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2.
Int J Health Plann Manage ; 35(1): 104-119, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31271233

RESUMEN

PURPOSE: In Malaysia, private healthcare sector has become a major player in delivering healthcare services alongside the government healthcare sector. However, wide disparities in health outcomes have been recorded, and adverse events in these contexts have yet to be explored. The purpose of this study was to explore associations between nurse's ethnicity and experience, hospital size, accreditation, and teaching status with adverse events in Malaysian private hospitals. METHODS: A cross-sectional survey was conducted in 12 private hospitals in Malaysia. A total of 652 (response rate = 61.8%) nurses participated in the study. Data were collected using self-administered questionnaire on nurses' characteristic, adverse events and events reporting, and perceived patient safety. RESULTS: Patient and family complaints events were the most common adverse events in Malaysian private hospitals as result of increased cost of care (3.24 ± 0.95) and verbal miscommunication (3.52 ± 0.87). CONCLUSION: Hospital size, accreditation status, teaching status, and nurse ethnicity had a mixed effect on patient safety, perceived adverse events, and events reporting. Policy makers can benefit that errors are related to several human and system related factors. Several system reforms and multidisciplinary efforts were recommended for optimizing health, healthcare and preventing patient harm.

3.
Cien Saude Colet ; 25(1): 47-56, 2020 Jan.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31859854

RESUMEN

The training of nurses in Brazil remain a challenge for the university, given the existing ethnic diversity and regional particularities. Thus, the aim of this study was to identify the challenges in the training process of indigenous nurses in Mato Grosso, Brazil. It is an exploratory and qualitative study, carried out with 11 indigenous nurses. Data analysis was based on Paulo Freire's interculturality. It was verified that both participants sought the integration of indigenous traditional knowledge with scientific technical knowledge during their practices, which facilitates a satisfactory interaction with the community. During nursing undergraduate school, they had little or no contact with contents related to indigenous health and at the end of the training they observed they were not prepared to meet the diverse health demands. Historically, they are subordinated in relation to non-indigenous people, which manifests as disadvantages in the teaching-learning process, related to technical / technological as well as social aspects.


Asunto(s)
Educación en Enfermería/organización & administración , Indios Sudamericanos/educación , Adulto , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
4.
BMC Nurs ; 18: 63, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31827389

RESUMEN

Background: Students studying in a country where another language is spoken face multiple challenges including their ability to fully integrate with peers and academic pressures in trying to obtain an undergraduate nursing degree. The aim of the study was to explore the lived experiences of students, from varying cultural and ethnic backgrounds, undertaking an undergraduate nursing degree. Methods: The study adopted a qualitative design and eight individual semi-structured interviews were conducted. The interviews were analysed using manifest content analysis according to Graneheim and Lundman. Results: Students reported feelings of isolation and the lack of opportunities to integrate with native students within academia and practice. The need for personal support was a crucial factor that was independent of gender and students reported challenges related to both language and culture during the programme. Conclusions: Suggestions arising from this study includes appropriate support systems within academia and practice. It is imperative that universities and practice settings promote and integrate cultural awareness within academia and practice in meeting the needs of students and providing culturally appropriate nursing care, thereby providing opportunities for all students to become competent and professional practitioners.

5.
Artículo en Inglés | MEDLINE | ID: mdl-31487759

RESUMEN

Volunteering at a free clinic may influence career choice amongst health profession students. The purpose of this research is to explore knowledge, skill, attitudes, self-efficacy, interest in future work with the underserved, and interest in primary care amongst physician assistant (PA) students through the analysis of demographic characteristics of PA students at a student-run free clinic in the United States. Data were collected from 56 PA students with a quantitative survey collection in October 2018 after their participation at a student-run free clinic in Intermountain West, Salt Lake City, Utah, USA. Out of three sub-scales i. e. attitudes, effect, and readiness, students responded most positively to effect of experience of participating in free clinic. Students who spoke Spanish showed higher levels of self-efficacy and readiness for a future career in comparison to non-Spanish speakers.


Asunto(s)
Hispanoamericanos/educación , Asistentes Médicos/educación , Autoeficacia , Clínica Administrada por Estudiantes/organización & administración , Adulto , Actitud/etnología , Selección de Profesión , Competencia Clínica/estadística & datos numéricos , Estudios de Evaluación como Asunto , Femenino , Hispanoamericanos/psicología , Humanos , Conocimiento , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendencias , Clínica Administrada por Estudiantes/estadística & datos numéricos , Estudiantes del Área de la Salud/estadística & datos numéricos , Estados Unidos/etnología , Voluntarios/psicología , Voluntarios/estadística & datos numéricos
6.
J Strength Cond Res ; 33(12): 3295-3301, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31453934

RESUMEN

Hurley, E, Comstock, BA, Haile, L, and Beyer, KS. Relative age effect in collegiate soccer: influence of nationality, playing position, and class. J Strength Cond Res 33(12): 3295-3301, 2019-The purpose of this study was to evaluate the existence of relative age effects (RAEs) in collegiate soccer. In addition, the impact of nationality, position, class, and National Collegiate Athletic Association (NCAA) tournament qualification status on the prevalence of RAEs was assessed. Birth dates from male NCAA Division I soccer athletes (n = 4,082) from the 2017/2018 season were categorized into quarters based on calendar and scholastic quarters. All athlete birth-date distributions were compared with the expected birth-date distributions for the United States. International-born athletes (INT) displayed a significant difference in birth-date distribution when assessed with calendar quarters, whereas American-born athletes (USA) showed a significant difference in birth-date distributions when assessed with scholastic quarters. Furthermore, INT showed significant RAEs for midfielders and defenders, whereas USA showed significant RAEs midfielders and goalkeepers. In terms of class, INT had significant RAEs for all classes, whereas USA had significant RAEs only for freshmen and sophomores. All INT had significant RAEs regardless of tournament qualification status; however, USA had significant RAEs only for nontournament teams. In summary, significant RAEs exist in male Division I college soccer; however, the presence of RAEs is influenced by nationality, position, class, and NCAA tournament qualification status. Coaches should be aware of RAEs during the recruitment process to avoid potential selection bias.


Asunto(s)
Grupos Étnicos , Selección de Personal , Fútbol , Universidades , Factores de Edad , Humanos , Masculino , Sesgo de Selección , Estados Unidos
7.
Nurse Educ Today ; 82: 1-7, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31408833

RESUMEN

BACKGROUND: Gypsy Roma Travellers are Europe's largest ethnic minority group. Yet they remain one of the most stigmatised communities who have significant health inequalities. Whilst nurses have a role in promoting health access, there have been minimal studies exploring health care professionals' attitudes towards these communities and no studies exploring nursing students' perceptions. OBJECTIVES: To explore nursing students understanding, knowledge and perceptions of working with Gypsy Roma Travellers. PARTICIPANTS: 23 nursing students from across four European countries (UK, Spain, Belgium, Turkey) participated in the study. The students ages ranged between 19 and 32 year old, there was a mix of students between year one to year three of their programme and both male (n = 3) and female students (n = 19). METHODS: This qualitative research utilised focus groups and one to one interviews based at the four different universities, all following a pre-agreed interview schedule. Focus groups and interviews were conducted by the research team in the students' first language and later translated into English for analysis using thematic analysis. The COREQ criteria were used in the reporting of the study. RESULTS: Four themes were identified which included: Exposure to Gypsy Roma Traveller Communities, Perceptions of Gypsy Roma Traveller cultures, Unhealthy lifestyles and culture and Nursing Gypsy Roma Travellers. CONCLUSIONS: Although personal and professional contact with Gypsy Roma Travellers was limited, most of the students' perceptions of these communities were negative. Nurse educational programmes need to embed transformational learning opportunities enabling student nurses to critically reflect upon values and beliefs of Gypsy Roma Travellers developed both before and during their nursing preparatory programme if they are to work effectively in a respectful, culturally sensitive way. There is also generally, a lack of research focussing upon healthcare professionals' attitudes towards these communities that needs to be explored through further research.


Asunto(s)
Percepción , Racismo/psicología , Roma/etnología , Estudiantes de Enfermería/psicología , Adulto , Bélgica/etnología , Femenino , Grupos Focales/métodos , Humanos , Masculino , Investigación Cualitativa , Racismo/etnología , Racismo/estadística & datos numéricos , Roma/estadística & datos numéricos , España/etnología , Estudiantes de Enfermería/estadística & datos numéricos , Encuestas y Cuestionarios , Turquia/etnología , Reino Unido/etnología
8.
Health Equity ; 3(1): 395-402, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31406953

RESUMEN

Purpose: This piece details the evaluation and implementation of a student-led educational intervention designed to train health professionals on the impact of racism in health care and provide tools to mitigate it. In addition, this conference, cosponsored by medical, nursing, and social work training programs, facilitates development of networks of providers with the knowledge and skills to recognize and address racism in health care. Methods: The conference included 2 keynote speakers, an interprofessional panel, and 15 workshops. Participants (n=220) were asked to complete a survey assessing perceptions of conference content and impact. We compared responses pre- and postconference using Wilcoxon signed-rank tests. Results: Of the survey respondents (n=44), 45.5% were medical students, 13.6% nursing students, and 9% social work students; 65.9% self-identified as a race/ethnicity other than non-Hispanic white; and 63.6% self-identified as female. We found that 47.7% respondents reported they were more comfortable discussing how racism affects health (p<0.001), 36.4% had better understanding of the impact of racism on an individual's health (p<0.001), and 54.5% felt more connected to other health professionals working to recognize and address racism in medicine (p<0.001). Conclusion: These findings suggest that a student-organized conference could potentially be an effective strategy in addressing a critical gap in racism training for health care professionals.

9.
J Physician Assist Educ ; 30(3): 143-148, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31385910

RESUMEN

PURPOSE: Physician assistant (PA) programs are the linchpin of endeavors to increase the diversity of the PA profession. Key to this role is understanding whether students from various backgrounds value certain program attributes differently. The current study investigated whether PA students' demographic characteristics were associated with their likelihood of having considered program diversity, and the importance they placed on program diversity when selecting a program to attend. METHODS: In 2017, 3882 recently matriculated PA students provided key demographic information (ie, gender, race, and ethnicity) and indicated whether they had considered student body and faculty diversity when choosing PA programs to attend. Those who had considered a factor then reported how important it was to them for their program to have that attribute. The current study investigated whether students' demographic characteristics were associated with their likelihood of considering PA program diversity and their subsequent ratings of the importance of program diversity. RESULTS: Female, Asian, and underrepresented racial and ethnic minority students, compared with male and non-Hispanic white students, were significantly more likely to consider program diversity when choosing PA programs to attend and rated program diversity as being more important. CONCLUSIONS: Program diversity is a greater concern for female and racial and ethnic minority students when selecting PA programs to attend. Less diverse programs could potentially increase their appeal to minority students by highlighting opportunities to connect with communities of color outside of the PA program and by prioritizing the recruitment of minority faculty.


Asunto(s)
Diversidad Cultural , Asistentes Médicos/educación , Estudiantes del Área de la Salud/psicología , Adulto , Conducta de Elección , Grupos de Población Continentales/psicología , Grupos de Población Continentales/estadística & datos numéricos , Femenino , Humanos , Masculino , Asistentes Médicos/estadística & datos numéricos , Escuelas para Profesionales de Salud , Estudiantes del Área de la Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
11.
Contemp Nurse ; 55(2-3): 156-170, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31288623

RESUMEN

Background: As the largest professional group employed within the health care system, the capacity for nurses to contribute to improving the health of Australian Indigenous people is substantial. Cultural safety has recently been incorporated into the national codes of conduct for nurses. Nurse academics have a key role in ensuring graduates are culturally safe practitioners. Staff capacity is a crucial consideration if cultural safety is to be embedded effectively within nursing curriculum. Aims: The aim of this study was to explore capability in relation to cultural safety with Nurse Academics at a regional university in New South Wales, Australia. Design: Mixed methods approach incorporating a survey and individual interviews. Methods: Casual and permanent nurse academics involved in teaching the undergraduate nursing program were eligible to participate. Results: Fifteen staff completed the survey and eight participated in an interview. Although the importance of cultural safety was recognised, there was a lack of comprehensive understanding and lack of confidence to teach the philosophy and practices of cultural safety. There was strong support cultural safety and anti-racism professional development. Impact statement: Building staff capacity is a crucial consideration if cultural safety is to be embedded within nursing curriculum. Conclusions: Cultural safety professional development is a starting point for nurses to develop their skills in providing culturally safe care and an essential step towards shifting the institutional and professional culture of the nursing profession. Research findings are clear it is time for Nurse Academics to "Step up" to effectively embed cultural safety in undergraduate nursing curriculum.


Asunto(s)
Competencia Cultural , Asistencia Sanitaria Culturalmente Competente/organización & administración , Asistencia Sanitaria Culturalmente Competente/estadística & datos numéricos , Bachillerato en Enfermería/organización & administración , Pueblos Indígenas/estadística & datos numéricos , Estudiantes de Enfermería/psicología , Estudiantes de Enfermería/estadística & datos numéricos , Adulto , Australia , Curriculum , Femenino , Humanos , Masculino , Adulto Joven
12.
Health Expect ; 22(4): 813-823, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31250521

RESUMEN

AIM: To co-produce consensus on the key issues important in educating mental health-care professionals to optimize mental health medication adherence in Black, Asian and Minority Ethnic (BAME) groups. OBJECTIVES: To identify perceptions of factors enabling or disabling medication adherence. To achieve consensus on content and delivery of an educational intervention for mental health-care professionals. METHODS: Data were collected from 2016 to 2018. Using individual interviews and a consensus workshop with carers and service users (SUs treated under the 1983 Mental Health Act 1983/revised 2007 for England and Wales), the experience of taking prescribed mental health medication and perspectives on adherence were explored. Data were analysed using 2-stage qualitative coding via the software tool NVivo version 11 to analyse transcribed data and to produce the main explanatory categories. RESULTS: SU and carer participants' perspectives substantially altered the original research design. The need to educate students rather than trained professionals was emphasized, and they suggested that educational content should be packaged in a contemporary manner (a virtual reality experience). Findings indicated that education should focus upon understanding the impact of taking prescribed antipsychotic medication on both SUs and carers. DISCUSSION: The importance of effective communication between health professionals, SUs and carers and a willingness to learn about and appreciate how BAME culture influences perception of mental illness and mental well-being were highlighted. CONCLUSION: In working co-productively, researchers need to be flexible and adaptable to change.

14.
J Health Care Poor Underserved ; 30(2): 442-455, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31130529

RESUMEN

Rural American Indian and Alaska Native (AI/AN) communities face physician vacancy rates over 25%. A variety of programs aim to address those gaps, from early-life STEM initiatives for AI/ANs to physician loan repayment programs. However, unfilled clinical positions and underrepresentation of AI/AN physicians persist. We review existing workforce initiatives, then demonstrate that three recently developed clinical fellowship programs fill an important gap. The fellowships, led by faculty at large academic health centers, place fellows in clinical positions in rural AI/AN communities in partnership with tribal health systems and/or the Indian Health Service. In addition to providing clinical care, the fellowships seek to enhance health systems' capacity development through community-centered initiatives that include training and health promotion. Other academic health centers should consider working together with tribal communities to assess whether replication of the models could reduce local physician staffing gaps and health disparities.


Asunto(s)
Nativos de Alaska , Becas , Indios Norteamericanos , Médicos/provisión & distribución , Educación de Postgrado en Medicina/organización & administración , Educación de Pregrado en Medicina/organización & administración , Educación Premédica/organización & administración , Humanos , Médicos/organización & administración , Servicios de Salud Rural/organización & administración , Población Rural
16.
Adv Physiol Educ ; 43(2): 134-139, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-30933538

RESUMEN

Dr. James McCune Smith, the first African-American to obtain a medical degree, has a remarkable legacy of historical proportions, yet his immense impact on society remains relatively unknown. He may be most celebrated for his effectiveness in abolitionist politics, however, his pioneering influence in medicine is equally remarkable. As examples, McCune Smith pioneered the use of medically based statistics to challenge the notion of African-American racial inferiority. He scientifically challenged the racial theories promoted in Thomas Jefferson's Notes on the State of Virginia (Jefferson T., 1832), and he was a harsh critic of phrenology (study of the shape and size of the cranium as a supposed indication of character and mental abilities). Furthermore, notwithstanding being denied entry to America's universities and medical societies because of his race, McCune Smith became a giving physician to orphans, an accomplished statistician, medical author, and social activist who worked to end slavery. His pioneering work debunked doubts about the ability of African-Americans to transition into free society. Specifically, he used his training in medicine and statistics to refute the arguments of slave owners and prominent thought leaders that African-Americans were inferior and that slaves were better off than free African-Americans or white urban laborers. Frederick Douglass, narrator of the Anti-Slavery Movement, cited Dr. James McCune Smith as the single most important influence on his life. Dr. McCune Smith, along with Frederick Douglass, Gerrit Smith, John Brown and other intellectual pioneers of the time, were instrumental in making the elimination of slavery possible.


Asunto(s)
Afroamericanos/historia , Docentes Médicos/historia , Médicos/historia , Relaciones Raciales/historia , Historia del Siglo XIX , Humanos , Masculino
18.
J Am Acad Orthop Surg ; 27(21): e957-e968, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-30614894

RESUMEN

INTRODUCTION: Orthopaedic surgery residency programs have the lowest representation of ethnic/racial minorities compared with other specialties. This study compared orthopaedic residency enrollment rates and academic metrics of applicants and matriculated residents by race/ethnicity. METHODS: Data on applicants from US medical schools for orthopaedic residency and residents were analyzed from 2005 to 2014 and compared between race/ethnic groups (White, Asian, Black, Hispanic, and Other). RESULTS: Minority applicants comprised 29% of applicants and 25% of enrolled candidates. Sixty-one percent of minority applicants were accepted into an orthopaedic residency versus 73% of White applicants (P < 0.0001). White and Asian applicants and residents had higher USMLE Step 1. White applicants and matriculated candidates had higher Step 2 Clinical Knowledge scores and higher odds of Alpha Omega Alpha membership compared with Black, Hispanic, and Other groups. Publication counts were similar in all applicant groups, although Hispanic residents had significantly more publications. Black applicants had more volunteer experiences. CONCLUSIONS: In orthopaedic surgery residency, minority applicants enrolled at a lower rate than White and Asian applicants. The emphasis on USMLE test scores and Alpha Omega Alpha membership may contribute to the lower enrollment rate of minority applicants. Other factors such as conscious or unconscious bias, which may contribute, were not evaluated in this study.


Asunto(s)
Grupos Étnicos/estadística & datos numéricos , Internado y Residencia/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Ortopedia/educación , Ortopedia/estadística & datos numéricos , Selección de Personal/estadística & datos numéricos , Humanos , Estados Unidos
19.
J Asthma ; 56(3): 273-284, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-29641357

RESUMEN

OBJECTIVE: Adverse cross-cultural interactions are a persistent problem within medicine impacting minority patients' use of services and health outcomes. To test whether 1) enhancing the evidence-based Physician Asthma Care Education (PACE), a continuing medical education program, with cross cultural communication training (PACE Plus) would improve the asthma outcomes of African American and Latino/Hispanic children; and 2) whether PACE is effective in diverse groups of children. METHODS: A three-arm randomized control trial was used to compare PACE Plus, PACE, and usual care. Participants were primary care physicians (n = 112) and their African American or Latino/Hispanic pediatric patients with persistent asthma (n = 867). The primary outcome of interest included changes in emergency department visits for asthma overtime, measured at baseline, and 9 and 21 months following the intervention. Other outcomes included hospitalizations, asthma symptom experience, caregiver asthma-related quality of life, and patient-provider communication measures. RESULTS: Over the long term, PACE Plus physicians reported significant improvements in confidence and use of patient-centered communication and counseling techniques (p < 0.01) compared to PACE physicians. No other significant benefit in primary and secondary outcomes was observed in this trial. CONCLUSION: PACE Plus did not show significant benefit in asthma-specific clinical outcomes. More trials and multi-component strategies continue to be needed to address complex risk factors and reduce disparities in asthma care. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01251523 December 1, 2010.


Asunto(s)
Asma/tratamiento farmacológico , Comunicación , Competencia Cultural , Educación Médica Continua/organización & administración , Médicos de Atención Primaria/educación , Afroamericanos , Asma/fisiopatología , Asma/terapia , Cuidadores/psicología , Niño , Preescolar , Servicio de Urgencia en Hospital/estadística & datos numéricos , Práctica Clínica Basada en la Evidencia , Femenino , Hispanoamericanos , Humanos , Masculino , Satisfacción del Paciente , Relaciones Médico-Paciente , Calidad de Vida , Características de la Residencia , Factores de Riesgo , Autoimagen , Índice de Severidad de la Enfermedad
20.
Educ Health (Abingdon) ; 32(3): 146-149, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-32317424

RESUMEN

Background: The Quilombola community is made up of descendants of enslaved Africans. These people represent an ethnic minority group within the Brazilian Black population with worse health indicators including higher rates of maternal mortality. Context: The Brazilian National Guidelines for education of health professionals state that cultural competence and education of ethnic-racial relations need to be reinforced. Activities: An action research initiative was developed with the main goal of contributing to the development of cultural competence, interprofessional education, and collaborative work as well as improving the maternal and child indicators of the Quilombola community. An elective module for undergraduate health courses with the subject "Cultural Competence in Health Care for Quilombola Women" was implemented. Data on health-related needs identification, students' perceptions about interactions with the community, and competencies necessary to work with the Quilombola community were considered. Outcomes: Our educational strategy reinforces the importance of considering the processes that influence the health care of this population. The reflective capacity and communication skills emerged as the most important attitudinal and psychomotor components, respectively. Future Directions: Sustainability comes from partnerships established between the Quilombola community and the university to institutionalize educational and research strategies. This project contributes to reducing health inequities and deconstructing racism in the training of future health professionals. Conclusions: The creation of links, the building of trust between users and health staff, and the ability to reflect, with emphasis on communication, were shown as the main components of culturally competent behavior in maternal health care in the studied Quilombola population.


Asunto(s)
Competencia Cultural/educación , Empleos en Salud/educación , Grupos Minoritarios , Grupo de Ascendencia Continental Africana , Brasil , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Servicios de Salud Materno-Infantil , Salud Rural , Estudiantes del Área de la Salud/psicología , Salud de la Mujer
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