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1.
Rev. enferm. UERJ ; 29: e55404, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1177546

RESUMO

Objetivo: planejar ações estratégicas para a melhoria da qualidade do cuidado e segurança do paciente em Unidade de Pronto Atendimento. Método: pesquisa descritiva, de abordagem qualitativa, desenvolvida em uma Unidade de Pronto Atendimento de um município do sul do Brasil, entre setembro de 2018 e fevereiro de 2019, tendo como participantes os enfermeiros dessa unidade. Utilizou-se como referencial metodológico a Pesquisa Convergente Assistencial, a logicidade do Planejamento Estratégico Situacional e a ferramenta 5W3H. Foram realizadas oficinas com os participantes, para escolha de problemas na segurança do paciente, proposição de melhorias, adequação e aprovação de planos de ação. Para análise dos dados utilizou-se o software R e grafos de similitude. Resultados: os problemas "comunicação" e "número insuficiente de profissionais" foram escolhidos por 24 enfermeiros, sugerindo cinco propostas, detalhadas em seis planos de ação. Conclusão: o planejamento estratégico situacional permitiu planejar ações estratégicas de melhoria na assistência que são de governabilidade dos enfermeiros.


Objective: to plan strategic actions to improve the quality of care and patient safety in the Emergency Care Unit. Method: this qualitative, descriptive, exploratory study was conducted in an Emergency Care Unit in a municipality in south Brazil, from September 2018 to February 2019, with the unit's nurses as participants. The methodological frame of reference was given by Convergent Care Research, the logic of Situational Strategic Planning, and the 5W3H tool. Workshops were held with the participants to choose problems in patient safety, propose improvements, and adaptation and approval of action plans. Data were analyzed using R software and similarity graphs. Results: nurses chose the problems "communication" and "too few staff" and made five proposals, detailed in six action plans. Conclusion: by situational strategic planning, strategic actions under nurses' governance were planned to improve care.


Objetivo: planificar acciones estratégicas para mejorar la calidad de la atención y la seguridad del paciente en la Unidad de Atención de Emergencias. Método: investigación descriptiva, con un enfoque cualitativo, desarrollada en una Unidad de Atención de Emergencias de una ciudad del sur de Brasil, entre septiembre de 2018 y febrero de 2019, cuyas participantes fueron las enfermeras de esta unidad. El marco metodológico utilizado fue la Investigación Convergente de Atención, la lógica de la Planificación Estratégica Situacional y la herramienta 5W3H. Se llevaron a cabo talleres con los participantes para elegir problemas en la seguridad del paciente, proponer mejoras, adecuación y aprobación de planes de acción. El software R y los gráficos similares se utilizaron para el análisis de datos. Resultados: los problemas de "comunicación" e "número insuficiente de profesionales" fueran elegidos por 24 enfermeras; se sugieren entonces cinco propuestas, detalladas en seis planes de acción. Conclusión: la planificación estratégica situacional permitió planificar acciones estratégicas para mejorar la atención que rigen las enfermeras.


Assuntos
Humanos , Masculino , Feminino , Qualidade da Assistência à Saúde , Planejamento Estratégico , Enfermagem em Emergência , Segurança do Paciente , Assistência Ambulatorial , Brasil , Centros de Saúde , Epidemiologia Descritiva , Pesquisa Qualitativa , Enfermeiras e Enfermeiros
2.
Nurs Open ; 8(3): 1115-1124, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34482655

RESUMO

AIM: The aim of the present research was to investigate the obstacles, which prevent nurses being present with patients. BACKGROUND: It is vital for nurses to be able to spend time with patients for an accurate assessment of patients' needs to take place and to allow patients to express their concerns. The factors, which prevent nurses spending time with patients, are still unclear. METHOD: Data were collected using semi-structured interviews with thirty-five participants, including the nurses and physicians from educational hospitals of Tehran. The analysis was performed through the conventional content analysis. To achieve accuracy and trustworthiness of the data, the Lincoln and Guba criteria were used. RESULT: The results of the study can be summarized as: "conflict between human considerations and bureaucratic structure," "failure to meet basic needs," "the personal and interpersonal aspects of caring" and "safety in caring context." CONCLUSION: To ensure high-quality care, it is important to understand more fully the factors that prevent nurses spending time with patients. Interventions are needed to allow nurses to spend more time with the patients. IMPLICATION FOR NURSING MANAGEMENT: Health service managers should consider that the intrinsic motivation of nurses is to care for patients. They can increase the presence of nurses at patients' bedside and improve care quality by creating an attractive working environment, appreciating nurses' values, paying attention to their opinions and establishing professional communication based on mutual respect.


Assuntos
Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem no Hospital , Humanos , Irã (Geográfico) , Motivação , Qualidade da Assistência à Saúde
3.
Bull World Health Organ ; 99(9): 674-679, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34475604

RESUMO

Problem: Mental ill health in the United Kingdom of Great Britain and Northern Ireland has been a major driver of labour market exclusion through sickness absence, reduced productivity and job loss. Approach: A government-supported programme for improving access to psychological therapies was launched in 2008 and expanded across England in 2010. The aim was to provide evidence-based treatments for people with common mental disorders through three principal strategies: (i) routine session-by-session outcome monitoring; (ii) integration with the wider care system; and (iii) delivery of psychological therapies as part of a stepped-care approach. Local setting: Access to effective psychological therapies was previously low in the United Kingdom. In 2010, only about 35% of people with moderately severe mental disorders were in specialist or non-specialist treatment. Relevant changes: The accessibility of quality mental health services has increased, as has the efficiency of the country's mental health system. The numbers of people entering treatment have increased steadily from 0.43 million in 2012-2013 to 1.09 million in 2018-2019. The recovery rate of patients in treatment increased from 42.8% to 52.1% during 2012-2018. The number of people moved off sick pay and benefits rose from 3683 to 18 039 over the same period. Lessons learnt: A clinical guideline on psychological therapies is a prerequisite for increasing the accessibility and efficiency of mental health services. An integrated approach allows mental health services to have better reach. Routine collection of patient-level outcome data plays an important role in the value and function of the mental health care system.


Assuntos
Acesso aos Serviços de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Qualidade da Assistência à Saúde , Eficiência Organizacional , Humanos , Transtornos Mentais/epidemiologia , Saúde Mental , Irlanda do Norte , Avaliação de Processos e Resultados em Cuidados de Saúde , Reino Unido
4.
Isr Med Assoc J ; 23(9): 569-575, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472232

RESUMO

BACKGROUND: Aerodigestive clinics are run by interdisciplinary medical and surgical teams, and provide complex care coordination and combined endoscopies. OBJECTIVES: To describe the design and patient population of the first pediatric aerodigestive center in Israel. METHODS: A retrospective single-center cohort study was conducted describing patients followed in the aerodigestive clinic of Schneider Children's Medical Center of Israel, a tertiary pediatric hospital, between its inception in January 2017 and June 2020. RESULTS: During the study period, 100 patients were seen at the combined respiratory and digestive (NoAM) clinic, with a total of 271 visits. Median age at first assessment was 29.5 months (range 3-216). Fifty-six patients (56%) had esophageal atresia and tracheoesophageal fistula. Thirty-nine patients had an identified genetic disorder, 28 had a primary airway abnormality, 28 were oxygen dependent, and 21 were born premature. Fifty-two patients underwent triple endoscopy, consisting of flexible bronchoscopy, rigid bronchoscopy, and gastroscopy. In 33 patients, esophageal dilatation was necessary. Six patients underwent posterior tracheopexy at a median of 6 months of age (range 5 days to 8 years) all with ensuing symptom improvement. The total mean parental satisfaction score on a Likert-type scale of 1-5 (5 = highest satisfaction) was 4.5. CONCLUSIONS: A coordinated approach is required to provide effective care to the growing population of children with aerodigestive disorders. The cross fertilization between multiple disciplines offers a unique opportunity to develop high quality and innovative care. Outcome measures must be defined to objectively measure clinical benefit.


Assuntos
Doenças do Sistema Digestório/terapia , Endoscopia/métodos , Equipe de Assistência ao Paciente/organização & administração , Assistência ao Paciente/métodos , Doenças Respiratórias/terapia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Doenças do Sistema Digestório/fisiopatologia , Hospitais Pediátricos/organização & administração , Humanos , Lactente , Israel , Pais/psicologia , Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/normas , Satisfação do Paciente , Qualidade da Assistência à Saúde , Doenças Respiratórias/fisiopatologia , Estudos Retrospectivos , Centros de Atenção Terciária/organização & administração
5.
Artigo em Russo | MEDLINE | ID: mdl-34486856

RESUMO

This article discusses clauses of national standards compatible with international standards of ISO 9000-9001 family,in section of measurement of degree of satisfaction of patients with medical services quality. The main methods applied are sociological survey SERVQUAL focused on measurement of degree of satisfaction of patients, GAP-analysis (identification of discrepancies and gaps) and technique of management decision-making concerning improvement of medical services quality. The SERVQUAL survey with its five qualitative criteria was applied. The primary data was obtained from sampling of 500 well structured questionnaires. In total, 365 respondents participated in the study. The produced correlation matrix confirmed strong relations between criteria estimating expected and interpreted quality of medical services and full average interpreted quality. The analysis of reliability confirmed that questions of questionnaire are reliable and the results of statistical calculations can be used in further analysis. The analysis of descriptive statistics, correlation matrix, patient profile, reliability and qualitative GAP analysis were carried out. The requirements of assuring reliability and adequacy of questionnaire, representativeness of sample size to carry out high quality measurements were kept. The results on every criterion were obtained. The qualitative results of discrepancy of and perceptions of patients are received. The negative values of indices of discrepancy of the interpreted and expected outcomes of medical services are received. The level of satisfaction of patients remains insufficient. The study proposes to improve quality of medical services in hospital, especially by criterion "Materiality" to justify expectations of patients. The results of the study are of practical importance for executives of regional health care administrations, head physicians of medical organizations engaged in improvement of medical care quality and increasing of efficiency of medical services.


Assuntos
Satisfação do Paciente , Satisfação Pessoal , Hospitais , Humanos , Qualidade da Assistência à Saúde , Reprodutibilidade dos Testes , Inquéritos e Questionários
6.
PLoS One ; 16(9): e0256767, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34469483

RESUMO

A report published last year by the Centers for Medicare & Medicaid Services (CMS) highlighted that COVID-19 case counts are more likely to be high in lower quality nursing homes than in higher quality ones. Since then, multiple studies have examined this association with a handful also exploring the role of facility quality in explaining resident deaths from the virus. Despite this wide interest, no previous study has investigated how the relation between quality and COVID-19 mortality among nursing home residents may have changed, if at all, over the progression of the pandemic. This understanding is indeed lacking given that prior studies are either cross-sectional or are analyses limited to one specific state or region of the country. To address this gap, we analyzed changes in nursing home resident deaths across the US between June 1, 2020 and January 31, 2021 (n = 12,415 nursing homes X 8 months) using both descriptive and multivariable statistics. We merged publicly available data from multiple federal agencies with mortality rate (per 100,000 residents) as the outcome and CMS 5-star quality rating as the primary explanatory variable of interest. Covariates, based on the prior literature, consisted of both facility- and community-level characteristics. Findings from our secondary analysis provide robust evidence of the association between nursing home quality and resident deaths due to the virus diminishing over time. In connection, we discuss plausible reasons, especially duration of staff shortages, that over time might have played a critical role in driving the quality-mortality convergence across nursing homes in the US.


Assuntos
COVID-19/mortalidade , Casas de Saúde , Pandemias , Qualidade da Assistência à Saúde , SARS-CoV-2 , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Estados Unidos/epidemiologia
7.
Pan Afr Med J ; 39: 91, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34466193

RESUMO

Introduction: Mozambique is one of the poorest nations in the world and its health budget is heavily dependent on external funding. Increasingly, donors prefer to direct their funds through international non-governmental organizations instead of direct donations to the State budget. In the current climate of increased emphasis on health system strengthening, a strong and stable partnership between government and international non-governmental organizations is pivotal for health system strengthening in Mozambique. Methods: the study evaluates the current partnership through a standardized survey to healthcare workers employed by international non-governmental organizations in health (INGO, private) and the ministry of health (MOH, public). Results of the survey have been analyzed only descriptively and no statistical evaluations have been performed. Results: out of the valid 109 responses obtained 55.1% were from MOH cadres and 45.0% from INGO cadres. Most have been in the health sector for more than 5 years. Most of the respondents recognize that INGOs assist the government in strengthening the health system (71.6%), see the internal brain drain to INGOs and salary scale difference as major problems (70.6% and 78.0%); 87.2% reported that the coordination between INGOs and government needs to be improved. MOH cadres perceived the migration of cadres to INGOs and the need for improving coordination as major issues more acutely than their INGO counterparts (80.0% vs. 59.2% and 88.3% vs. 85.7% respectively). INGOs were perceived to offer better quality health services by 51.4% of respondents (of these 69.4% were INGO respondents). The quality of health services was alike between INGOs and MOH for 33% of the respondents. Conclusion: through the various efforts outlined the MOH and INGOs are moving towards an environment of mutual accountability, joint planning and coordination as well as harmonization of activities; but there are still challenges to be addressed. Prioritization and increased funding of the planning unit and planning and cooperation directorate as well as strategies for workforce retention are urgently needed.


Assuntos
Atenção à Saúde/organização & administração , Pessoal de Saúde/organização & administração , Organizações/organização & administração , Parcerias Público-Privadas/organização & administração , Estudos Transversais , Humanos , Agências Internacionais , Moçambique , Setor Privado , Setor Público , Qualidade da Assistência à Saúde , Inquéritos e Questionários
8.
Yonsei Med J ; 62(9): 850-857, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34427072

RESUMO

PURPOSE: During the COVID-19 pandemic, Korea has temporarily expanded coverage of teleconsultation to ensure access to essential health services. As a preliminary study, we investigated service utilization patterns and the characteristics of doctors and patients involved in these temporary teleconsultation services. MATERIALS AND METHODS: Using national health insurance claims data from February 23, 2020 to June 30, 2020 from the Health Insurance Review and Assessment Service, 228269875 cases were identified. Among them, 567390 cases that received teleconsultation services were included in our study. We performed descriptive analyses according to the types of healthcare institutions. RESULTS: In total, 6193 healthcare institutions provided teleconsultation. Of these, 5466 (88.3%) were clinics. Physicians providing teleconsultations were most likely to be doctors of internal medicine (34.0%) or pediatricians (7.0%) and based in the Seoul Metropolitan area (30.4%). In terms of patients undergoing teleconsultation, the most common major disease categories treated were circulatory system diseases (I00-I99). In a detailed analysis, hypertensive diseases (I10-I15) were the most common diagnoses, with a total of 88726 cases (15.6%), followed by diabetes mellitus at 60298 cases (10.6%). The proportion of Medical Aid recipients receiving teleconsultations was higher (9.5%) than other socioeconomic groups. Among all participants, 356622 cases (84.6%) were from a return visit, and 108838 cases (19.2%) received teleconsultation services without being prescribed drugs. CONCLUSION: Temporarily allowed teleconsultation services were provided mostly to the following patients: 1) those scheduled for revisitation, 2) those with chronic diseases, and 3) those living in pandemic hotspots.


Assuntos
COVID-19 , Consulta Remota , Humanos , Pandemias , Qualidade da Assistência à Saúde , SARS-CoV-2
9.
J Nurs Adm ; 51(9): 468-473, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34432739

RESUMO

OBJECTIVE: The objective of this study was to explore the relationship between staff nurses' perceptions of nurse manager caring behaviors and patient experience. BACKGROUND: Despite numerous interventions aimed at changing the provision of patient care to improve care quality, patient experience scores have remained moderate. Little research has been conducted exploring how caring relationships in the professional practice environment might play a role in the patient experience of care. METHODS: A cross-sectional, correlational design was used to examine the relationship between staff nurses' perceptions of nurse manager caring behaviors as measured by the Caring Assessment Tool-Administration (CAT-Adm) and acute-care patient experience using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. RESULTS: There was a positive relationship between the staff nurses' perceptions of nurse manager caring behaviors and patients' HCAHPS overall hospital rating. There also was a positive relationship between the CAT-Adm scores and nurse manager visibility. CONCLUSION: Departments had higher HCAHPS overall hospital rating when the staff nurses perceived their unit manager as caring. In addition, the more staff nurses actually visualized their nurse manager during a shift, the more they perceived their nurse manager as caring.


Assuntos
Atitude do Pessoal de Saúde , Enfermeiras Administradoras/psicologia , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem no Hospital/psicologia , Estudos Transversais , Humanos , Qualidade da Assistência à Saúde , Inquéritos e Questionários
10.
BMJ Open ; 11(8): e048657, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433599

RESUMO

INTRODUCTION: There is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an 'at-a-glance' overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined. METHODS: This mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop. ETHICS AND DISSEMINATION: This study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University's Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.


Assuntos
Serviços de Saúde para Idosos , Qualidade de Vida , Idoso , Cuidadores , Serviços de Saúde , Humanos , Qualidade da Assistência à Saúde
11.
BMJ Open Qual ; 10(Suppl 1)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34344739

RESUMO

BACKGROUND: Inadequate quality of care has been identified as one of the most significant challenges to achieving universal health coverage in low-income and middle-income countries. To address this WHO-SEARO, the point of care quality improvement (POCQI) method has been developed. This paper describes developing a dynamic framework for the implementation of POCQI across India from 2015 to 2020. METHODS: A total of 10 intervention strategies were designed as per the needs of the local health settings. These strategies were implemented across 10 states of India, using a modification of the 'translating research in practice' framework. Healthcare professionals and administrators were trained in POCQI using a combination of onsite and online training methods followed by coaching and mentoring support. The implementation strategy changed to a fully digital community of practice platform during the active phase of the COVID-19 pandemic. Dashboard process, outcome indicators and crude cost of implementation were collected and analysed across the implementation sites. RESULTS: Three implementation frameworks were evolved over the study period. The combined population benefitting from these interventions was 103 million. A pool of QI teams from 131 facilities successfully undertook 165 QI projects supported by a pool of 240 mentors over the study period. A total of 21 QI resources and 6 publications in peer-reviewed journals were also developed. The average cost of implementing POCQI initiatives for a target population of one million was US$ 3219. A total of 100 online activities were conducted over 6 months by the digital community of practice. The framework has recently extended digitally across the South-East Asian region. CONCLUSION: The development of an implementation framework for POCQI is an essential requirement for the initiative's successful country-wide scale. The implementation plan should be flexible to the healthcare system's needs, target population and the implementing agency's capacity and amenable to multiple iterative changes.


Assuntos
Atenção à Saúde/normas , Assistência ao Paciente/normas , Sistemas Automatizados de Assistência Junto ao Leito , Melhoria de Qualidade , Qualidade da Assistência à Saúde , COVID-19 , Instalações de Saúde , Pessoal de Saúde , Humanos , Ciência da Implementação , Índia , Pandemias
12.
Cad Saude Publica ; 37(7): e00267720, 2021.
Artigo em Português | MEDLINE | ID: mdl-34346984

RESUMO

The study aimed to assess the quality of care for persons with mental health distress in primary healthcare services in Brazil and the association with organizational structure variables. This evaluative study used data from the Brazilian National Program to Improve Acess and Quality in Primary Care (PMAQ-AB), collected in 2018. The study excluded teams that reported not performing this type of care. The sum of the 13 selected mental health indicators produced a score that was classified in three groups of quality: G1 (0 to 5 points - lower quality), G2 (6 to 9 points - medium quality), and G3 (10 to 13 points - higher quality), and the results were associated with nine organizational context variables favoring the teams' permanence in the respective quality groups. The study evaluated 36,384 teams, located in 5,026 municipalities (counties). The score ranged from 1 to 13 points (G1 = 9.7%; G2 = 25.1%; G3 = 65.2%). Having an environment favorable to dispensing medicines and privacy during patient consultations; existence of a medical specialist, psychologist, and pharmacist; inter-consultation with the Expanded Family Health Care Centers (NASF) and Centers for Psychosocial Care (CAPS); and weekly or biweekly team meetings, were more frequent in the teams with higher quality (p < 0.001). In conclusion, structural conditions related to infrastructure and availability of healthcare workers, as well as inter-consultation and spaces for reflection to discuss the (re)organization of work processes in care for patients with mental health distress are factors that influence the quality of care, requiring attention, especially given recent political setbacks.


Assuntos
Saúde Mental , Qualidade da Assistência à Saúde , Brasil , Serviços de Saúde , Acesso aos Serviços de Saúde , Humanos , Atenção Primária à Saúde
13.
BMJ Glob Health ; 5(Suppl 2)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34362791

RESUMO

INTRODUCTION: Mistreatment of women during childbirth is increasingly recognised as a significant issue globally. Research and programmatic efforts targeting this phenomenon have been limited by a lack of validated measurement tools. This study aimed to develop a set of concise, valid and reliable multidimensional measures for mistreatment using labour observations applicable across multiple settings. METHODS: Data from continuous labour observations of 1974 women in Nigeria (n=407), Ghana (n=912) and Guinea (n=655) were used from the cross-sectional WHO's multicountry study 'How women are treated during facility-based childbirth' (2016-2018). Exploratory factor analysis was conducted to develop a scale measuring interpersonal abuse. Two indexes were developed through a modified Organisation for Economic Co-operation and Development approach for generating composite indexes. Measures were evaluated for performance, validity and internal reliability. RESULTS: Three mistreatment measures were developed: a 7-item Interpersonal Abuse Scale, a 3-item Exams & Procedures Index and a 12-item Unsupportive Birth Environment Index. Factor analysis results showed a consistent unidimensional factor structure for the Interpersonal Abuse Scale in all three countries based on factor loadings and interitem correlations, indicating good structural construct validity. The scale had a reliability coefficient of 0.71 in Nigeria and approached 0.60 in Ghana and Guinea. Low correlations (Spearman correlation range: -0.06-0.19; p≥0.05) between mistreatment measures supported our decision to develop three separate measures. Predictive criterion validation yielded mixed results across countries. Both items within measures and measure scores were internally consistent across countries; each item co-occurred with other items in a measure, and scores consistently distinguished between 'high' and 'low' mistreatment levels. CONCLUSION: The set of concise, comprehensive multidimensional measures of mistreatment can be used in future research and quality improvement initiatives targeting mistreatment to quantify burden, identify risk factors and determine its impact on health and well-being outcomes. Further validation and reliability testing of the measures in other contexts is needed.


Assuntos
Parto , Qualidade da Assistência à Saúde , Estudos Transversais , Parto Obstétrico , Feminino , Humanos , Gravidez , Reprodutibilidade dos Testes
14.
BMJ Glob Health ; 5(Suppl 2)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34362792

RESUMO

BACKGROUND: Accountability for mistreatment during facility-based childbirth requires valid tools to measure and compare birth experiences. We analyse the WHO 'How women are treated during facility-based childbirth' community survey to test whether items mapping the typology of mistreatment function as scales and to create brief item sets to capture mistreatment by domain. METHODS: The cross-sectional community survey was conducted at up to 8 weeks post partum among women giving birth at hospitals in Ghana, Guinea, Myanmar and Nigeria. The survey contained items assessing physical abuse, verbal abuse, stigma, failure to meet professional standards, poor rapport with healthcare workers, and health system conditions and constraints. For all domains except stigma, we applied item-response theory to assess item fit and correlation within domain. We tested shortened sets of survey items for sensitivity in detecting mistreatment by domain. Where items show concordance and scale reliability ≥0.60, we assessed convergent validity with dissatisfaction with care and agreement of scale scores between brief and full versions. RESULTS: 2672 women answered over 70 items on mistreatment during childbirth. Reliability exceeded 0.60 in all countries for items on poor rapport with healthcare workers and in three countries for items on failure to meet professional standards; brief scales generally showed high agreement with longer versions and correlation with dissatisfaction. Brief item sets were ≥85% sensitive in detecting mistreatment in each country, over 90% for domains of physical abuse and health system conditions and constraints. CONCLUSION: Brief scales to measure two domains of mistreatment are largely comparable with longer versions and can be informative for these four distinct settings. Brief item sets efficiently captured prevalence of mistreatment in the five domains analysed; stigma items can be used and adapted in full. Item sets are suitable for confirmation by context and implementation to increase accountability and inform efforts to eliminate mistreatment during childbirth.


Assuntos
Acesso aos Serviços de Saúde , Qualidade da Assistência à Saúde , Estudos Transversais , Feminino , Humanos , Parto , Gravidez , Reprodutibilidade dos Testes , Inquéritos e Questionários
15.
J Nurs Adm ; 51(7-8): 359-361, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34405974

RESUMO

In the changing healthcare climate, a robust continuous professional development program is critical to ensure excellent patient care and the best outcomes. It is essential for educators and leaders to understand the factors that enhance the impact of continuous professional development. Organizational leadership must support successful education programs and the ability to provide educational activities. In this month's Magnet® Perspectives, we will review how the Institute of Medicine and Quadruple Aim framework can support structural empowerment through continuous professional development to improve outcomes.


Assuntos
Liderança , Enfermeiras Administradoras/organização & administração , Supervisão de Enfermagem/organização & administração , Inovação Organizacional , Humanos , Relações Interprofissionais , Recursos Humanos de Enfermagem no Hospital , Qualidade da Assistência à Saúde/organização & administração
16.
J Nurs Adm ; 51(7-8): 379-388, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34405977

RESUMO

OBJECTIVE: Researchers examined associations between Index for Professional Nursing Governance (IPNG) types and outcomes. BACKGROUND: Effects of professional nursing governance on nurse-related outcomes by Magnet® status are not well studied. METHODS: Associations were evaluated between average IPNG scores from 2170 RNs, and nurse-sensitive indicators (NSIs) as well as patient and RN satisfaction outcomes (N = 205 study units; 20 hospitals), following Magnet requirements. RESULTS: Magnet hospitals had significantly better IPNG shared governance scores than non-Magnet hospitals (Magnet, 106.7; non-Magnet, 101.3). For Magnet hospitals, units scoring as shared governance outperformed traditional governance for 9 of 19 outcomes (47.4%) (NSI, 2; patient satisfaction, 3; RN satisfaction, 4). Self-governance outperformed shared governance for 8 of 15 outcomes (53.3%) (NSI, 2; patient satisfaction, 6; RN satisfaction, 0). For non-Magnet hospitals, shared governance significantly outperformed traditional governance for 1 of 15 outcomes (6.7%) (patient satisfaction). CONCLUSIONS: Having shared or self-governance is a strategy that can be considered by nurse leaders to improve select nurse-related outcomes.


Assuntos
Satisfação no Emprego , Liderança , Recursos Humanos de Enfermagem no Hospital/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Atitude do Pessoal de Saúde , Administração Hospitalar , Humanos , Recursos Humanos de Enfermagem no Hospital/psicologia , Satisfação Pessoal , Qualidade da Assistência à Saúde , Estados Unidos
17.
Rev Esc Enferm USP ; 55: e03773, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34346969

RESUMO

OBJECTIVE: To apprehend the factors related to the onset and/or worsening of urinary incontinence in the hospitalized elderly patient, considering the Donabedian's triad. METHOD: This is a qualitative, descriptive study, conducted with nurses and nursing technicians from a public university hospital. Data were collected using the focus group technique; content analysis was used for treatment and analysis, with subsequent coding of the registration units in the software WebQDA, relating the corpus obtained with the Donabedian's pillars. RESULTS: The most reported factors related to the onset and/or worsening of urinary incontinence in hospitalized elderly patients were linked to the pillar structure, with emphasis on the attribute human resources, followed by the attributes material resources and physical structure; the second Donabedian's pillar with the greatest association with the reports was process and, finally, the pillar outcome. CONCLUSION: The identification of factors related to the outcome investigated in the hospital environment provided the participants with reflection and awareness about the problem, therefore allowing the proposition of measures and interventions to minimize it and ensure safe and quality care to the hospitalized elderly patient.


Assuntos
Qualidade da Assistência à Saúde , Incontinência Urinária , Idoso , Grupos Focais , Humanos , Pesquisa Qualitativa , Incontinência Urinária/epidemiologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-34444376

RESUMO

Evidence-based strategies are needed to curb the growing cases of physical inactivity related morbidities. Delivering holistic care through collaborative shared decision making could boost the effectiveness of physical activity referral schemes (PARS) and foster the quality of care for patients with multimorbidity. A qualitative study involving semi-structured telephone interviews was utilised to gain insights from Australian PARS stakeholders (general practitioners, exercise physiologists, and patients). A pluralistic evaluation approach was employed to explore and integrate participants' opinions and experiences of PARS and their recommendations were used to develop a model for quality care delivery in PARS initiatives. Five overarching themes: promote, relate, incentivise, communicate, and educate were identified as the 'PRICE' for developing effective and functional PARS programmes that foster quality patient care. It was evident that PARS programmes or policies aimed at optimising publicity, encouraging incentives, improving interdisciplinary information sharing and professional relationships between patients and healthcare professionals can transform healthcare delivery and provide top quality PARS care services to patients. Therefore, governments, healthcare systems, and PARS administrators can translate and leverage the insights from this study to optimise the delivery of high quality care to PARS patients.


Assuntos
Exercício Físico , Clínicos Gerais , Austrália , Humanos , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Encaminhamento e Consulta
20.
BMC Health Serv Res ; 21(1): 840, 2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34412624

RESUMO

BACKGROUND: The increased prevalence of chronic diseases and an ageing population challenge healthcare delivery, particularly hospital-based care. To address this issue, health policy aims to decentralize healthcare by transferring responsibility and introducing new services in primary healthcare. In-depth knowledge of associated implementation processes is crucial for health care managers, policymakers, and the health care personnel involved. In this article, we apply an ethnographic approach in a study of nurses' contributions to the implementation of a new inpatient service in an outpatient primary care emergency clinic and explore the competencies involved. The approach allowed us to explore the unexpressed yet significant effort, knowledge and competence of nurses that shaped the new service. METHODS: The study combines observations (250 h) and several in situ interviews with healthcare personnel and individual in-depth interviews with nurses (n = 8) at the emergency clinic. In our analysis, we draw on a sociological perspective on healthcare work and organization that considers nursing a practice within the boundaries of clinical patient work, organizational structures, and managerial and professional requirements. RESULTS: We describe the following three aspects of nurses' contributions to the implementation of the new service: (1) anticipating worst-case scenarios and taking responsibility for preventing them, (2) contributing coherence in patient care by ensuring that new and established procedures are interconnected, and (3) engaging in "invisible work". The nurses draw on their own experiences from their work as emergency nurses and knowledge of the local and regional contexts. They utilize their knowledge, competence, and organizing skills to influence the implementation process and ensure high-quality healthcare delivery in the extended service. CONCLUSIONS: Our study illustrates that nurses' contributions are vital to coordinating and adjusting extended services. Organizing work, in addition to clinical work, is a crucial aspect of nursing work. It 'glues' the complex and varied components of the individual patient's services into coherent and holistic care trajectories. It is this organizing competence that nurses utilize when coordinating and adjusting extended services. We believe that nurses' organizing work is generally invaluable in implementing new services, although it has not been well emphasized in practice and research.


Assuntos
Antropologia Cultural , Enfermeiras e Enfermeiros , Atenção à Saúde , Hospitais , Humanos , Qualidade da Assistência à Saúde
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