Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.788
Filtrar
2.
Medicine (Baltimore) ; 98(33): e16697, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415361

RESUMO

BACKGROUND: Patient-centered care should be the focus of health services, where improvements in the communication skills of health professionals promote excellent health and quality care. Thus, this study is a protocol for a systematic review and meta-analysis to evaluate the effectiveness of training programs in communication skills to promote self-efficacy in the communication of health personnel. METHODS: This systematic review protocol is conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) statement guidelines and the Cochrane Handbook of Systematic Reviews of Interventions. The review should include studies carried out with health professionals who have undergone training in communication skills aimed at promoting their self-efficacy. Clinical trials (randomized, non-randomized), community trials, and quasi-experimental studies should be included. Therefore, the comprehensive search strategy will be conducted in the following databases: PubMed/Medline, Scopus, Web of Science, EMBASE, Science Direct, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL). Two independent reviewers will conduct all study selection procedures, data extraction, and methodological evaluation, and disagreements will be referred to a third reviewer. RevMan 5.3 software will be used to gather data and perform the meta-analysis if possible. RESULTS: This systematic review will provide evidence on more effective programs for communication skills training and will consider information such as duration, educational strategies, assessment measures, and outcomes that promote health worker self-efficacy. DISCUSSION: This systematic review should provide evidence for effective communication skills training for health professionals in order to guide new strategies for quality care. DISSEMINATION AND ETHICS: The findings of this scoping review will be disseminated in print, at conferences, or via peer-reviewed journals. Ethical approval is not necessary as this paper does not involve patient data. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019129384.


Assuntos
Comunicação , Educação/métodos , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Autoeficácia , Adulto , Feminino , Humanos , Masculino , Metanálise como Assunto , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Revisão Sistemática como Assunto
3.
Rev. Ciênc. Plur ; 5(1): 52-70, jun. 2019. ilus, tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1007343

RESUMO

Introdução:Os serviços de emergência médica exigem do profissional da saúde uma pronta resposta às demandas de cada paciente. Nesse contexto, o estresse laboral pode ser extremamente destrutivo não só para o trabalhador, mas também para o serviço de saúde prestado.Objetivo:Assim, este estudo tem como objetivo analisar os fatores desencadeantes do estresse laboral em profissionais de saúde que trabalham em serviços de emergência médica.Metodologia:Para isso, foi realizada uma revisão integrativa de literatura, tendo como fonte as basesde dados Lilacs, MedLinee Scielo. Foram incluídos estudos transversais ou longitudinais em inglês, português ou espanhol sem restrição de período de publicação que tinham como objetivo avaliar os níveis de estresse em profissionais de saúde que trabalham em serviços de emergência médica. Logo, nove artigos transversais e dois longitudinais foram incluídos, totalizando onze artigos.Resultados:Como resultado, observou-se que uma série de fatores ambientais (más condições de trabalho, atividades de administração) e pessoais(união estável, menor tempo de serviço) são associados ao estresse laboral. Todavia, principalmente os fatores relacionados ao ambiente são passíveis de intervenção.Conclusões:Dessa forma, surge a necessidade de políticas de melhoria do ambiente de trabalho e de empoderamento do profissional de saúde que trabalha em serviços de emergência médica (AU).


Introduction:The emergency medical services require the health professional to respond promptly to the demands of each patient. In this context, work stress can be extremely destructive not only for the worker, but also for the health service provided. Objective:Thus, this study aims to analyze the factors that trigger work stress in health professionals working in emergency medical services.Methods:For this, a integrative review of the literature was performed, based on the Lilacs, MedLineand Scielodatabases. We included cross-sectional or longitudinal studies in English, Portuguese or Spanish without restriction of publication period that aimed to evaluate stress levels in health professionals working in emergency medical services. Therefore, nine transverse and two longitudinal articles were included, totaling eleven articles.Results:As a result, it was observed that a series of environmental factors (poor working conditions, administration activities) and personal factors (stable union, shorter working time) are associated with work stress. However, mainly environmental factors are amenable to intervention.Conclusions:Thus, there is a need for policies to improve the work environment and the empowerment of the health professional working in emergency medical services (AU).


Assuntos
Pessoal de Saúde , Pessoal de Saúde/psicologia , Serviços Médicos de Emergência/métodos , Estresse Ocupacional/psicologia , Brasil , Saúde Pública , Revisão
4.
J Glob Health ; 9(1): 011101, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31275570

RESUMO

Background: Measures of quality of care in low- and middle-income countries (LMICs) rarely include experience of care. This gap in service quality metrics may be driven by a lack of understanding of client and provider perspectives. Understanding these perspectives is a critical first step in not only improving metrics, but also in improving service delivery. This study identifies the items antenatal care (ANC) clients and health care providers in Tanzania associate with a quality ANC service and explores the experience of care domain from both client and provider perspectives. Methods: We conducted semi-structured interviews with15 providers and 35 clients in Tanzania that included a free-listing activity to elicit items clients and providers associate with quality ANC services. We analyzed the free-listing for rank order and frequency to identify the most salient items, which were included in the second phase of data collection. We then conducted semi-structured interviews with a pile sort activity with the same 15 providers and 32 new clients to understand the importance of the items identified in the free-listing. We used a thematic analysis driven by the framework approach to analyze interview data. Results: Both clients and providers perceived quality of ANC as being comprised of items related to experience of care, provision of care, and cross-cutting essential physical and human resources. The free-listing findings illuminated that the experience of care was equally important to clients and providers as the availability of physical and human resources and the content of the care delivered. In addition, clients and providers perceived that a positive patient care experience - marked by good communication, active listening, keeping confidentiality, and being spoken to politely - increased utilization of health services and improved health outcomes. Conclusions: The experience of care in LMICs is an overlooked, yet critically important topic. Understanding the experience of care from those who receive and deliver services is key to measuring and improving the quality of ANC. Our research highlights the importance of incorporating experience of care into future quality improvement activities and quality measures. By doing so, we identify barriers and facilitating factors of practical use to policy-makers and governments in LMICs.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Pessoal de Saúde/psicologia , Cuidado Pré-Natal , Qualidade da Assistência à Saúde , Adolescente , Adulto , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Tanzânia , Adulto Jovem
5.
JAMA ; 322(3): 229-239, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31310299

RESUMO

Importance: Keeping a diary for patients while they are in the intensive care unit (ICU) might reduce their posttraumatic stress disorder (PTSD) symptoms. Objectives: To assess the effect of an ICU diary on the psychological consequences of an ICU hospitalization. Design, Setting, and Participants: Assessor-blinded, multicenter, randomized clinical trial in 35 French ICUs from October 2015 to January 2017, with follow-up until July 2017. Among 2631 approached patients, 709 adult patients (with 1 family member each) who received mechanical ventilation within 48 hours after ICU admission for at least 2 days were eligible, 657 were randomized, and 339 were assessed 3 months after ICU discharge. Interventions: Patients in the intervention group (n = 355) had an ICU diary filled in by clinicians and family members. Patients in the control group (n = 354) had usual ICU care without an ICU diary. Main Outcomes and Measures: The primary outcome was significant PTSD symptoms, defined as an Impact Event Scale-Revised (IES-R) score greater than 22 (range, 0-88; a higher score indicates more severe symptoms), measured in patients 3 months after ICU discharge. Secondary outcomes, also measured at 3 months and compared between groups, included significant PTSD symptoms in family members; significant anxiety and depression symptoms in patients and family members, based on a Hospital Anxiety and Depression Scale score greater than 8 for each subscale (range, 0-42; higher scores indicate more severe symptoms; minimal clinically important difference, 2.5); and patient memories of the ICU stay, reported with the ICU memory tool. Results: Among 657 patients who were randomized (median [interquartile range] age, 62 [51-70] years; 126 women [37.2%]), 339 (51.6%) completed the trial. At 3 months, significant PTSD symptoms were reported by 49 of 164 patients (29.9%) in the intervention group vs 60 of 175 (34.3%) in the control group (risk difference, -4% [95% CI, -15% to 6%]; P = .39). The median (interquartile range) IES-R score was 12 (5-25) in the intervention group vs 13 (6-27) in the control group (difference, -1.47 [95% CI, -1.93 to 4.87]; P = .38). There were no significant differences in any of the 6 prespecified comparative secondary outcomes. Conclusions and Relevance: Among patients who received mechanical ventilation in the ICU, the use of an ICU diary filled in by clinicians and family members did not significantly reduce the number of patients who reported significant PTSD symptoms at 3 months. These findings do not support the use of ICU diaries for preventing PTSD symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT02519725.


Assuntos
Cuidados Críticos/psicologia , Unidades de Terapia Intensiva , Respiração Artificial/psicologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Idoso , Família/psicologia , Feminino , Pessoal de Saúde/psicologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Registros
6.
Soins ; 64(836): 45-48, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31208583

RESUMO

Maternity professionals are sometimes required to provide care to migrant women in precarious circumstances. Decisions regarding the future and the social and medical support provided to these mothers and their babies must be made quickly and be efficient and effective, despite having to contend with a lack of resources. A qualitative study focused on professionals' emotional reactions in these contexts combining pregnancy, vulnerability, migration and perinatal care. It enabled an original research protocol to be established favouring professionals' reflexivity.


Assuntos
Pessoal de Saúde/psicologia , Pessoas em Situação de Rua , Serviços de Saúde Materna , Migrantes , Emoções , Feminino , Humanos , Gravidez , Pesquisa Qualitativa
7.
Soins ; 64(836): 52-54, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31208585

RESUMO

In humanitarian contexts, the confrontation with extreme trauma generates in therapists specific countertransference reactions which can unsettle the care. The transmission of the trauma occurs around an emerging scenario which must be supervised in order for it to become a therapeutic tool.


Assuntos
Contratransferência (Psicologia) , Pessoal de Saúde/psicologia , Socorro em Desastres , Ferimentos e Lesões/psicologia , Humanos , Ferimentos e Lesões/terapia
8.
BMC Psychol ; 7(1): 38, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234924

RESUMO

BACKGROUND: Long-Term Conditions are physical health issues which profoundly impact physical and psychological outcomes and have reached epidemic worldwide levels. An increasing evidence-base has developed for utilizing Supported Self-Management to ensure Health, Social Care & Voluntary staff are knowledgeable, skilled, and experienced to enable patients to have the confidence and capability to self-manage their conditions. However, despite Health Psychology theories underpinning chronic care models demonstrating beliefs are crucially associated with intention and behaviour, staff beliefs towards Supported Self-Management have received little attention. Therefore, the study aimed to explore healthcare professionals' beliefs towards Supported Self-Management for Long-Term Conditions using the Theory of Planned Behaviour. METHODS: A mixed-methods approach was conducted within a single UK local government authority region in 2 phases: (1) Qualitative focus group of existing Supported Self-Management project staff (N = 6); (2) Quantitative online questionnaire of general Long-Term Conditions staff (N = 58). RESULTS: (1) Eighty two utterances over 20 theme sub-codes demonstrated beliefs that Supported Self-Management improves healthcare outcomes, but requires enhancements to patient and senior stakeholder buy-in, healthcare culture-specific tailoring, and organizational policy and resources; (2) Mean scores indicated moderate-strength beliefs that Supported Self-Management achieves positive healthcare outcomes, but weak-strength intentions to implement Supported Self-Management and beliefs it is socially normative and perceived control over implementing it. Crucially, regression analyses demonstrated intentions to implement Supported Self-Management were only associated with beliefs that important others supported it and perceived control over, or by whether it was socially encouraged. CONCLUSIONS: Healthcare professionals demonstrated positive attitudes towards Supported Self-Management improving healthcare outcomes. However, intentions towards implementing this approach were low with staff only slightly believing important others (including patients and clinicians) supported it and that they had control over using it. Future Supported Self-Management projects should seek to enhance intention (and consequently behaviour) through targeting beliefs that important others do indeed actually support this approach and that staff have control over implementing it, as well as enhancing social encouragement.


Assuntos
Atitude do Pessoal de Saúde , Doença Crônica/terapia , Pessoal de Saúde/psicologia , Autogestão , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
9.
BMC Public Health ; 19(1): 695, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170964

RESUMO

BACKGROUND: Malaria remains endemic in Ghana despite several interventions. Studies have demonstrated very high levels of asymptomatic malaria parasitaemia in both under-five and school-age children. Mass testing, treatment and tracking (MTTT) of malaria in communities is being proposed for implementation with the argument that it can reduce parasite load, amplify gains from the other control interventions and consequently lead to elimination. However, challenges associated with implementing MTTT such as feasibility, levels of coverage to be achieved for effectiveness, community perceptions and cost implications need to be clearly understood. This qualitative study was therefore conducted in an area with on-going MTTT to assess community and health workers' perceptions about feasibility of scale-up and effectiveness to guide scale-up decisions. METHODS: This qualitative study employed purposive sampling to select the study participants. Ten focus group discussions (FGDs) were conducted in seven communities; eight with community members (n = 80) and two with health workers (n = 14). In addition, two in-depth interviews (IDI) were conducted, one with a Physician Assistant and another with a Laboratory Technician at the health facility. All interviews were recorded, transcribed, translated and analyzed using QSR NVivo 12. RESULTS: Both health workers and community members expressed positive perceptions about the feasibility of implementation and effectiveness of MTTT as an intervention that could reduce the burden of malaria in the community. MTTT implementation was perceived to have increased sensitisation about malaria, reduced the incidence of malaria, reduced household expenditure on malaria and alleviated the need to travel long distances for healthcare. Key challenges to implementation were doubts about the expertise of trained Community-Based Health Volunteers (CBHVs) to diagnose and treat malaria appropriately, side effects of Artemisinin-based Combination Therapies (ACTs) and misconceptions that CBHVs could infect children with epilepsy. CONCLUSION: The study demonstrated that MTTT was perceived to be effective in reducing malaria incidence and related hospital visits in participating communities. MTTT was deemed useful in breaking financial and geographical barriers to accessing healthcare. The interventions were feasible and acceptable to community members, despite observed challenges to implementation such as concerns about CBHVs' knowledge and skills and reduced revenue from internally generated funds (IGF) of the health facility.


Assuntos
Pessoal de Saúde/psicologia , Implementação de Plano de Saúde , Controle de Infecções , Malária/psicologia , Programas de Rastreamento/psicologia , Adulto , Anti-Infecciosos/uso terapêutico , Artemisininas/uso terapêutico , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Grupos Focais , Gana/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Malária/epidemiologia , Masculino , Programas de Rastreamento/métodos , Parasitemia/epidemiologia , Parasitemia/psicologia , Percepção , Pesquisa Qualitativa
10.
Work ; 63(2): 205-218, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156202

RESUMO

BACKGROUND: Mindfulness interventions aim to foster greater attention and awareness of present moment experiences. Uptake of mindfulness programs in the workplace has grown as organizations look to support employee health, wellbeing, and performance. OBJECTIVE: In support of evidence-based decision making in workplace contexts, we created an evidence map summarizing physical and mental health, cognitive, affective, and interpersonal outcomes from systematic reviews of randomized controlled trials (RCTs) of mindfulness interventions. METHODS: We searched nine electronic databases to July 2017, dually-screened all reviews, and consulted topic experts to identify systematic reviews on mindfulness interventions. The distribution of evidence is presented as an evidence map in a bubble plot. RESULTS: In total, 175 systematic reviews met inclusion criteria. Reviews included a variety of mindfulness-based interventions. The largest review included 109 randomized controlled trials. The majority of these addressed general health, psychological conditions, chronic illness, pain, and substance use. Twenty-six systematic reviews assessed studies conducted in workplace settings and with healthcare professionals, educators, and caregivers. The evidence map shows the prevalence of research by the primary area of focus. An outline of promising applications of mindfulness interventions is included. CONCLUSIONS: The evidence map provides an overview of existing mindfulness research. It shows the body of available evidence to inform policy and organizational decision-making supporting employee wellbeing in work contexts.


Assuntos
Meditação/métodos , Atenção Plena/métodos , Pessoal de Saúde/psicologia , Promoção da Saúde/métodos , Promoção da Saúde/normas , Humanos , Programas de Rastreamento/métodos , Meditação/psicologia , Atenção Plena/tendências , Local de Trabalho/psicologia
11.
Postgrad Med ; 131(5): 357-365, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155994

RESUMO

Objective: Our aim was to explore how differing attitudes, expectations, and experiences among people with obesity (PwO) and healthcare providers (HCPs) might have an impact on effectively implementing current obesity treatment guidelines. Methods: Online surveys were conducted among 3,008 adult PwO (BMI≥30 by self-reported height and weight) and 606 HCPs. Results: PwO with weight loss ≥ 10% during the previous three years were more likely to have been diagnosed with obesity and to have discussed a weight loss plan with an HCP. However, only 21% believe HCPs have a responsibility to actively contribute to their obesity treatment. Further, HCPs tend not to effectively communicate the diagnosis of obesity, its nature as a serious and chronic disease, the full range of treatment options, and obesity's implications for health and quality of life. Regarding treatment goals, HCPs more often focus on BMI reduction, while PwO's goals focus on improved functioning, energy, and appearance. HCPs also tend to underestimate their patients' motivation to address their obesity. Twenty-eight percent of HCPs 'completely agreed' that losing weight was a high priority for PwO, whereas more than half of PwO 'completely agreed' that losing weight was a high priority for them. When asked how their HCP could better support them, PwO most often expressed a desire for helpful resources, as well as assistance with specific and realistic goal-setting to improve health. Conclusions: HCPs can more effectively implement obesity treatment guidelines by more clearly and proactively communicating with PwO about their diagnosis, health implications of obesity, desired treatment goals, and the full range of treatment options. HCPs should understand that most PwO believe that managing their disease is solely their own responsibility. HCPs can also encourage more effective conversations by better appreciating their patients' motivation and treatment goals.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Pessoal de Saúde/psicologia , Obesidade/patologia , Autorrelato , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/terapia , Autogestão/psicologia , Apoio Social , Perda de Peso
12.
Work ; 63(1): 49-56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31127744

RESUMO

BACKGROUND: Health coaching promotes healthy lifestyles and may be particularly helpful for employees with chronic disease. OBJECTIVE: Evaluate the effects of a health coaching program that targeted health-system employees with at least one cardiovascular disease (CVD) risk factor. METHODS: Fifty-four employees volunteered for a health coaching program (6-session, 12-week program, at least one cycle). 40 (74%) completed (mean age [SD] = 53.3 [10.3] years, Female = 95%, Caucasian = 83%). A certified and integrative health coach/nutritionist provided coaching. Self-reported outcomes were collected using a pre-post design. RESULTS: Participants reported high rates of obesity (75%), hypertension (52.5%), diabetes/prediabetes (47.5%), and hyperlipidemia (40%). In addition, 20% reported chronic pain/rehabilitation needs, 17.5% seasonal depression, and 30% other significant co-morbidities. Following coaching, participants reported significant weight loss (mean [SD] 7.2 [6.6] pounds, p < 0.0001, d = 1.11), increased exercise (from 0.8 to 2.3 sessions/week, p < 0.001, d = .89), reduced perceived stress (p < 0.04, d = .42), and a trend for improved sleep (p = 0.06, d = .38). Reduced stress correlated with both increased exercise (r = -.39, p < 0.05) and decreased fatigue (r = .36, p = 0.07). CONCLUSION: Health coaching for healthcare employees with obesity and other CVD risk factors is a promising approach to losing weight, reducing stress, making healthy lifestyle changes, and improving health and well-being.


Assuntos
Doença Crônica/psicologia , Pessoal de Saúde/psicologia , Tutoria/métodos , Adulto , Idoso , Doença Crônica/epidemiologia , Feminino , Promoção da Saúde/métodos , Promoção da Saúde/estatística & dados numéricos , Humanos , Hiperlipidemias/epidemiologia , Hiperlipidemias/psicologia , Hipertensão/epidemiologia , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/psicologia , Projetos Piloto , Autorrelato
13.
Work ; 63(1): 57-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31127745

RESUMO

BACKGROUND: Work-related stress is a significant health and safety concern. OBJECTIVES: To assess the prevalence of burnout and occupational stress among emergency department (ED) professionals and to identify associated factors. METHODS: A cross-sectional study included all ED professionals of a French university hospital. Data were collected using the French versions of the Maslach Burnout Inventory and the Karasek Job Content Questionnaire. RESULTS: Of the 166 respondents (75.8%), 19.3% reported burnout and 27.1% job strain. Factors associated with burnout were work-related dissatisfaction, fear of making mistakes, lack of time to perform tasks, and being younger. Those factors associated with job strain were having at least one sick leave in the past year, being affected by hard work, interpersonal conflicts at workplace, and sleep disorders. CONCLUSIONS: Compared to the literature, our results showed a lower prevalence of burnout among physicians but similar among paramedics. The proportion of professionals with job strain was higher than that of the whole French working population. Organizational factors and the work environment were the primary causes of burnout and job strain, while being younger was the only associated sociodemographic factor. The identification of professionals experiencing difficulty is essential to ensure patient safety, particularly in the high-risk field of emergency medicine.


Assuntos
Esgotamento Profissional/etiologia , Serviço Hospitalar de Emergência/normas , Pessoal de Saúde/psicologia , Estresse Psicológico/etiologia , Adulto , Análise de Variância , Esgotamento Profissional/psicologia , Estudos Transversais , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , França , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Prevalência , Estresse Psicológico/psicologia , Inquéritos e Questionários , Local de Trabalho/psicologia , Local de Trabalho/normas
14.
Infect Dis Poverty ; 8(1): 30, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31036087

RESUMO

BACKGROUND: In 2012, the Ugandan Government declared an epidemic of Nodding Syndrome (NS) in the Northern districts of Gulu, Kitgum, Lamwo and Pader. Treatment guidelines were developed and NS treatment centres were established to provide symptomatic control and rehabilitation. However, a wide gap remained between the pre-defined care standards and the quality of routine care provided to those affected. This study is to qualitatively assess adherence to accepted clinical care standards for NS; identify gaps in the care of affected children and offer Clinical Support Supervision (CSS) to Primary Health Care (PHC) staff at the treatment centres; and identify psychosocial challenges faced by affected children and their caregivers. METHODS: This case study was carried out in the districts of Gulu, Kitgum, Lamwo and Pader in Uganda from September to December in 2015. Employing the 5-stage approach of Clinical Audit, data were collected through direct observations and interviews with PHC providers working in public and private-not-for-profit health facilities, as well as with caregivers and political leaders. The qualitative data was analysed using Seidel model of data processing. RESULTS: Clinical Audit and CSS revealed poor adherence to treatment guidelines. Many affected children had sub-optimal NS management resulting in poor seizure control and complications including severe burns. Root causes of these outcomes were frequent antiepileptic drugs stock outs, migration of health workers from their work stations and psychosocial issues. There was hardly any specialized multidisciplinary team (MDT) to provide for the complex rehabilitation needs of the patients and a task shifting model with inadequate support supervision was employed, leading to loss of skills learnt. Reported psychosocial and psychosexual issues associated with NS included early pregnancies, public display of sexual behaviours and child abuse. CONCLUSIONS: Despite involvement of relevant MDT members in the development of multidisciplinary NS guidelines, multidisciplinary care was not implemented in practice. There is urgent need to review the NS clinical guidelines. Quarterly CSS and consistent anticonvulsant medication are needed at health facilities in affected communities. Implementation of the existing policies and programs to deal with the psychosocial and psychosexual issues that affect children with NS and other chronic conditions is needed.


Assuntos
Atitude do Pessoal de Saúde , Fidelidade a Diretrizes , Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Síndrome do Cabeceio/terapia , Adolescente , Anticonvulsivantes/uso terapêutico , Criança , Pré-Escolar , Auditoria Clínica , Epilepsia , Humanos , Lactente , Entrevistas como Assunto , Síndrome do Cabeceio/tratamento farmacológico , Síndrome do Cabeceio/epidemiologia , Pesquisa Qualitativa , Resultado do Tratamento , Uganda
15.
Transplant Proc ; 51(4): 1038-1043, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31101167

RESUMO

PURPOSE: Organ transplant coordinators are affected by the experienced traumas of patients and relatives, which increases their risk of compassion fatigue. This study was conducted to determine the effect of compassion fatigue on organ transplant coordinators and to reveal its relationship with professional quality of life and endurance. MATERIALS AND METHODS: This descriptive study was carried out between November 2017 and March 2018 among organ transplant coordinators working in Turkey. Out of the total 187 coordinators, 91 (48.6%) agreed to participate. Data collection was performed via a demographic information questionnaire, the 24-item Compassion Scale developed by Pommier, the 30-item Professional Quality of Life (ProQOL) Scale developed by Stamm, and the 33-item Psychological Endurance Scale developed by Friborg et al. FINDINGS: Among the compassion subscales, the highest mean scores were in the kindness subscale, while the lowest mean scores were received from the indifference subscale. In the ProQOL, the compassion satisfaction subscale received the highest scores. The scores of the Psychological Endurance Scale were also high. There were statistically significant, weak to moderate correlations between all compassion subdimensions with absolute values of correlation coefficients (r) ranging from 0.260 to 0.690 (P < .05). There was a significant positive correlation between the burnout and compassion fatigue/traumatic stress subscales of the ProQOL (r = 0.660; P < .001). CONCLUSIONS: These results demonstrate that ProQOL and psychological endurance are essential determinants of compassion fatigue among organ transplant coordinators. We suggest that correcting the working quality of organ transplant coordinators will reduce compassion fatigue and increase their psychological stability.


Assuntos
Esgotamento Profissional , Fadiga por Compaixão , Pessoal de Saúde/psicologia , Transplante de Órgãos/psicologia , Qualidade de Vida/psicologia , Adulto , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Turquia
16.
Malawi Med J ; 31(1): 31-38, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31143394

RESUMO

Background: Heart disease is one of the leading chronic conditions posing a major and growing threat to the public. Studies on quality of care given to patients with heart diseases in Nigeria are not available. The purpose of this study was to explore healthcare professionals' perception of quality of care of patients with heart disease at a tertiary hospital in Nigeria. Methods: A mixed method design was utilized in this study. Twenty eight healthcare professionals consisting of cardiologists, nurses, physiotherapists and dieticians were recruited into the study through purposive sampling technique. A questionnaire developed and validated from existing questionnaire was used to survey the health care professionals' perception of care and qualitative design was further used to explore their perceptions of care. The data were analyzed using descriptive statistics of percentages and graphs. The qualitative data were analyzed using thematic analysis. Quality of care was assessed through structure, process and outcome of care indices. Results: The mean age of the healthcare professionals was 38.46±8.988 years. 19 (66.7%) reported that there were treatment guidelines for cardiac disease management but there was no system for internal quality assurance. 18 (95%) out of these 19 healthcare professionals reported that the treatment guidelines were either never applied or not applied regularly during treatment. Other areas that were perceived as poor were poor teamwork, poor staff strength, inadequate equipment, and inadequate consultation with staff during procurement of medical supplies. Conclusion: Quality of care for cardiac patients in a Nigerian tertiary hospital was perceived as sub-optimal. There is a need for the improvement of the structure and process of quality of care to enhance quality of care for cardiac patients in Nigeria.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Cardiopatias/terapia , Assistência ao Paciente/normas , Qualidade da Assistência à Saúde , Adulto , Educação Profissionalizante , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Percepção , Guias de Prática Clínica como Assunto , Pesquisa Qualitativa
17.
Rev Lat Am Enfermagem ; 27: e3144, 2019 Apr 29.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31038637

RESUMO

OBJECTIVES: to evaluate the influence of burnout and coping strategies used by health professionals of the hospital emergency service on their mental health status and to determine sociodemographic and labor characteristics. METHOD: descriptive cross-sectional study in a sample of 235 nursing professionals and physicians who worked in four hospital emergency services. The Maslach Burnout Inventory, the General Health Questionnaire and the Inventario Breve de Afrontamiento-cope 28 were used as data collection instruments and specific and original questionnaires of sociodemographic and labor variables. Descriptive, quantitative and multivariate statistics were applied. RESULTS: the dimension of depersonalization, avoidance-centered coping and being a physician were related to the presence of somatic symptoms, anxiety, social dysfunction and depression. Increased professional experience was associated with greater social dysfunction among health personnel and increased number of patients was related to depressive symptoms among health professionals. CONCLUSIONS: the dimensions of emotional exhaustion and depersonalization, avoidance-centered coping, being a physician and a daily smoker increase the risk of a psychiatric case. The practice of daily physical exercise is a protective factor.


Assuntos
Esgotamento Profissional/psicologia , Serviço Hospitalar de Emergência , Pessoal de Saúde/psicologia , Transtornos Mentais/epidemiologia , Saúde Mental , Adaptação Psicológica , Esgotamento Profissional/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Espanha/epidemiologia , Inquéritos e Questionários
18.
Public Health ; 171: 15-23, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31075546

RESUMO

OBJECTIVES: Rheumatic heart disease (RHD) is a preventable disease frequently recognized in urban slums. Disease rates in Brazilian slums are incommensurate with the country's economic status and the existence of its universal healthcare system. Our study aimed to investigate what system issues may allow for disease persistence, focusing on issues surrounding access and utilization of primary and specialized healthcare services. STUDY DESIGN: This was a two-part (formative phase followed by implementation phase) qualitative study based on interviews and focus groups and analyzed via content analysis. METHODS: One focus group and 17 in-depth interviews with community health workers, primary care providers, and cardiologists who serve slum residents in Brazil and six interviews with key informants (community health researchers and cardiologists) were performed. Interviews with community health workers and primary care providers were from a single heath post in the neighborhood of Liberdade, a populous and previously unstudied slum in Salvador. Cardiologists were recruited from tertiary care referral hospitals in Salvador. RESULTS: Our findings revealed six major chronological categories/themes of issues and twenty subthemes that patients must overcome to avoid developing RHD or to have it successfully medically managed. Major themes include the effects of living in a slum (1), barriers to access and utilization of primary healthcare services (2), treatment in primary healthcare services (3), access/utilization of specialized healthcare services (4), treatment in specialized healthcare services (5), and certain systemic issues (6). CONCLUSION: Slums make residents sick in a manner of ways, and various bottlenecks impeding medical access to both primary care and specialty care exist, requiring multifaceted interventions. We detail major themes and finally suggest interventions that can allow for the health system to successfully eliminate RHD as a public health concern for slum residents.


Assuntos
Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Áreas de Pobreza , Cardiopatia Reumática/prevenção & controle , Cobertura Universal do Seguro de Saúde , Brasil/epidemiologia , Cardiologistas/psicologia , Agentes Comunitários de Saúde/psicologia , Grupos Focais , Humanos , Médicos de Atenção Primária/psicologia , Pesquisa Qualitativa , Cardiopatia Reumática/epidemiologia , Determinantes Sociais da Saúde
19.
Public Health ; 171: 31-40, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31082758

RESUMO

OBJECTIVES: The aims of this study were (1) to identify attributes for patient safety at a primary healthcare level and (2) to analyze conceptions of patients, professionals, and managers about how these attributes are being addressed. STUDY DESIGN: This was a qualitative study. METHODS: Participants were recruited from three primary care settings in Brazil. A total of 37 subjects (four physicians, three nurses, three dentists, three managers, five community assistants, and 19 patients) participated on interviews about their perceptions of safety attributes at the primary care settings involved in the study. Some of these participants attended a focus group meeting. A thematic categorical analysis was carried out to interpret the interviews. RESULTS: The main attributes for patient safety were valued by the participants. However, barriers such as discontinuity of care, interruptions during consultations, breakdowns in the communication, and ineffective teamwork were reported as frequent sources of patient safety issues. Reports of patients left unattended for excessive time because of the lack of accurate information and disruptions that took up to 35 min show that there is still a long way to go for primary care to be safe and effective in the study settings. CONCLUSIONS: It is necessary that the strategies meet the patient safety needs more effectively and efficiently. Further research is needed to understand the complex nature of the problems that affect patient safety in these settings so that appropriate decisions can be made.


Assuntos
Determinação de Necessidades de Cuidados de Saúde , Segurança do Paciente , Atenção Primária à Saúde/organização & administração , Pessoal Administrativo/psicologia , Pessoal Administrativo/estatística & dados numéricos , Adulto , Brasil , Comunicação , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
20.
BMC Public Health ; 19(1): 570, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088541

RESUMO

BACKGROUND: The most recent World Health Organization (WHO) guidelines on Human Immunodeficiency Virus (HIV) and infant feeding promotes exclusive breastfeeding (EBF) in resource limited settings for the prevention of mother to child transmission (PMTCT) of HIV. Literature reveals poor uptake of WHO feeding guidelines, with mixed feeding being a regular practice. In light of the limited success in EBF promotion, a realist review was conducted, analysing the use of feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa, where the majority of HIV childhood infections occur. We considered what mechanisms were at play, for whom and in what circumstances they led to exclusive breastfeeding. METHODS: Because infant feeding counselling is a complex social intervention with a non-linear causal pathway for preventing mother to child HIV transmission, a realist methodology was chosen for this study. Using Pawson's five stage sequence for conducting realist reviews, the results are presented as a set of identified and refined context-mechanism-outcome (CMO) configurations. These CMO configurations were used to show how particular outcomes occurred in specific contexts due to a generative mechanism and were developed through identifying a review question and program theory, searching for primary studies, quality appraisal, data extraction and data synthesis. RESULTS: From an initial 1010 papers, 27 papers met the inclusion criteria and were used to refine the program theory. Exclusive breastfeeding occurred when a woman was motivated regarding motherhood, had correct learning and understanding about infant feeding practices through counselling, no fear of breastfeeding or the impact of opposing feeding related cultural beliefs, and the support from others to be assertive about their feeding choices when faced with pressure to mix-feed. An additional CMO configuration was added during the refinement of the program theory identifying that mothers needed to not just understand but also prioritize EBF advice over cultural beliefs and stigma. CONCLUSION: The intended audience for this review are researchers and health care workers in PMTCT, particularly sub-Saharan Africa, who may benefit from the work that has been done to identify contexts for the success and failures of EBF.


Assuntos
Aleitamento Materno/psicologia , Aconselhamento/métodos , Infecções por HIV/psicologia , Pessoal de Saúde/psicologia , Mães/psicologia , Adulto , África ao Sul do Saara , Comportamento Alimentar/psicologia , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Soropositividade para HIV/psicologia , Soropositividade para HIV/transmissão , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Motivação
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA