucidate our current status in understanding cultural awareness and sensitivity. DESIGN, SETTING AND PARTICIPANTS: A web-based cross-sectional study was carried out among 601 undergraduate health science students (medical and dental courses) at a health sciences university in eastern Nepal via various modes of social-media platforms like WhatsApp, Messenger, Gmail, etc. OUTCOME MEASURES: Medical students' attitude towards cultural diversity and its association with the sociodemographic profile of the students. RESULTS: A total of 601 students participated in the study, out of which, 64.2% were men with a sex ratio of 1.8:1 and a mean age of 22.3±1.9 years. More than two-thirds (77.2%) of the students had an excellent to good attitude towards cultural diversity. The proportion of students reporting 'excellent' attitude towards cultural diversity was higher among male students compared with female students (37.8% vs 20.5%) and students aged >22 years compared with younger students (37.1% vs 26.7%). Gender (p<0.001) and age (p=0.009) were significantly associated with the attitude towards cultural diversity. CONCLUSIONS: Medical students, in general, are aware of the impacts of a cross-cultural society on the delivery of quality healthcare and also about the need to be aware of prejudices doctors may have towards certain cultures. Majority suggest the inclusion of concepts of multicultural awareness and sensitivity in the medical curriculum itself.


Subject(s)
Students, Medical , Adult , Attitude of Health Personnel , Cross-Sectional Studies , Cultural Diversity , Curriculum , Female , Humans , Male , Nepal , Surveys and Questionnaires , Universities , Young Adult
7.
BMC Health Serv Res ; 22(1): 591, 2022 May 03.
Article in English | MEDLINE | ID: mdl-35505322

ABSTRACT

INTRODUCTION: Respectful maternity care (RMC) is fundamental to women's and families' experience of care and their decision about where to give birth. Studies from multiple countries describe the mistreatment of women during facility-based childbirth, though only a small number of studies from Guatemala have been published. Less information is available on women's negative and positive experiences of childbirth care and health workers' perceptions and experiences of providing maternity care. METHODS: As part of a program implemented in the Western Highlands of Guatemala to improve quality of reproductive maternal newborn and child health care, a mixed methods assessment was conducted in three hospitals and surrounding areas to understand women's and health workers' experience and perceptions of maternity care. The quantitative component included a survey of 31 maternity health workers and 140 women who had recently given birth in these hospitals. The qualitative component included in-depth interviews (IDIs) and focus group discussions (FGDs) with women and maternity health workers and managers. RESULTS: Women reported a mix of positive and negative experiences of childbirth care related to interpersonal and health system factors. 81% of surveyed women reported that health workers had treated them with respect while 21.4% of women reported verbal abuse. Fifty-five percent and 12% of women, respectively, reported not having access to a private toilet and bath or shower. During IDIs and FGDs, many women described higher rates of verbal abuse directed at women who do not speak Spanish. A regression analysis of survey results indicated that speaking Ixil or K'iche at home was associated with a higher likelihood of women being treated negatively during childbirth in a facility. Health worker survey results corroborated negative aspects of care described by women and also reported mistreatment of health workers by clients and families (70.9%) and colleagues (48.2%). CONCLUSIONS: This study adds to the literature on women's experience of institutional childbirth and factors that influence this experience by triangulating experience and perceptions of both women and health workers. This assessment highlights opportunities to address mistreatment of both women and health workers and to build on positive care attributes to strengthen RMC for all women.


Subject(s)
Maternal Health Services , Attitude of Health Personnel , Child , Female , Guatemala , Health Services Accessibility , Humans , Infant, Newborn , Male , Parturition , Pregnancy , Quality of Health Care
9.
Ned Tijdschr Geneeskd ; 1662022 03 23.
Article in Dutch | MEDLINE | ID: mdl-35499686

ABSTRACT

Aggression is a common phenomenon in many sectors of healthcare, not only in psychiatry wards. We agree with a review by Weltens et al. (PLoS One. 2021;16:e0258346) that more attention should be paid to staff-related factors and organizational factors. When it comes to reducing aggression towards healthcare staff, there is much to be gained in training of staff members in skills dealing with and de-escalating (verbal and physical) aggressive behaviour. In addition, healthcare organizations can contribute to the safety of its employees. A broader safety plan focused on patient factors, staff factors and organizational factors is more likely to be effective than a plan focused only on patient factors. This is supported by a recent review of interventions for de-escalating aggressive behaviour.


Subject(s)
Aggression , Attitude of Health Personnel , Humans
10.
South Med J ; 115(5): 294-300, 2022 May.
Article in English | MEDLINE | ID: mdl-35504608

ABSTRACT

OBJECTIVES: Bedside rounds provide a valuable opportunity for residents to learn vital clinical skills, yet they are increasingly being replaced by card-flip rounds in conference rooms. Residents express mixed views about the educational value of bedside rounds; however, little is known about their perspectives regarding how the structure and content of bedside rounds can be optimized for their learning. We sought to explore residents' attitudes toward bedside rounds and perceptions regarding how to maximize their educational value. METHODS: Hospital Medicine faculty at one hospital were instructed to bedside round with their teams daily. Focus groups with residents after the rotation explored their perspectives on the educational value of bedside rounds. Thematic analysis identified modifiable factors that affected resident learning to inform future faculty development efforts. RESULTS: Interns described four categories of modifiable factors that impacted their learning during bedside rounds: institutional factors, such as patient geography and computer availability; rounding structure, including length of rounds, patient selection, and location of patient presentations; faculty behaviors, such as preparation for rounds, establishing explicit expectations for rounds, creating a safe learning climate, and promoting intern autonomy; and educational content, including whether it was targeted to the appropriate learner level and consisted of content appropriate for the bedside. CONCLUSIONS: Residents outlined institutional factors that should be addressed and three high-yield content areas for faculty development programs: rounding structures, faculty behaviors, and bedside educational content. These findings helped us develop guidelines and faculty development sessions for attendings engaging in bedside rounds.


Subject(s)
Internship and Residency , Teaching Rounds , Attitude of Health Personnel , Clinical Competence , Educational Status , Humans
11.
PLoS One ; 17(5): e0264494, 2022.
Article in English | MEDLINE | ID: mdl-35533193

ABSTRACT

BACKGROUND: In 2018, the right to lawful abortion in the Republic of Ireland significantly expanded, and service provision commenced on 1 January, 2019. Community provision of early medical abortion to 9 weeks plus 6 days gestation delivered by General Practitioners constitutes the backbone of the Irish abortion policy implementation. We conducted a study in 2020-2021 to examine the barriers and facilitators of the Irish abortion policy implementation. METHODS: We collected data using qualitative in-depth interviews (IDIs) which were conducted in-person or remotely. We coded and analysed interview transcripts following the grounded theory approach. RESULTS: We collected 108 IDIs in Ireland from May 2020 to March 2021. This article draws on 79 IDIs with three participant samples directly relevant to the community model of care: (a) 27 key informants involved in the abortion policy development and implementation representing government healthcare administration, medical professionals, and advocacy organisations, (b) 22 healthcare providers involved in abortion provision in community settings, and (c) 30 service users who sought abortion services in 2020. Facilitators of community-based abortion provision have been: a collaborative approach between the Irish government and the medical community to develop the model of care, and strong support systems for providers. The MyOptions helpline for service users is a successful national referral model. The main barriers to provision are the mandatory 3-day wait, unclear or slow referral pathways from primary to hospital care, barriers for migrants, and a shortage and incomplete geographic distribution of providers, especially in rural areas. CONCLUSIONS: We conclude that access to abortion care in Ireland has been greatly expanded since the policy implementation in 2019. The community delivery of care and the national helpline constitute key features of the Irish abortion policy implementation that could be duplicated in other contexts and countries. Several challenges to full abortion policy implementation remain.


Subject(s)
Abortion, Induced , General Practitioners , Attitude of Health Personnel , Female , Humans , Ireland , Policy , Pregnancy
12.
BMJ Lead ; 6(1): 15-19, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35537012

ABSTRACT

OBJECTIVES: Despite training and the recognition that speaking up can mitigate harm to patients and save lives, healthcare professionals do not consistently speak up when they have patient safety concerns. The purpose of this study was to identify barriers to and facilitators of speaking up about patient safety concerns to inform the development of interventions that will increase this behaviour. DESIGN: From October 2017 to February 2018, the study team conducted focus groups and interviews with nurses, advanced practice providers and physicians at three healthcare facilities. Participants were prompted to share their personal experiences with and perspectives on speaking up about patient safety concerns and to discuss strategies for communicating those concerns. SETTING: Tertiary academic healthcare centre. PARTICIPANTS: 62 healthcare professionals participated in the study. Purposeful sampling was used to include participants of different health professions and experience levels. MAIN OUTCOME MEASURES: We planned to answer questions about why more healthcare professionals do not consistently speak up when they have legitimate patient safety concerns and to identify ways to enhance current interventions on speaking up behaviours, RESULTS: Twelve focus group discussions and two interviews were conducted with 62 participants. We identified two recurring themes: (1) The predominantly hierarchical culture of medicine is a barrier to speaking up and (2) Institutional, interpersonal and individual factors can modulate the impact of medicine's hierarchical culture on speaking up behaviours and inform the strategies employed. CONCLUSIONS: The data highlighted the importance of moving beyond targeting front-line healthcare professionals for training in the skills of speaking up and engaging institutional leaders and systems to actively promote and reward speaking up behaviours.


Subject(s)
Health Personnel , Patient Safety , Attitude of Health Personnel , Communication , Humans , Qualitative Research
14.
BMC Med Educ ; 22(1): 336, 2022 May 02.
Article in English | MEDLINE | ID: mdl-35501754

ABSTRACT

BACKGROUND: The attending physician in general internal medicine (GIM) guarantees comprehensive care for persons with complex and/or multiple diseases. Attendings from other medical specialties often report that transitioning from resident to attending is burdensome and stressful. We set out to identify the specific challenges of newly appointed attendings in GIM and identify measures that help residents better prepare to meet these challenges. METHODS: We explored the perceptions of 35 residents, attendings, and department heads in GIM through focus group discussions and semi-structured interviews. We took a thematic approach to qualitatively analyze this data. RESULTS: Our analysis revealed four key challenges: 1) Embracing a holistic, patient centered perspective in a multidisciplinary environment; 2) Decision making under conditions of uncertainty; 3) Balancing the need for patient safety with the need to foster a learning environment for residents; and 4) Taking on a leader's role and orchestrating an interprofessional team of health care professionals. Newly appointed attendings required extensive practical experience to adapt to their new roles. Most attendings did not receive regular, structured, professional coaching during their transition, but those who did found it very helpful. CONCLUSIONS: Newly appointed attending physician in GIM face a number of critical challenges that are in part specific to the field of GIM. Further studies should investigate whether the availability of a mentor as well as conscious assignment of a series of increasingly complex tasks during residency by clinical supervisors will facilitate the transition from resident to attending.


Subject(s)
Internship and Residency , Physicians , Attitude of Health Personnel , Humans , Internal Medicine/education , Medical Staff, Hospital
15.
Child Adolesc Ment Health ; 27(2): 196-198, 2022 May.
Article in English | MEDLINE | ID: mdl-35365896

ABSTRACT

In the United Kingdom, mental health professionals have been historically reluctant to diagnose Personality Disorder in young people over many decades, and there is little evidence that much has changed. However, there are consequences to this reluctance. Personality Disorders in young people are absent from national prevalence studies and research is sparse, as a lack of diagnosed patients makes it hard to recruit for studies. Consequently, national policy-makers lack an awareness of the scale of the problem and the focus on service provision to address it. Deliberate misdiagnosis of Personality Disorder due to professionals' unwillingness to use the diagnosis is not only unethical but can also cause harm as it stops young people from receiving the evidence-based interventions and support that they require. Young people and families often experience reassurance and relief when they receive an accurate diagnosis. Professionals need to reconsider whether their reluctance to diagnose is in their patients' best interests.


Subject(s)
Health Personnel , Mental Health , Adolescent , Attitude of Health Personnel , Child , Family , Humans , Personality Disorders/diagnosis
16.
Subst Abus ; 43(1): 1051-1056, 2022.
Article in English | MEDLINE | ID: mdl-35435816

ABSTRACT

Background: Pharmacist stigma via examination of social distance preference and negative attitudes toward persons who misuse opioids is prevalent and may lower the quality of care provided to patients. Few studies have previously extended beyond the immediate post-intervention period to examine stigma change. Methods: This longitudinal cohort study utilized a pre-survey administered before the training program, a post-survey immediately upon completion of the training program, and a delayed post-survey, administered 12 months after the training program. Co-primary outcomes were changes in social distance scale (SDS) total score from baseline to post-survey and from baseline to 12 months. Secondary outcomes included change in SDS question scores and change in negative attitudes. One hundred eighty-seven of the 1211 eligible pharmacists in the state completed the training. Matched responses of forty-four pharmacists who completed all three surveys were examined. Results: The mean total SDS score was significantly lower in the immediate post-training survey than the pre-training mean (14.75 vs. 16.57, p = .000). The 12 months mean total SDS score was also significantly lower than the pre-training mean (15.32 vs. 16.57, p = .017). Significant changes in negative attitudes from baseline to post-survey and from baseline to 12 months were seen. Conclusion: Stigma reduction components integrated into opioid training decreased pharmacist social distance preference and negative attitudes toward patients who misuse opioids immediately after the training and, most notably, were sustained for 12 months.


Subject(s)
Opioid-Related Disorders , Pharmacists , Analgesics, Opioid/therapeutic use , Attitude of Health Personnel , Humans , Longitudinal Studies , Opioid-Related Disorders/drug therapy
17.
BMC Health Serv Res ; 22(1): 519, 2022 Apr 19.
Article in English | MEDLINE | ID: mdl-35440039

ABSTRACT

BACKGROUND: Given the importance of the continuous follow-up of chronic patients, we evaluated the performance of French private practice general practitioners (GPs) practicing in multi-professional group practices (MGP) regarding chronic care management during the first Covid-19 lockdown in Spring 2020 compared to GPs not in MGP. We consider two outcomes: continuity of care provision for chronic patients and proactivity in contacting these patients. METHODS: The cross-sectional web questionnaire of 1191 GPs took place in April 2020. We exploit self-reported data on: 1) the frequency of consultations for chronic patients during lockdown compared to their "typical" week before the pandemic, along with 2) GPs' proactive behaviour when contacting their chronic patients. We use probit and bivariate probit models (adjusted for endogeneity of choice of engagement in MGP) to test whether GPs in MGP had significantly different responses to the Covid-19 crisis compared to those practicing outside MGP. RESULTS: Out of 1191 participants (response rate: 43.1%), around 40% of GPs were female and 34% were younger than 50 years old. Regression results indicate that GPs in MGP were less likely to experience a drop in consultations related to complications of chronic diseases (- 45.3%). They were also more proactive (+ 13.4%) in contacting their chronic patients compared to their peers practicing outside MGP. CONCLUSION: We demonstrate that the MGP organisational formula was beneficial to the follow-up of patients with chronic conditions during the lockdown; therefore, it appears beneficial to expand integrated practices, since they perform better when facing a major shock. Further research is needed to confirm the efficiency of these integrated practices outside the particular pandemic setup.


Subject(s)
COVID-19 , General Practitioners , Attitude of Health Personnel , COVID-19/epidemiology , Chronic Disease , Communicable Disease Control , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged
18.
Int J Palliat Nurs ; 28(4): 178-185, 2022 Apr 02.
Article in English | MEDLINE | ID: mdl-35465698

ABSTRACT

BACKGROUND: With more frail elderly living and likely to die in nursing homes, advance care planning (ACP) is critical in overall efforts to provide good palliative care. However, it is unclear how willing older, vulnerable residents in nursing homes are to take on an active role in care decisions. AIM: The objective of this pilot study was to examine nursing homes' healthcare professionals' and residents' views on ACP and the extent of similarities and differences in their views. METHODS: Our sample of 24 healthcare professionals and 24 residents were identified and recruited through contacts established from existing collaborations with the nursing homes. Surveys were administered to the participants by a trained research assistant between April 2015 and August 2015. RESULTS: Almost all the healthcare professionals (95.8%) would like to make an ACP for themselves in the future, while residents were divided in their choices (P<<0.01). Most residents (79.1%) felt that the most important guide for their surrogate in making decisions for them when they lose decision-making capacity should be based on their best interests. However, most healthcare professionals (75.0%) felt that it should be based on the resident's wishes and values. CONCLUSIONS: Healthcare professionals tended to overestimate the importance of patient autonomy compared to the residents. This study demonstrates that as much as advocacy and awareness are ongoing, nursing home residents' motivation to participate in ACP is lacking. The lack of motivation in ACP participation could be due to medical paternalism and familial determination, which have been a cultural norm for older Singaporeans. This study demonstrates there is a lack of cultural sensitivity in this group of healthcare professionals in approaching nursing home residents' end-of-life care decision-making.


Subject(s)
Advance Care Planning , Aged , Attitude of Health Personnel , Humans , Nursing Homes , Pilot Projects , Singapore
19.
BMC Health Serv Res ; 22(1): 530, 2022 Apr 21.
Article in English | MEDLINE | ID: mdl-35449014

ABSTRACT

BACKGROUND: Signs of disorder in neighbourhoods (e.g., litter, graffiti) are thought to influence the behaviour of residents, potentially leading to violations of rules and petty criminal behaviour. Recently, these premises have been applied to the hospital context, with physical and social disorder found to have a negative association with patient safety. Building on these results, the present study investigates whether physical and social disorder differ between hospitals, and their relationship to safety culture. METHODS: We conducted a cross sectional survey with Likert-style and open response questions administered in four Australian hospitals. All staff were invited to participate in the pilot study from May to September 2018. An analysis of variance (ANOVA) was used to examine differences in disorder by hospital, and hierarchical linear regression assessed the relationship of physical and social disorder to key aspects of safety culture (safety climate, teamwork climate). Open responses were analysed using thematic analysis to elaborate on manifestations of hospital disorder. RESULTS: There were 415 survey respondents. Significant differences were found in perceptions of physical disorder across the four hospitals. There were no significant differences between hospitals in levels of social disorder. Social disorder had a significant negative relationship with safety and teamwork climate, and physical disorder significantly predicted a poorer teamwork climate. We identified five themes relevant to physical disorder and four for social disorder from participants' open responses; the preponderance of these themes across hospitals supported quantitative results. CONCLUSIONS: Findings indicate that physical and social disorder are important to consider in attempting to holistically understand a hospital's safety culture. Interventions that target aspects of physical and social disorder in a hospital may hold value in improving safety culture and patient safety.


Subject(s)
Patient Safety , Safety Management , Attitude of Health Personnel , Australia/epidemiology , Cross-Sectional Studies , Hospitals , Humans , Organizational Culture , Pilot Projects , Surveys and Questionnaires
20.
BMC Health Serv Res ; 22(1): 529, 2022 Apr 21.
Article in English | MEDLINE | ID: mdl-35449100

ABSTRACT

BACKGROUND: Despite the increased deployment and added value of Advanced Practitioner Physiotherapy (APP) in musculoskeletal care internationally, APP is not yet widely accepted within Dutch primary care. This may be due to specific constraints in the implementation of APP within the Dutch healthcare system. This study aimed to explore the experiences and perceptions of Advanced Practitioner Physiotherapists (APPs) and General Practitioners (GPs) with respect to implementing APP within Dutch primary care. METHODS: This explorative and interpretive qualitative study included 12 APPs and 3 GPs who were in various stages of implementing an APP care model. Semi-structured interviews were conducted between January and March 2021. The topic list was based on existing literature, the personal input of researchers, and the Constellation Approach framework. Data were analysed using a thematic inductive approach. RESULTS: Four main themes emerged from the data; 1) Both GPs' trust in APP and a clear added value of APP are critical for starting implementation, 2) APPs need continuous support from GPs, 3) APPs believe that their position needs strengthening, and 4) Implementation of the APP model creates tension over ownership. These four themes highlight the perceived difficulties in gaining trust, lack of clarity over the added value of APP, ambiguity over APPs' professional profile and positioning, a need on behalf of GPs to maintain authority, lack of reimbursement structure, and the struggle APPs face to strike a balance with current care. CONCLUSION: This study demonstrates that implementing an APP model of care is challenging, in part, because the deployment of APP does not sufficiently align with the core values of GPs, while GPs appear reluctant to hand over control of elements of patient care to APPs. APPs do not appear to have ownership over the implementation, given their strong dependence on the practice, values and needs of GPs. TRIAL REGISTRATION: Ethical approval was obtained from the Medical Ethics Committee of VU University Medical Centre in Amsterdam; reference number 2020.17 . All participants were asked to provide written informed consent prior to participating in the study.


Subject(s)
General Practitioners , Physical Therapists , Attitude of Health Personnel , Humans , Physical Therapy Modalities , Primary Health Care/methods , Qualitative Research , Trust
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