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2.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34455733

RESUMO

PURPOSE: Nurses working during the coronavirus disease 2019 (COVID-19) pandemic have reported elevated levels of anxiety, burnout and sleep disruption. Hospital administrators are in a unique position to mitigate or exacerbate stressful working conditions. The goal of this study was to capture the recommendations of nurses providing frontline care during the pandemic. DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews were conducted during the first wave of the COVID-19 pandemic, with 36 nurses living in Canada and working in Canada or the United States. FINDINGS: The following recommendations were identified from reflexive thematic analysis of interview transcripts: (1) The nurses emphasized the need for a leadership style that embodied visibility, availability and careful planning. (2) Information overload contributed to stress, and participants appealed for clear, consistent and transparent communication. (3) A more resilient healthcare supply chain was required to safeguard the distribution of equipment, supplies and medications. (4) Clear communication of policies related to sick leave, pay equity and workload was necessary. (5) Equity should be considered, particularly with regard to redeployment. (6) Nurses wanted psychological support offered by trusted providers, managers and peers. PRACTICAL IMPLICATIONS: Over-reliance on employee assistance programmes and other individualized approaches to virtual care were not well-received. An integrative systems-based approach is needed to address the multifaceted mental health outcomes and reduce the deleterious impact of the COVID-19 pandemic on the nursing workforce. ORIGINALITY/VALUE: Results of this study capture the recommendations made by nurses during in-depth interviews conducted early in the COVID-19 pandemic.


Assuntos
Esgotamento Profissional/psicologia , COVID-19/enfermagem , Recursos Humanos de Enfermagem no Hospital/psicologia , Serviços de Saúde do Trabalhador , Estresse Psicológico/psicologia , Adulto , Esgotamento Profissional/prevenção & controle , Canadá , Comunicação , Feminino , Humanos , Entrevistas como Assunto , Liderança , Masculino , Determinação de Necessidades de Cuidados de Saúde , Política Organizacional , Pandemias , Equipamento de Proteção Individual , SARS-CoV-2 , Licença Médica , Estresse Psicológico/prevenção & controle , Estados Unidos , Carga de Trabalho
3.
WMJ ; 120(2): 137-141, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34255954

RESUMO

INTRODUCTION: The COVID-19 pandemic presented health care organizations with a unique challenge in determining effective management of a large-scale incident across an extended time period. CASE PRESENTATION: This report describes the response of a multisite integrated system to the COVID-19 pandemic through activation of the Hospital Incident Command System. DISCUSSION: A robust emergency response plan with multidisciplinary involvement can help to ensure clear lines of accountability and expedite decision-making. Consistent physician input across affected specialties allows for a robust understanding of impacted areas, peer-to-peer communication, and a sense of ownership across the medical staff. The necessity of effective communication with staff and patients during times of crisis cannot be understated. The potential for information overload in a pandemic is significant but can be overcome through consistent and transparent communication from leadership. CONCLUSION: Health systems should have a well-organized emergency response system prepared to launch in small-scale or large-scale situations. The threshold to implement the response system and accountability to make that decision must be a clearly defined organizational policy.


Assuntos
COVID-19/epidemiologia , Sistemas de Apoio a Decisões Administrativas , Planejamento em Desastres , Planejamento Hospitalar , Comunicação , Humanos , Estudos de Casos Organizacionais , Política Organizacional , Pandemias , SARS-CoV-2 , Capacidade de Resposta ante Emergências , Wisconsin/epidemiologia
4.
J Occup Health ; 63(1): e12248, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34217154

RESUMO

OBJECTIVES: This study identifies the ecological (ie, policy, environment, intrapersonal, and interpersonal) factors affecting the implementation of an Infant at Work program in a university setting. METHODS: Data were collected among faculty, staff, and graduate students at a large Midwestern university from February to July 2020 via focus group (FG) discussions with university employees (n = 22) and semistructured interviews with university administrators (n = 10). We used techniques from expanded grounded theory, allowing for a constant comparative approach to data contextualization and theme identification. RESULTS: Three themes emerged from the FG data: (i) program and policy scope, (ii) employee and employer benefits, and (iii) workplace concerns. Onsite daycares, flexible schedules and participation, and expanded childcare options were some of the programs and policies employees desired. However, barriers to implementing these types of programs include cost, safety, and structure of the work environment. CONCLUSIONS: Findings offer practical recommendations and strategies to improve work/life balance among parents transitioning back to work in a university environment. Findings also provide insight into the feasibility of family-friendly workplace policies and environments. Additionally, findings provide a framework for other organizations to implement similar Infant at Work programs to improve employee work/life balance.


Assuntos
Docentes/psicologia , Cuidado do Lactente/psicologia , Política Organizacional , Retorno ao Trabalho/psicologia , Local de Trabalho/psicologia , Adulto , Docentes/organização & administração , Feminino , Grupos Focais , Teoria Fundamentada , Humanos , Lactente , Cuidado do Lactente/organização & administração , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Admissão e Escalonamento de Pessoal , Avaliação de Programas e Projetos de Saúde , Meio Social , Universidades , Local de Trabalho/organização & administração
5.
BMJ Open ; 11(7): e043256, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253657

RESUMO

PURPOSE: To characterise the dynamics and consequences of bullying in academic medical settings, report factors that promote academic bullying and describe potential interventions. DESIGN: Systematic review. DATA SOURCES: We searched EMBASE and PsycINFO for articles published between 1 January 1999 and 7 February 2021. STUDY SELECTION: We included studies conducted in academic medical settings in which victims were consultants or trainees. Studies had to describe bullying behaviours; the perpetrators or victims; barriers or facilitators; impact or interventions. Data were assessed independently by two reviewers. RESULTS: We included 68 studies representing 82 349 respondents. Studies described academic bullying as the abuse of authority that impeded the education or career of the victim through punishing behaviours that included overwork, destabilisation and isolation in academic settings. Among 35 779 individuals who responded about bullying patterns in 28 studies, the most commonly described (38.2% respondents) was overwork. Among 24 894 individuals in 33 studies who reported the impact, the most common was psychological distress (39.1% respondents). Consultants were the most common bullies identified (53.6% of 15 868 respondents in 31 studies). Among demographic groups, men were identified as the most common perpetrators (67.2% of 4722 respondents in 5 studies) and women the most common victims (56.2% of 15 246 respondents in 27 studies). Only a minority of victims (28.9% of 9410 victims in 25 studies) reported the bullying, and most (57.5%) did not perceive a positive outcome. Facilitators of bullying included lack of enforcement of institutional policies (reported in 13 studies), hierarchical power structures (7 studies) and normalisation of bullying (10 studies). Studies testing the effectiveness of anti-bullying interventions had a high risk of bias. CONCLUSIONS: Academic bullying commonly involved overwork, had a negative impact on well-being and was not typically reported. Perpetrators were most commonly consultants and men across career stages, and victims were commonly women. Methodologically robust trials of anti-bullying interventions are needed. LIMITATIONS: Most studies (40 of 68) had at least a moderate risk of bias. All interventions were tested in uncontrolled before-after studies.


Assuntos
Bullying , Feminino , Humanos , Masculino , Política Organizacional
6.
Can J Anaesth ; 68(10): 1474-1484, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34195922

RESUMO

PURPOSE: In response to the rapid spread of SARS-CoV-2, hospitals in Canada enacted temporary visitor restrictions to limit the spread of COVID-19 and preserve personal protective equipment supplies. This study describes the extent, variation, and fluctuation of Canadian adult intensive care unit (ICU) visitation policies before and during the first wave of the COVID-19 pandemic. METHODS: We conducted an environmental scan of Canadian hospital visitation policies throughout the first wave of the pandemic. We conducted a two-phased study analyzing both quantitative and qualitative data. RESULTS: We collected 257 documents with reference to visitation policies (preCOVID, 101 [39%]; midCOVID, 71 [28%]; and lateCOVID, 85 [33%]). Of these 257 documents, 38 (15%) were ICU-specific and 70 (27%) referenced the ICU. Most policies during the midCOVID/lateCOVID pandemic period allowed no visitors with specific exceptions (e.g., end-of-life). Framework analysis revealed five overarching themes: 1) reasons for restricted visitation policies; 2) visitation policies and expectations; 3) exceptions to visitation policy; 4) patient and family-centred care; and 5) communication and transparency. CONCLUSIONS: During the first wave of the COVID-19 pandemic, most Canadian hospitals had public-facing visitor restriction policies with specific exception categories, most commonly for patients at end-of-life, patients requiring assistance, or COVID-19 positive patients (varying from not allowed to case-by-case). Further studies are needed to understand the consistency with which visitation policies were operationalized and how they may have impacted patient- and family-centred care.


Assuntos
COVID-19 , Pandemias , Adulto , Canadá , Humanos , Unidades de Terapia Intensiva , Política Organizacional , Políticas , SARS-CoV-2 , Visitas a Pacientes
7.
Int J Equity Health ; 20(1): 164, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-34261500

RESUMO

In this paper we explore some of the ways systemic racism operates and is maintained within our health and social services. We look at a very specific context, that of Nunavik Quebec, land and home to 13,000 Nunavimmiut, citizens of Quebec and Canada, signatories of the James Bay and Northern Quebec Agreement. We operationalize some of the ways in which policies and practices create and support social hierarchies of knowledges, also called epistemic racism, and how it impacts our ability to offer quality care that Indigenous peoples can trust and use.


Assuntos
Política de Saúde , Serviços de Saúde do Indígena , Disparidades em Assistência à Saúde , Racismo , Canadá/etnologia , Disparidades em Assistência à Saúde/etnologia , Humanos , Povos Indígenas , Conhecimento , Grupo com Ancestrais Oceânicos , Política Organizacional , Grupos Populacionais
8.
J Sci Med Sport ; 24(8): 781-786, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34148795

RESUMO

OBJECTIVES: To conduct a document analysis of sports and leisure activity heat-related injury prevention resources in Australia and develop an understanding of the content within those resources. DESIGN & METHODS: Heat resources were included if they dealt specifically with, or could be extrapolated to, prevention of heat-related injuries. Collating strategies for the catalogue included: (1) a detailed search of the organisation's website and (2) an online search for sport specific heat resources. A content analysis of each resource was first performed, and descriptive codes were assigned to the data using qualitative data analysis software. Every coded text was recorded as an individual data point (n). Common sub-categories were identified by thematic analysis and collated under three broader categories. RESULTS: A total of 468 data points were identified within the 64 heat resources found. Guidelines (n = 20) and policies (n = 18) were the most common type of resources followed by factsheets (n = 9), webpages (n = 8), laws and by-laws (n = 2). Three overarching categories emerged through the data analysis process: preventive strategies (n = 299, 63.9%), risk factors (n = 94, 20.1%), treatment (n = 75, 16.0%). Activity modification, which included information on rescheduling games and extra breaks, was the most common intervention. Cricket, soccer, swimming and triathlon had the most complete set of heat resources. CONCLUSIONS: The findings of this study provide an insight into the composition of heat-related sports injury prevention resources within Australia and identify areas for development. As the resources were incomplete for many sports, the development of more comprehensive heat safety resources is required to ensure the safety of participants.


Assuntos
Política de Saúde , Transtornos de Estresse por Calor/prevenção & controle , Temperatura Alta , Atividades de Lazer , Esportes/fisiologia , Austrália , Humanos , Política Organizacional , Fatores de Risco , Medicina Esportiva/organização & administração
13.
Br J Nurs ; 30(9): 565, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33983818

RESUMO

Sam Foster, Chief Nurse, Oxford University Hospitals, considers the question of a single NHS uniform for England, with the launch of a consultation on the idea.


Assuntos
Vestuário , Política Organizacional , Medicina Estatal , Inglaterra , Humanos , Medicina Estatal/organização & administração
14.
J Law Med Ethics ; 49(1): 50-58, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33966653

RESUMO

U.S. immigration policies and enforcement can make immigrants fearful of accessing healthcare. Although current immigration policies restrict enforcement in "sensitive locations" including healthcare facilities, there are reports of enforcement actions in such settings.


Assuntos
Emigração e Imigração/legislação & jurisprudência , Pessoal de Saúde/psicologia , Aplicação da Lei , Política Organizacional , Instalações de Saúde , Humanos , Inquéritos e Questionários , Estados Unidos , Local de Trabalho
15.
J Law Med Ethics ; 49(1): 64-73, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33966659

RESUMO

The authors surveyed hospitals across the country on their policies regarding overlapping surgery, and found large variation between hospitals in how this practice is regulated. Specifically, institutions chose to define "critical portions" in a variety of ways, ultimately affecting not only surgical efficiency but also the autonomy of surgical trainees and patient experiences at these different hospitals.


Assuntos
Hospitais , Política Organizacional , Admissão e Escalonamento de Pessoal , Procedimentos Cirúrgicos Operatórios , Guias como Assunto , Humanos , Inquéritos e Questionários , Estados Unidos
17.
Med Care ; 59(Suppl 3): S259-S269, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33976075

RESUMO

BACKGROUND: In the unique context of rural Veterans' health care needs, expansion of US Department of Veterans Affairs and Community Care programs under the MISSION Act, and the uncertainties of coronavirus disease 2019 (COVID-19), it is critical to understand what may support effective interorganizational care coordination for increased access to high-quality care. OBJECTIVES: We conducted a systematic review to examine the interorganizational care coordination initiatives that Veterans Affairs (VA) and community partners have pursued in caring for rural Veterans, including challenges and opportunities, organizational domains shaping care coordination, and among these, initiatives that improve or impede health care outcomes. RESEARCH DESIGN: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search 2 electronic databases (PubMed and Embase) for peer-reviewed articles published between January 2009 and May 2020. Building on prior research, we conducted a systematic review. RESULTS: Sixteen articles met our criteria. Each captured a unique health care focus while examining common challenges. Four organizational domains emerged: policy and administration, culture, mechanisms, and relational practices. Exemplars highlight how initiatives improve or impede rural health care delivery. CONCLUSIONS: This is the first systematic review, to our knowledge, examining interorganizational care coordination of rural Veterans by VA and Community Care programs. Results provide exemplars of interorganizational care coordination domains and program effectiveness. It suggests that partners' efforts to align their coordination domains can improve health care, with rurality serving as a critical contextual factor. Findings are important for policies, practices, and research of VA and Community Care partners committed to improving access and health care for rural Veterans.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Acesso aos Serviços de Saúde , Qualidade da Assistência à Saúde , Serviços de Saúde Rural/organização & administração , Serviços de Saúde para Veteranos Militares/organização & administração , Humanos , Cultura Organizacional , Política Organizacional , Avaliação de Programas e Projetos de Saúde , Estados Unidos , United States Department of Veterans Affairs/legislação & jurisprudência
18.
Res Q Exerc Sport ; 92(2): 209-221, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34009092

RESUMO

Purpose: Physical education policies provide guidance and accountability to develop quality programs that increase physical literacy. The purpose of this study was to conduct a systematic review of physical education policy research to explore its effects on the school environment and programming as an essential component of physical education. Methods: Using the PRISMA guidelines of identify, screen, determine eligibility, and include, studies were extracted from four different databases, using search terms related to the essential physical education component of policy and environment. Of the 225 publications identified, 42 studies met the inclusion criteria for this investigation. Each paper was coded, and emergent themes were identified. Results: The policy research was predominantly descriptive and focused on: (a) minutes in physical education (83%), (b) moderate to vigorous physical activity (MVPA; 31%), (c) certified/qualified teachers (24%), (d) exemptions (17%), and (e) student-teacher ratio (12%). Emergent themes of adherence, policy strength, and implementation accountability were identified as influential physical education policy aspects. Conclusions: Policy research over the last 20 years was focused on the regulatory mandate of time. Policy research did not directly address disciplinary process variables of learning activities or outcomes of physical education. The effects of policy exemptions and class size were underrepresented. Themes may explain the lack of reporting student performance as the primary outcome. Further research is needed to examine the downstream effects of physical education policy and determine whether well-written policies increase the number of physically literate individuals.


Assuntos
Meio Ambiente , Política Organizacional , Educação Física e Treinamento/organização & administração , Adolescente , Criança , Previsões , Humanos , Comunicação Interdisciplinar , Pesquisa/tendências , Instituições Acadêmicas , Capacitação de Professores/normas
19.
Am J Crit Care ; 30(4): 302-311, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33870412

RESUMO

During the COVID-19 pandemic, evidence-based resources have been sought to support decision-making and strategically inform hospitals' policies, procedures, and practices. While greatly emphasizing protection, most guiding documents have neglected to support and protect the psychosocial needs of frontline health care workers and patients and their families during provision of palliative and end-of-life care. Consequently, the stage has been set for increased anxiety, moral distress, and moral injury and extreme moral hazard. A family-centered approach to care has been unilaterally relinquished to a secondary and nonessential role during the current crisis. This phenomenon violates a foundational public health principle, namely, to apply the least restrictive means to achieve good for the many. Instead, there has been widespread adoption of utilitarian and paternalistic approaches. In many cases the foundational principles of palliative care have also been neglected. No circumstance, even a global public health emergency, should ever cause health care providers to deny their ethical obligations and human commitment to compassion. The lack of responsive protocols for family visitation, particularly at the end of life, is an important gap in the current recommendations for pandemic triage and contingency planning. A stepwise approach to hospital visitation using a tiered, standardized process for responding to emerging clinical circumstances and individual patients' needs should be considered, following the principle of proportionality. A contingency plan, based on epidemiological data, is the best strategy to refocus health care ethics in practice now and for the future.


Assuntos
COVID-19/terapia , Empatia , Política Organizacional , Pneumonia Viral/terapia , Relações Profissional-Família , Visitas a Pacientes , COVID-19/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , SARS-CoV-2
20.
Support Care Cancer ; 29(9): 4895-4898, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33796936

RESUMO

PURPOSE: Family/caregiver visitation provides critical support for patients confronting cancer and is associated with positive outcomes. However, the COVID-19 pandemic brought historic disruptions including widespread visitation restrictions. Here, we characterize in-depth the visitor policies of NCI-designated comprehensive cancer centers (CCCs) and analyze geographic/temporal patterns across CCCs. METHODS: The public-facing CCC websites, including archived webpages, were reviewed to abstract initial visitation policies and revisions, including end-of-life (EoL) exceptions and timing of visitation restrictions relative to regional lockdowns. Chi-squared and Fisher's exact tests were employed to analyze associations between geographic region, timing, and severity of restrictions. RESULTS: Most CCCs (n=43, 86%) enacted visitation restrictions between March 15 and April 15, 2020. About half barred all visitors for COVID-negative inpatients (n=24, 48%) or outpatients (n=26, 52%). Most (n=36, 72%) prohibited visitors for patients with confirmed/suspected COVID-19. Most (n=40, 80%) published EoL exceptions but the specifics were highly variable. The median time from initial restrictions to government-mandated lockdowns was 1 day, with a wide range (25 days before to 26 days after). There was no association between timing of initial restrictions and geographic location (p=0.14) or severity of inpatient policies (p=1.0), even among centers in the same city. Outpatient policies published reactively (after lockdown) were more restrictive than those published proactively (p=0.04). CONCLUSION: CCCs enacted strict but strikingly variable COVID-19 visitation restrictions, with important implications for patients/families seeking cancer care. A unified, evidence-based approach to visitation policies is needed to balance proven infection control measures with the needs of patients and families.


Assuntos
COVID-19 , Institutos de Câncer/organização & administração , Neoplasias/terapia , Política Organizacional , Visitas a Pacientes , Humanos , Apoio Social , Estados Unidos/epidemiologia
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