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1.
JAMA ; 323(1): 70-81, 2020 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910284

RESUMEN

Importance: Time constraints, technology, and administrative demands of modern medicine often impede the human connection that is central to clinical care, contributing to physician and patient dissatisfaction. Objective: To identify evidence and narrative-based practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients. Evidence Review: Preliminary practices were derived through a systematic literature review (from January 1997 to August 2017, with a subsequent bridge search to September 2019) of effective interpersonal interventions; observations of primary care encounters in 3 diverse clinics (n = 27 encounters); and qualitative interviews with physicians (n = 10), patients (n = 27), and nonmedical professionals whose occupations involve intense interpersonal interactions (eg, firefighter, chaplain, social worker; n = 30). After evidence synthesis, promising practices were reviewed in a 3-round modified Delphi process by a panel of 14 researchers, clinicians, patients, caregivers, and health system leaders. Panelists rated each practice using 9-point Likert scales (-4 to +4) that reflected the potential effect on patient and clinician experience and feasibility of implementation; after the third round, panelists selected their "top 5" practices from among those with median ratings of at least +2 for all 3 criteria. Final recommendations incorporate elements from all highly rated practices and emphasize the practices with the greatest number of panelist votes. Findings: The systematic literature review (n = 73 studies) and qualitative research activities yielded 31 preliminary practices. Following evidence synthesis, 13 distinct practices were reviewed by the Delphi panel, 8 of which met criteria for inclusion and were combined into a final set of 5 recommendations: (1) prepare with intention (take a moment to prepare and focus before greeting a patient); (2) listen intently and completely (sit down, lean forward, avoid interruptions); (3) agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda); (4) connect with the patient's story (consider life circumstances that influence the patient's health; acknowledge positive efforts; celebrate successes); and (5) explore emotional cues (notice, name, and validate the patient's emotions). Conclusions and Relevance: This mixed-methods study identified 5 practices that have the potential to enhance physician presence and meaningful connection with patients in the clinical encounter. Evaluation and validation of the outcomes associated with implementing the 5 practices is needed, along with system-level interventions to create a supportive environment for implementation.


Asunto(s)
Relaciones Médico-Paciente , Atención Primaria de Salud , Medicina Clínica , Comunicación , Técnica Delfos , Humanos , Entrevistas como Asunto , Investigación Cualitativa , Factores de Tiempo
2.
J Nurs Adm ; 50(1): 16-21, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31804409

RESUMEN

OBJECTIVES: This qualitative study was designed to describe the experiences of mentors for a nursing research fellowship at a southeastern US academic medical center. BACKGROUND: Mentoring is an important aspect of nursing and is a key strategy to develop nurse leaders and faculty. Research mentors have been identified as essential for novice researchers to be able to complete clinical studies. However, there has been limited research on the experience of nursing research mentors, despite the emphasis on the critical nature of this role. METHODS: Eight mentors for 23 studies over 8 years of a nursing research fellowship participated in a study outlining their experiences as research mentors. RESULTS: Common themes emerged from mentors' identification of key components in the research mentoring process and elements necessary for effective support of frontline nurse researchers. CONCLUSIONS: Recommendations for developing effective, confident research mentors are drawn from the analyses.


Asunto(s)
Tutoría , Enfermeras Administradoras , Investigación en Enfermería , Humanos , Entrevistas como Asunto
3.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190010.supl.3, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800849

RESUMEN

INTRODUCTION: Brazil presented a high proportion of ill-defined causes of death (IDCD) in 2000, compromising accurate cause-of-death analysis. OBJECTIVE: To analyze specific underlying causes for deaths originally assigned as IDCD in the Mortality Information System (SIM - Sistema de Informação sobre Mortalidade), after investigation activities implemented in country between 2006 and 2017. METHOD: For all IDCD identified in the SIM, municipal health professionals collected information about the final disease obtained from hospital records, autopsies, forms of family health teams, and home investigation. Specific causes among reclassified IDCD after investigation were evaluated according to age groups and four calendar periods. RESULTS: Proportions of IDCD reassigned to other causes after review increased over time, reaching 30.1% in 2017. From a total of 257,367 IDCD reclassified in 2006-2017, neonatal-related conditions, injury, ischemic heart disease and stroke were the leading causes detected in the age groups 0-9 years, 10-29 years, 30-69 years, 70 years and over, respectively. DISCUSSION: The similarity and plausibility of cause-specific proportions derived from the reclassification of IDCD by age group over time indicate the accuracy of the investigation data. CONCLUSION: High proportions of IDCD reassigned to more informative causes after review indicate the success of this approach to correct misclassification in the SIM, an initiative that should be maintained. Training physicians on death certification along with better quality of medical care and access to health services would lead to further improvement.


Asunto(s)
Causas de Muerte , Recolección de Datos/métodos , Sistemas de Información/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Anciano , Autopsia/estadística & datos numéricos , Brasil/epidemiología , Niño , Preescolar , Certificado de Defunción , Femenino , Humanos , Lactante , Entrevistas como Asunto/estadística & datos numéricos , Masculino , Registros Médicos/estadística & datos numéricos , Persona de Mediana Edad , Factores de Tiempo , Adulto Joven
4.
J Clin Ethics ; 30(4): 338-346, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31851625

RESUMEN

Although tissue plasminogen activator (tPA) is the only medication approved by the United States Food and Drug Administration (FDA) for acute ischemic stroke, there is no consensus about the need for informed consent for its use. As a result, hospitals throughout the U.S. have varying requirements regarding obtaining informed consent from patients for the use of tPA, ranging from no requirement for informed consent to a requirement for verbal or written informed consent. We conducted a study to (1) determine current beliefs about obtaining patients' informed consent for tPA among a large group of stroke clinicians and (2) identify the ethical, clinical, and organizational factors that influence tPA consent practices. Semi-structured interviews were conducted by trained and experienced investigators and research staff to identify key barriers to implementing acute stroke services. Part of the interview explored current beliefs and practices around informed consent for tPA. This was a multicenter study that included 38 Veterans Health Administration (VHA) hospital locations. Participants were 68 stroke team clinicians, serving primarily on the neurology (35 percent) or emergency medicine (41 percent) service. We conducted thematic analysis based on principles of grounded theory to identify codes about consent for tPA. We used interpretive convergence to ensure consistency among the individual investigators' codes and to ensure that all of the investigators agreed on coding and themes. We found that 38 percent of the stroke clinicians did not believe any form of consent was necessary for tPA, 47 percent thought that some form of consent was necessary, and 15 percent were unsure. Clinicians who believed tPA required informed consent were divided on whether consent should be written (40 percent) or verbal (60 percent). We identified three factors describing clinicians' attitudes about consent: (1) legal and policy factors, (2) ethical factors, and (3) medical factors. The lack of consensus regarding consent for tPA creates the potential for delays in treatment, uneasiness among clinicians, and legal liability. The identified factors provide a potential framework to guide discussions about developing a standard of care for acquiring the informed consent of patients for the administration of tPA.


Asunto(s)
Isquemia Encefálica/terapia , Consentimiento Informado , Accidente Cerebrovascular/terapia , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/uso terapéutico , Actitud del Personal de Salud , Isquemia Encefálica/complicaciones , Isquemia Encefálica/diagnóstico , Hospitales de Veteranos , Humanos , Entrevistas como Asunto , Investigación Cualitativa , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/administración & dosificación , Activador de Tejido Plasminógeno/efectos adversos , Estados Unidos
5.
Rev Soc Bras Med Trop ; 53: e20180495, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31859937

RESUMEN

INTRODUCTION: This study aimed to document injuries caused by fish among professional fishermen in the Western Brazilian Amazon. METHODS: We undertook a descriptive, retrospective study, involving 51 professional fishermen, to determine clinical, epidemiological, and therapeutic aspects of their injuries. RESULTS: Among 51 fishermen interviewed, most injuries were due to mandi (Pimelodus spp.), and the hands were the most injured region, resulting in pain and bleeding in all cases. CONCLUSIONS: Our study findings confirm the morbidity of fish-related injuries, and reaffirm the need for relevant information regarding prevention and injury management.


Asunto(s)
Accidentes de Trabajo/estadística & datos numéricos , Mordeduras y Picaduras/epidemiología , Venenos de los Peces/envenenamiento , Explotaciones Pesqueras/estadística & datos numéricos , Adulto , Anciano , Animales , Brasil/epidemiología , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
6.
Rev Soc Bras Med Trop ; 53: e20190305, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31859953

RESUMEN

INTRODUCTION: We examined the ethnobiological perception of the population of the Alto Juruá region about different snake species, in terms of their dangerousness and manifestations of envenomation. METHODS: We interviewed 100 villagers who were active in the forests. RESULTS: Lachesis muta was considered the most venomous snake, and Bothrops atrox appeared to be the most feared snake species. CONCLUSIONS: The high incidence, severity, and mortality of B. atrox bites and the severity and mortality of L. muta bites were the factors that contributed to these species being perceived as the most feared and venomous snakes.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Cultura Popular , Serpientes/clasificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Brasil , Estudios Transversales , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Población Rural , Adulto Joven
7.
Enferm. intensiva (Ed. impr.) ; 30(4): 181-191, oct.-dic. 2019. tab
Artículo en Español | IBECS | ID: ibc-184482

RESUMEN

Introducción: Las competencias que abordan en su entorno laboral las enfermeras de cuidados intensivos (UCI), han aumentado con la adquisición de nuevas responsabilidades asociadas a cuidados y dispositivos a realizar al paciente crítico. Múltiples estudios avalan la necesidad de la especialización de las enfermeras que trabajan en este tipo de unidades. Apoyado en estas evidencias, la European Federation of Critical Care Nurse, recomienda unificar la formación de las enfermeras de cuidados intensivos. Por tanto, nos planteamos el siguiente objetivo: valorar las necesidades formativas que detectan las enfermeras de UCI a través de sus vivencias y experiencias profesionales. Método: Estudio cualitativo descriptivo, con enfoque fenomenológico, a través de una entrevista semiestructurada donde se estudiaron los 4 ámbitos que la European Federation of Critical Care Nurse recoge (clínico, profesional, gestión y educativo). Se entrevistaron a 15 enfermeras de una UCI polivalente. Resultados: Los entrevistados reconocen que la formación previa era deficiente para los cuidados y medidas de soporte que tuvieron que afrontar. Consideran que la formación posterior y la experiencia fueron determinantes para poder desarrollar efectivamente su labor profesional. Además afirman que las medidas de soporte y los cuidados son temas a desarrollar continuamente mediante una formación dirigida. Conclusión: Las enfermeras reconocen que debe existir una formación destinada a cumplir las competencias que las UCI requieren, y que estas se ven afectadas por el tipo de unidad y el tipo de pacientes atendidos


Introduction: The competences of intensive care (ICU) nurses in their healthcare environment, have increased with the acquisition of new responsibilities associated with new care and devices for critical patients. Many studies suggest the need for specific training of nurses that work in these units. Based on this evidence, the European Federation of Critical Care Nurses Associations, recommends unifying the training of intensive care nurses. Therefore we set ourselves the following objective: to assess the training needs detected by ICU nurses through their experience and practical knowledge. Method: Descriptive qualitative study, with a phenomenological approach, through semi-structured interview where the four areas (clinical practice, professional, management and educational) covered by the European Federation of Critical Care Nurses Associations were studied. Fifteen nurses from an adult polyvalent ICU were interviewed. Results: The interviewees acknowledged that the previous training was deficient for the care and support measures that they had to face. They considered that subsequent training and experience were decisive in order to carry out their work effectively. They also stated that support measures and care are topics to be developed continuously through targeted training. Conclusion: The nurses in this research study acknowledged that training is needed to achieve the competences required in ICU, and these are affected by the type of unit and patients


Asunto(s)
Humanos , Masculino , Femenino , Enfermeras y Enfermeros/estadística & datos numéricos , Cuidados Críticos/tendencias , Educación en Enfermería/tendencias , Unidades de Cuidados Intensivos/estadística & datos numéricos , Análisis Cualitativo , Competencia Clínica , Entrevistas como Asunto/estadística & datos numéricos
8.
Afr J Reprod Health ; 23(3): 106-119, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31782636

RESUMEN

Unmet need for contraception remains a challenge especially in low and middle-income countries. Community participation or the -active involvement of affected populations in all stages of decision-making and implementation of policies, programs, and services‖ is a precondition for attaining the highest standard of health. Participation as a key component of rights and quality of care frameworks could increase met needs. However, it has been inadequately addressed in contraceptive programs. A qualitative, exploratory methodology that included focus group discussions and in-depth interviews with community members, healthcare providers, and other stakeholders were conducted to identify domains or key thematic areas of action through which stakeholders could be engaged. The study conducted in Kenya, South Africa, and Zambia explored knowledge and use of contraceptives, barriers and enablers to access, quality of care, and participatory practices. Thematic analysis was used, facilitated by NVivo (version 10 QSR International) with a single master codebook. Comparing the thematic areas that emerged from the county data, four domains were selected: quality of care, informed decision-making, acceptability, and accountability. These domains informed the theory of change of a participatory programme aiming to meet unmet needs. Identifying possible generalizable domains establishes measurable and comparable intermediate outcomes for participatory programs despite diverse African contexts.


Asunto(s)
Participación de la Comunidad , Anticoncepción , Servicios de Planificación Familiar/estadística & datos numéricos , Personal de Salud , Evaluación de Necesidades , Anticoncepción/métodos , Grupos Focales , Necesidades y Demandas de Servicios de Salud , Humanos , Entrevistas como Asunto , Kenia , Investigación Cualitativa , Sudáfrica , Zambia
10.
Pan Afr Med J ; 34: 47, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31762913

RESUMEN

Introduction: Despite the fact that mothers know the exact age to wean their infants, majority of the mothers do not practice exclusive breastfeeding due to cultural beliefs and practices. The purpose of the study was to explore cultural beliefs and practices associated with weaning children at the Maternal Child Health Clinic Kalisizo Hospital. Methods: This was a simple qualitative study. Seven in-depth-interviews were conducted among 7 mothers of children within the ages 0-12 months attending post-natal care services using self-generated semi-structured key informant's guide. This took place at the Maternal Child Health Clinic Kalisizo Hospital. Purposive sampling method was used to select mothers for the study. Three themes were generated namely: identification of the different cultural beliefs and practices associated with weaning, how the different cultural beliefs are practiced and the impacts of these cultural beliefs and practices. Data were analysed using thematic analysis. Results: Although a majority of the mothers knew the recommended age to wean their infants, they did not ignore the ill-informed cultural beliefs, taboos and practices from their elders such as peer pressure, advice and counselling from mother-in laws and teachings from older women who are seen as role models. Conclusion: Adherence to cultural beliefs, taboos and practices, have a powerful influence on weaning, hence hindering exclusive breast feeding.


Asunto(s)
Lactancia Materna/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Madres/estadística & datos numéricos , Destete/etnología , Adolescente , Adulto , Lactancia Materna/etnología , Femenino , Humanos , Lactante , Recién Nacido , Entrevistas como Asunto , Centros de Salud Materno-Infantil , Investigación Cualitativa , Uganda , Adulto Joven
11.
Hosp Pract (1995) ; 47(5): 241-248, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31682467

RESUMEN

Objectives: One of the current concerns of hospitals is how to become a health promoting hospital (HPH). This qualitative research aimed at exploring the views of members of the medical staff in two Iran hospitals about the defined standards to transform the hospitals into a health promoting one.Methods: The research reported in this paper was a content analysis qualitative study. The license numbered (IR.UMSHA.REC.1395.388) was obtained from the ethics committee of Hamadan Medical Science University. Sampling was carried out through the snowballing method. Also, 55 interviews were conducted with the members of the medical staff. To collect data, the semi-structured interview guide was used based on the standards of HPHs. The framework analysis method was used to analyze the data qualitatively.Results: From three central questions on the basis of the main study question, nine themes were earned. Policies governing the hospitals were in the direction of converting them to health promoting organizations including the creation of a health promoting work environment, empowering personnel and health promoting corporate culture. Also, suggestions to create a HPH included improving management, paying attention to patients and their satisfaction, as well as increasing effective interpersonal relationships in the hospital.Conclusion: The findings showed that it can be a key strategy in this field to use staff's solutions for the existing problems and their opinions on the challenges against establishing the standards for HPHs. People usually accept more comfortable and easy changes in decision-making and implementing processes of which they are involved.


Asunto(s)
Actitud del Personal de Salud , Promoción de la Salud , Cuerpo Médico de Hospitales/psicología , Femenino , Humanos , Entrevistas como Asunto , Irán , Masculino , Cultura Organizacional , Investigación Cualitativa
12.
Georgian Med News ; (294): 150-155, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31687969

RESUMEN

The aim of this study were to investigate the attitude of university students on the environmental issues, analyze the information received and develop measures for the participation of students in environmental health-improving and preventive activities.. The qualitative study was conducted by using face to face interviewing method with university students. Environmental pollution is one of the most important threats in Georgia and arount the world. The immediate objects of pollution are land, water, soil, air, which directly affects human health and worsens it. The participants have favorable attitudes toward the environment, but they are less involved in environmental activities. Basically these measures are limited to the so-called one-time campaigns. Based on the results, it is recommended the development of integrated measures and schemes to stimulate student participation in the implementation of socially active algorithms to improve the environment.


Asunto(s)
Actitud , Salud Ambiental/educación , Contaminación Ambiental , Estudiantes/psicología , Georgia (República) , Humanos , Entrevistas como Asunto , Investigación Cualitativa
13.
J Surg Oncol ; 120(8): 1335-1340, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31674041

RESUMEN

BACKGROUND AND OBJECTIVES: Negative consequences of tobacco use during cancer treatment are well-documented but more in-depth, patient-level data are needed to understand patient beliefs about continued smoking (vs cessation) during gastrointestinal (GI) cancer treatment. METHODS: We conducted semi-structured interviews with 10 patients who were active smokers being treated for GI cancers and 5 caregivers of such patients. All interviews were audio-recorded, transcribed verbatim, and uploaded to NVivo. We consensus coded data inductively using conventional content analysis and iteratively developed our codebook. We developed data matrices to categorize the themes regarding patient perspectives on smoking as well as presumed barriers to smoking cessation during active therapy. RESULTS: Our interviews revealed three consistent themes: (a) Smoking cessation is not necessarily desired by many patients who have received a cancer diagnosis; (b) Failure in past quit attempts may lead to feelings of hopeless about future attempts, especially during cancer treatment; (c) Patients perceived little to no access to smoking cessation treatment at the time of their cancer diagnosis. CONCLUSIONS: Well-designed systemic changes that promote the positive and efficacious effects of quitting smoking during cancer treatment, and that provide barrier-free access to such treatments may be helpful in promoting tobacco-free behavior during cancer treatment.


Asunto(s)
Actitud Frente a la Salud , Neoplasias Gastrointestinales/psicología , Cese del Hábito de Fumar/psicología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Fumar/psicología
14.
Pan Afr Med J ; 33: 209, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692730

RESUMEN

Introduction: management of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) within primary health care (PHC) facilities involve nursing students as part of them integrating theory to practice. Clinical learning for nursing students requires adequate support from the Nursing Education Institution (NEI) and nursing professionals. Given the dearth of literature regarding clinical support for nursing students in the management of TB/HIV in PHC setting, this study is aimed at exploring and describing nursing students' experiences regarding clinical support. Methods: a phenomenological design was used to explore and describe the experiences of nursing students using an individual, unstructured, in-depth interview. Audio-taped interviews were transcribed verbatim and analysed using Atlas TI software. Results: themes derived from the study were factors inhibiting clinical support which incorporated shortage of professional nurses (PNs), lack of accompaniment, fear of managing TB/HIV patients and negative attitudes of PNs; outcomes of poor clinical support included inability to integrate TB/HIV theory to practice and lack of confidence among nursing students; nursing students' desired outcomes through clinical support included becoming a competent TB/HIV nurse and the ability to integrate TB/HIV theory to practice; and strategies to strengthen and promote clinical support in TB/HIV management through strengthened occupational health and safety learning, provision of knowledge regarding post-exposure prophylaxis and infection control, and appointed clinical PN for students in each facility. Conclusion: the development of policies for clinical support, increasing supervision, appointment of clinical preceptors and accompanists in facilities where nursing students are placed would promote clinical learning within the NEI and the production of competent and confident nurses.


Asunto(s)
Infecciones por VIH/enfermería , Atención Primaria de Salud/organización & administración , Estudiantes de Enfermería/estadística & datos numéricos , Tuberculosis/enfermería , Adulto , Competencia Clínica , Femenino , Humanos , Entrevistas como Asunto , Masculino , Adulto Joven
15.
Nurs Res ; 68(6): E8-E12, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31693558

RESUMEN

BACKGROUND: Scarce and differing reasons for including closing questions in qualitative research exist, but how data generated from these questions are used remains uncertain. OBJECTIVES: The purpose of the study was to understand if and how researchers use closing questions in qualitative research, specifically the research questions were: (a) "Why do qualitative researchers include or exclude closing questions during interviews?" and (b) "How do qualitative researchers use data from closing questions?" METHODS: A qualitative descriptive design using a single, asynchronous, web-based, investigator-designed survey containing 14 items was used to collect data. Convenience and snowball sampling were used to recruit participants. Data were analyzed using descriptive statistics and qualitative content analysis. Codes were developed from the qualitative data. Subcategories were derived from similar codes, and these subcategories were further scrutinized and were used to create broad categories. RESULTS: The number of respondents per question ranged from 76 to 99; most identified nursing and sociology as their academic disciplines, lived in the United States, and were involved in qualitative research for 1-10 years. Data, the interview, the interviewee, and the interviewer were broad categories to emerge as reasons for including closing questions. Only one respondent reported a reason for excluding closing questions. The uses of closing question data were described in four broad categories: analysis, data, the interview guide, and inquiry. DISCUSSION: Researchers frequently included closing questions in qualitative studies. The reasons for including these questions and how data are used vary, and support limited previously published literature. One unique reason, adding "new breath" to the interview, emerged. Study findings can aid qualitative researchers in deciding whether to include closing questions.


Asunto(s)
Internet , Entrevistas como Asunto , Investigación Cualitativa , Encuestas y Cuestionarios , Toma de Decisiones , Humanos
16.
Pan Afr Med J ; 34: 10, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31762879

RESUMEN

Introduction: There is an increasing commitment in the African Region towards diabetes care, following acknowledgement that it is an important public health issue which needs to be addressed in order to improve population health. We conducted a situational analysis of diabetes care in Guinea Bissau in order to identify the main issues faced in the management of the disease in this country. Methods: The study design was qualitative and data collection was done using semi directive interviews and focus groups with participants involved in primary diabetes care and management in Guinea Bissau (health care professionals, non-governmental organization staff, traditional healers) and patients. The data was analyzed using the five-phase approach of the thematic analysis framework. Results: The major themes identified included: the lack of specialists and properly trained healthcare personnel; no standardized care protocol for diagnosis, treatment, follow up and proper management for diabetic patients; resources poor primary health care settings; no validated epidemiological dataset on prevalence and the lack of awareness about diabetes (in general population and also in medical staff). Conclusion: This first situational analysis can serve as a baseline to develop an action plan to address the main issues identified.


Asunto(s)
Diabetes Mellitus/terapia , Personal de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Adulto , Niño , Diabetes Mellitus/diagnóstico , Grupos Focales , Guinea Bissau , Humanos , Entrevistas como Asunto
17.
Psychiatr Prax ; 46(8): 432-438, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31683333

RESUMEN

OBJECTIVE: This study aimed at investigating the perspective of executives on the implementation of peer support in psychiatric facilities - an aspect that has been insufficiently addressed in research so far. METHODS: We guided qualitative interviews with eleven executives of psychiatric institutions from Germany and Switzerland, in which peer workers are employed. The interview transcripts were evaluated according to the principles of content analysis. RESULTS: The study participants evaluated the inclusion of peer workers very positively overall. Peer support was described as a special quality feature of a psychiatric institution. In addition, improvements were reported with regard to a more respectful and conscious interaction with colleagues and patients as well as a more positive therapeutic climate. Based on their experience, the executives named a number of change management tasks, e. g. with regard to the preparation of the organization, personnel selection and financing, job descriptions and the integration of the peer workers in the team. DISCUSSION: Our results underline the specific advantages of peer support for the further development of psychiatric practice. Some implications for personnel management are discussed.


Asunto(s)
Consejo , Trastornos Mentales/terapia , Grupo Paritario , Alemania , Humanos , Relaciones Interpersonales , Entrevistas como Asunto , Trastornos Mentales/psicología , Suiza
18.
Spine (Phila Pa 1976) ; 44(22): 1578-1584, 2019 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-31689253

RESUMEN

STUDY DESIGN: Retrospective review with qualitative phone interview. OBJECTIVE: This study aims to identify the factors leading to delayed diagnosis or referral to a spinal surgeon in patients who subsequently require surgery for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: AIS can be effectively treated with bracing to prevent curve progression in skeletally immature patients. Australia currently has in place a national self-detection screening program to diagnose AIS. METHODS: A retrospective review was performed for patients who underwent surgery for scoliosis at Princess Margaret Hospital for Children and Royal Perth Hospital between June 1, 2010 and May 27, 2014. Data were retrieved from the digital medical record and a semistructured phone interview was used to determine path to diagnosis and referral. RESULTS: Mean Cobb angle at first specialist review was 49.5°â€Š±â€Š14.0° for patients who subsequently required surgery for AIS. These patients experienced an average interval of 20.7 months from detection of symptoms to review in a specialist clinic. CONCLUSION: In a condition in which early detection and intervention may halt progression of disease, AIS is detected relatively late and there are specific delays to diagnosis and referral to specialist clinics. LEVEL OF EVIDENCE: 4.


Asunto(s)
Derivación y Consulta/estadística & datos numéricos , Escoliosis , Adolescente , Humanos , Entrevistas como Asunto , Estudios Retrospectivos , Escoliosis/diagnóstico , Escoliosis/epidemiología , Escoliosis/cirugía , Columna Vertebral/cirugía , Tiempo de Tratamiento/estadística & datos numéricos , Resultado del Tratamiento , Australia Occidental
20.
Afr Health Sci ; 19(2): 1849-1857, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31656467

RESUMEN

Background: Emergency nurses' understanding and interpretation of intimate partner violence influence the care they provide to women exposed to intimate partner violence. Objectives: The aim of this study was to uncover discourses that may help understand emergency nurses' responses towards women exposed to intimate partner violence. Materials and methods: This study used a qualitative design to explore emergency nurses' discourses. Purposive sampling was used to select 15 participants working at an emergency unit in a public hospital in South Africa. Data were collected through three focus group discussions comprised of five emergency nurses each. Foucauldian discourse analysis was used to analyse the transcribed data. Results: Four themes emerged from the focus group discussions: (1) strong women subject themselves to societal expectations and endure intimate partner violence, (2) women are vulnerable and powerless against intimate partner violence, (3) intimate partner violence is a private and secret phenomenon, and (4) emergency nurses have limited scope to intervene when they encounter women exposed to intimate partner violence. Conclusion: Emergency nurses are in a position to intervene in intimate partner violence through portraying a non-judgmental approach that lay the foundation for disclosure, supporting women to change their intimate partner violence (IPV) situations, documentation, referral and safety planning.


Asunto(s)
Enfermería de Urgencia , Violencia de Pareja , Rol de la Enfermera/psicología , Enfermeras y Enfermeros/psicología , Atención de Enfermería/psicología , Personal de Enfermería/psicología , Adulto , Servicio de Urgencia en Hospital , Emociones , Femenino , Humanos , Entrevistas como Asunto , Persona de Mediana Edad , Percepción , Investigación Cualitativa , Sudáfrica
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