Towards a liquid healthcare: primary care organisational and management strategies during the COVID-19 pandemic - a qualitative study.

BACKGROUND: The COVID-19 pandemic has changed the organisational and management strategies of healthcare institutions such as primary care centres. Organisational culture as well as leadership style are key issues for the success of these institutions. Due to the multidimensional nature of identity processes, it is necessary to explore the changes experienced by health professionals from these perspectives. This study explores health professionals' organisational and management strategies in primary care settings during the COVID-19 pandemic. DESIGN: Qualitative, exploratory study based on the analysis of participants' accounts within a hermeneutic phenomenologicaly approach. METHODS: Research was conducted in primary care settings in two neighbouring Spanish healthcare regions. The sample included participants with different demographics (gender, age), professional roles (practice managers, general practitioners, paediatricians), employment status (permanent, temporary, zero-hours), and years of experience (under or over ten years' experience). Data were collected between July and December 2020 through focus groups and in-depth, semi-structured individual interviews. RESULTS: A total of 53 primary care workers participated in the study, of which 38 were individually interviewed and 15 participated in three focus groups. Of these, 78.4% were healthcare professionals, 49% were female nurses, and 70.5% had more than 10 years of work experience in primary care. Two main themes emerged: "liquid" healthcare and "the best healthcare system in the world". During the first wave of the COVID-19 pandemic, new, more fluid organisational and management models were implemented in primary care settings, which have remained in place since. Primary care workers' perceived a lack of appreciation and inclusion in decision-making that risked their alienation and disengagement. CONCLUSION: Primary care workers' professional identity became gradually blurred due to shifting perceptions of their professional roles in a context of increasing improvisation and flexible working practices. This affected their professional performance. TRIAL REGISTRATION: The study was approved by the Clinical Research Ethical Committee of the Talavera de la Reina Integrated Management Area (CEIm del AGI de Talavera de la Reina in Spain, Hospital Nuestra Señora del Prado, ref: 23/2020).

Internal dynamics within primary care teams in two Spanish regions during the COVID-19 pandemic: a qualitative study.

BACKGROUND: Pandemics and epidemics have represented public health emergencies with severe consequences at a global level. Primary care teams have played a crucial role in disease surveillance and monitoring during the COVID-19 pandemic through early detection, contact tracing, and isolation of positive cases. The objective of this study was to explore the impact of the COVID-19 pandemic on primary care teams regarding their internal dynamics and their professional performance. METHODS: Qualitative study carried out between July and December 2020 in two large central and southern Spanish regions (Castilla la Mancha and Madrid). Semi-structured interviews and focus groups were conducted with primary care workers. Data was analysed using thematic content analysis. Participants were accessed using purposive sampling. RESULTS: A total of 53 primary care workers participated in the study, of which 38 were individually interviewed, and 15 participated in three focus groups.The analysis of their experiences revealed two main themes regarding the impact of the COVID-19 pandemic on primary care teams: 1) The need to reorganise traditional roles: Primary care settings closed their doors to the public and their workers restructured their roles to ensure the delivery of essential services; 2) The need to implement a new primary care delivery model: Each primary care team had to self-organise, making sure their reference population was cared for and developing resource optimisation strategies. CONCLUSIONS: Primary care teams have quickly adapted their roles and internal dynamics to respond to the demands generated by COVID-19. In the new delivery model, some positive aspects could be highlighted - such as increased communication between professionals and the use of telemedicine for some cases. However, it is important to address the negative impact that the COVID-19 crisis has had on of the main functions of primary care. These measures are necessary to promote well-being in primary care teams, and to provide quality care that addresses the complex and individual needs of each person and reduces inequalities in healthcare delivery.

Culinary Solitude in the Diet of People with Functional Diversity.

This qualitative ethnographic study identifies how problems in the feeding process of a group of people with functional diversity influence different eating situations. The study, which was carried out in the Autonomous Community of Castilla La Mancha, Spain, is based on interviews conducted at the headquarters of the different participating associations for functionally diverse people, at the participants' homes, and in public spaces. The study included 27 subjects aged between 18-75 years. Their functional diversity had caused significant changes in their sociability, particularly in contexts associated with food consumption. The analysis identified three main themes: social ghettoisation and culinary loneliness; stigma, shame, feeling like a burden, and loneliness; and exclusion or self-exclusion at the dining table. Our participants' narratives underscored the importance of acknowledging the significance of changes in eating-related sociability due to functional diversity. For the study subjects, grief, loneliness, and shame contributed to disassociating food consumption from social celebrations, withdrawing from restaurant meals, or conversations while eating to avoid other people's stares.

Emotions in the Time of COVID-19: Affections and Impacts among the Spanish Primary Care Workforce.

BACKGROUND: The literature review shows that most studies on the psychological impact of COVID-19 on healthcare professionals have focused on hospital staff, with few specifically addressing the primary care workforce. This study aims to explore primary care workers' verbal accounts of the emotions they experienced. METHODS: This is a qualitative study carried out between July and December 2020 in Spain. Semi-structured interviews and focus groups were conducted with primary care workers. Data were analysed through thematic content analysis. Participants were selected using purposive sampling. RESULTS: A total of 53 primary care workers participated in the study, of whom 38 were individually interviewed, and 15 participated in three focus groups. Our analysis revealed themes in two categories: (1) from infection to affection; and (2) affected, but not patients-a discourse based on the acceptance of their experience as part of their work in primary care, creating an ideological construct or "shield" based on emotional self-management. CONCLUSIONS: Self-reflection on the emotional impact of COVID-19 is scarce. Examples of emotional affections include an obsessive focus on hygiene, the inability to establish clear boundaries between the personal and the professional spheres, and experiencing-and having to self-manage-emotional strain.

The Integration of Gender Perspective into Young People's Sexuality Education in Spain and Portugal: Legislation and Educational Models.

Throughout history, Sexuality Education (SE) has undergone many changes in formal education curricula. The education systems should incorporate SE and promote an understanding of sexuality from the critical perspective of gender. Objectives: To examine the approach to SE in young people in Spain and Portugal, considering the incorporation of the gender perspective, and analyze the legislation in both countries. A scoping review was conducted considering studies with SE programs, gender perspective, and legislation in Spanish, Portuguese, and English, without any time limits. The population consisted of young people aged 10 to 18 years who did not attend higher education. Databases used: CINAHL Complete, ERIC, LILACS, SciELO, MEDLINE, Psychology and Behavioral Sciences Collection, Scopus, Open Access Scientific Repository of Portugal, Base de Datos de Tesis Doctorales, Theses and Dissertations Online, and governmental websites. Thirty-two studies were found, including intervention, diagnosis, and documental programs. Eight of the studies adopted the gender perspective. Legislation in both countries is vast, with 23 main references. Although SE is legislated in both countries, the social-health and educational programs are insufficient. The relevance of the gender perspective is not incorporated into SE.

Eating experiences and quality of life in patients with larynx cancer in Spain. A qualitative study.

PURPOSE: This paper aims at describing the eating experience of people diagnosed with and treated for laryngeal cancer. Going beyond the mere conceptualization of "after-effect" or the quantification of the disease's impact on the basis of standardized questionnaires, we present a qualitative analysis of the narratives of such experiences. METHODS: Ethnographic study. Data is obtained from conversations, semi-structured interviews, participant observation, and written documents. A discourse analysis of the narrative information was conducted, with process coding and using the constant comparative method, inductive content analysis, category analysis, units of meaning associated with each other, and triangulation. RESULTS: The impact of cancer on eating processes is not limited to nutrition, but also affects the social and cultural value of food, which is put into question. The symbolic and social values which accompany the traditional way of eating are modified, which is connected with impaired quality of life. CONCLUSIONS: The impact on the eating process and its relationship with quality-of-life impairment are clear and connect with the importance of eating ways in culture and social organization. Greater attention should be paid to these contexts in clinical practice, which can affect even more than the impact on communicative processes.

Treatment Adherence in Chronic Conditions during Ageing: Uses, Functionalities, and Cultural Adaptation of the Assistant on Care and Health Offline (ACHO) in Rural Areas.

The increasingly common scenario of an ageing population is related to a rise in the prevalence of problems associated with chronic conditions and comorbidities. Polypharmacy is frequent among this population, and it is a situation that can create medication management and adherence issues. This article introduces the features and functionalities of a voice assistant (Assistant on Health and Care Offline, ACHO) that aims to facilitate treatment adherence among elderly adults. Specifically adapted for its use in rural contexts, it does not require an Internet connection. Its development consisted of two stages: a first stage of problem diagnosis, in which the classic tools of ethnographic fieldwork were used, and a second stage of design implementing methodologies developed by Ambient Assisted Living (AAL) programmes. The main design characteristic of this new digital care system is that it is adapted to the needs of its end-users. It includes features such as voice customisation and the personal identification of medication, it can be connected to other digital devices, and information is introduced and supervised by healthcare professionals. These custom features introduce a safer medication administration procedure, improve supervision strategies, and increase patients' trust in the prescription process.

The Denied Pleasure of Eating: A Qualitative Study with Functionally Diverse People in Spain.

This qualitative study explores the difficulties in experiencing eating-derived pleasure within a group of functionally diverse people, based on personal interviews and Grounded Theory. Understanding the feelings and subjective experiences of functionally diverse people can help develop new approaches to address their loss of pleasure and motivation regarding food intake. The study included 27 participants, aged between 18 and 75 years, all of whom had a functional deficiency that affected the occupational aspects of the eating process. Interviews were conducted in clinical settings and several centres for differently abled people. Four main themes emerged from the analysis: eating through obligation; fear of eating; the social life of food; and the importance of the taste and visual aesthetics of food. These themes underscore the importance of taking into account the phenomenological experiences of pleasure in the eating process.

Fathers in the Care of Children with Disabilities: An Exploratory Qualitative Study.

OBJECTIVE: to explore the perception and experience of fathers of children with disabilities in caring for their children; to know their role and how these tasks impact their daily life, health and physical, mental and/or emotional well-being. METHODOLOGY: qualitative approach study with phenomenological design. The sample consisted of seven young fathers of underage children with various diagnoses. The data were collected through semi-structured interviews; the discourse analysis was carried out through open and axial coding processes. Three themes emerged from the results of the analysis: (1) shared responsibilities, (2) somewhat difficult to fit in, and (3) either you join or you split. RESULTS: Fathers must readjust their work schedule, reduce their working hours, or give up their job altogether to take care of their children, as well as give up their social life. They lack time to enjoy their leisure time, to spend time with their partner, to take care of themselves. This involvement in caregiving generates an important occupational imbalance that has repercussions above all on their mental health. CONCLUSIONS: The sharing of caregiving tasks also impacts significantly on parents' lives, it also takes away time and opportunities, and sometimes health and quality of life.

Construyendo y entendiendo la ocupación en contextos privados de libertad: experiencias de familias con hijos en situación de discapacidad en campamentos de refugiados / Construindo e compreendendo a ocupação em contextos privados de liberdade: experiências de famílias com crianças em situação de deficiência em campos de refugiados / Building and understanding occupation in contexts deprived of freedom: experiences of families with children in a situation of disability in refugee camps

Resumen Introducción Desde la Terapia Ocupacional se ha prestado una especial atención a la descripción y el análisis de las ocupaciones que tienen lugar en contextos de mayor vulnerabilidad y precariedad social en los que el desempeño y la participación ocupacional en condiciones de salud, bienestar y sentido personal pueden verse comprometidos de forma significativa. Objetivo Describir y explicar la ocupación desde un enfoque cultural en familias con hijos en situación de discapacidad que residen en un contexto privado de libertad como son los campamentos de refugiados saharauis. Método Estudio descriptivo transversal, de naturaleza etnográfica, realizado en los campamentos de refugiados saharauis de Tindouf (Argelia). Resultados En los campamentos, el tiempo invertido en el desarrollo de las actividades de la vida diaria dista mucho de occidente, partiendo de que el propio concepto 'tiempo' presenta un significado muy distinto. Los quehaceres diarios de los saharauis están marcados por tres "tiempos": (1) la luz del sol, (2) el rezo y (3) la hora del té, siendo las dos últimas las ocupaciones más significativas de la población refugiada. El significado de la cultura parecía ser una parte integral de la práctica profesional, así como las circunstancias vitales con las que convivían las familias con miembros en situación de discapacidad. Conclusión La Terapia Ocupacional debe verse interpelada a ofrecer oportunidades de vida cotidiana más digna para todas las personas, apoyando y protegiendo los derechos de participación ocupacional de todos los sujetos, especialmente de aquellos que experimentan situaciones de mayor vulnerabilidad.

Abstract Introduction From Occupational Therapy, special attention has been paid to the description and analysis of the occupations that take place in contexts of greater vulnerability and social precariousness in which occupational performance and participation in conditions of health, well-being, and personal sense can be significantly compromised. Objective To describe and explain the occupation from a cultural approach in families with children with disabilities living in a context deprived of freedom such as the Sahrawi refugee camps. Method Cross-sectional descriptive study, of an ethnographic nature, carried out in the Saharan refugee camps of Tindouf (Algeria). Results In the camps, the time invested in the development of daily life activities is far from the West, since the very concept of 'time' has a very different meaning. The daily chores of the Saharawis are marked by three "times": (1) sunlight, (2) prayer, and (3) tea time, the last two being the most significant occupations of the refugee population. The meaning of culture seemed to be an integral part of professional practice, as well as the life circumstances with which families with disabled members lived. Conclusion Occupational Therapy must be challenged to offer opportunities for a more dignified daily life for all people, supporting and protecting the rights of occupational participation of all subjects, especially those who experience situations of greater vulnerability.

Resumo Introdução Do ponto de vista da Terapia Ocupacional, foi dada atenção especial à descrição e análise das ocupações que ocorrem em contextos de maior vulnerabilidade e precariedade social nos quais o desempenho ocupacional e a participação em condições de saúde, bem-estar e senso pessoal podem ser significativamente comprometidos. Objetivo Descrever e explicar a ocupação a partir de uma abordagem cultural em famílias com crianças deficientes que vivem em um contexto privado de liberdade, como os campos de refugiados saharauis. Método: Estudo descritivo transversal, de natureza etnográfica, realizado nos campos de refugiados saarianos de Tindouf (Argélia). Resultados Nos campos, o tempo gasto no desenvolvimento das atividades da vida diária está longe do Ocidente, uma vez que o próprio conceito de "tempo" tem um significado muito diferente. As tarefas diárias dos saharauis são marcadas por três "tempos": (1) luz solar, (2) oração, e (3) hora do chá, sendo as duas últimas as ocupações mais significativas da população refugiada. O significado da cultura parecia ser parte integrante da prática profissional, assim como as circunstâncias de vida com as quais as famílias com membros deficientes viviam. Conclusão : A terapia ocupacional deve ser desafiada a oferecer oportunidades para uma vida diária mais digna para todas as pessoas, apoiando e protegendo os direitos de participação ocupacional de todos os sujeitos, especialmente aqueles que vivenciam situações de maior vulnerabilidade.

Eating Experiences of People with Disabilities: A Qualitative Study in Spain.

BACKGROUND: Disability causes changes in the eating process, which is central to the definition of each individual's social and psychological spaces. METHODS: This is a qualitative study based on grounded theory. Interviews were carried out in clinical hospital settings and headquarters of several disability organisations. The study included 27 individuals, aged between 18-75 years. All participants had a disability that caused a functional deficiency in the occupational aspects of the eating process. RESULTS: The respondents' narratives were analysed through observations made in different contexts, allowing us to describe and understand the significance attributed by the participants to their reality and experiences. Three key themes emerged from the analysis: (1) waning bodies (assumption of a diminished corporality); (2) redefinition of food-related social spaces; and (3) perceived burdensomeness, shame, and loneliness. CONCLUSIONS: Assisted feeding tends to prioritise the nutritional component of food ingestion. However, cultural, social, and contextual factors have a critical impact on an individual's well-being and quality of life. This study stresses the importance of re-addressing intervention models affecting differently-abled people and incorporating approaches that take into account the contextual aspects of occupational therapy.