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1.
PLoS One ; 16(10): e0257296, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34648522

RESUMO

The Fridays for Future strikes involve students striking for increased action on climate change, and this movement has spread to 185 countries and received widespread media attention. This exploratory study investigates motives for participating or not in the climate strikes and future participation among students in Switzerland. In a sample of N = 638 university students, we found that trust in climate scientists, low trust in governments, response efficacy, protest enjoyment and the perceived success of the strikes predicted participation. Contrary to statements in the public media but consistent with the literature, students who participated in the climate strikes reported consuming less meat, flying less and taking more steps to compensate the CO2 emissions from flights compared to students who did not participate. We discuss how the insights from this study help reveal the determinants of youth collective action on climate change.


Assuntos
Mudança Climática , Conservação dos Recursos Naturais , Greve , Adulto , Feminino , Humanos , Masculino , Motivação , Estudantes , Suíça , Confiança , Universidades , Adulto Jovem
2.
Int J Equity Health ; 20(1): 210, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556148

RESUMO

BACKGROUND: Health care workers in Kenya have launched major strikes in the public health sector in the past decade but the impact of strikes on health systems is under-explored. We conducted a qualitative study to investigate maternal and child health care and services during nationwide strikes by health care workers in 2017 from the perspective of pregnant women, community health volunteers (CHVs), and health facility managers. METHODS: We conducted in-depth interviews and focus group discussions (FGDs) with three populations: women who were pregnant in 2017, CHVs, and health facility managers. Women who were pregnant in 2017 were part of a previous study. All participants were recruited using convenience sampling from a single County in western Kenya. Interviews and FGDs were conducted in English or Kiswahili using semi-structured guides that probed women's pregnancy experiences and maternal and child health services in 2017. Interviews and FGDs were audio-recorded, translated, and transcribed. Content analysis followed a thematic framework approach using deductive and inductive approaches. RESULTS: Forty-three women and 22 CHVs participated in 4 FGDs and 3 FGDs, respectively, and 8 health facility managers participated in interviews. CHVs and health facility managers were majority female (80%). Participants reported that strikes by health care workers significantly impacted the availability and quality of maternal and child health services in 2017 and had indirect economic effects due to households paying for services in the private sector. Participants felt it was the poor, particularly poor women, who were most affected since they were more likely to rely on public services, while CHVs highlighted their own poor working conditions in response to strikes by physicians and nurses. Strikes strained relationships and trust between communities and the health system that were identified as essential to maternal and child health care. CONCLUSION: We found that the impacts of strikes by health care workers in 2017 extended beyond negative health and economic effects and exacerbated fundamental inequities in the health system. While this study was conducted in one County, our findings suggest several potential avenues for strengthening maternal and child health care in Kenya that were highlighted by nationwide strikes in 2017.


Assuntos
Atitude Frente a Saúde , Serviços de Saúde Materno-Infantil , Greve , Adolescente , Adulto , Agentes Comunitários de Saúde/psicologia , Agentes Comunitários de Saúde/estatística & dados numéricos , Feminino , Grupos Focais , Administradores de Instituições de Saúde/psicologia , Administradores de Instituições de Saúde/estatística & dados numéricos , Humanos , Quênia , Masculino , Serviços de Saúde Materno-Infantil/organização & administração , Pessoa de Meia-Idade , Gravidez , Gestantes/psicologia , Pesquisa Qualitativa , Voluntários/psicologia , Voluntários/estatística & dados numéricos , Adulto Jovem
4.
Ann Intern Med ; 174(9): 1319-1320, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34224264
6.
Am J Emerg Med ; 44: 1-4, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33556843

RESUMO

BACKGROUND: In July of 2017, after more than 15 months of negotiations, an academic teaching hospital in Boston failed to reach an agreement on the terms of contract renewal with its nursing union resulting in a strike. Replacement nurses were hired by the hospital to fulfill nursing duties for five days. OBJECTIVES: This study aims to measure the effects of this nursing strike on the patients seen in the emergency department (ED) by examining operational metrics before and during the strike. METHODS: Retrospective analysis of patient visits occurring for the five days of the strike (July 12-16, 2017) compared with the analogous five-day period immediately preceding that of the strike (July 5-9, 2017). RESULTS: During the strike, ED volume decreased by 23.6% (691 vs. 528 visits), and the decrease was more pronounced for adult vs. pediatric visits. There were no differences in patient sex, race/ethnicity or age groups. EMS transports decreased by 49.1% (171 vs. 87 transports). Although patient dispositions were similar in both periods, length of stay decreased for discharged patients (median 204 vs 178 minutes, p=0.01), and did not change significantly for admitted patients (median 322 vs. 320 minutes, p=0.33). There was one patient death in each of the periods. CONCLUSION: Although rare, nursing strikes do occur. These data may be useful for hospitals preparing for a strike.


Assuntos
Enfermagem em Emergência , Serviço Hospitalar de Emergência , Recursos Humanos de Enfermagem no Hospital/provisão & distribuição , Greve , Adulto , Boston , Feminino , Hospitais de Ensino , Humanos , Masculino , Estudos Retrospectivos
7.
Public Health Nurs ; 38(3): 473-479, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33538355

RESUMO

Urging the government to exercise a complete border closure to inhibit the spread of the novel coronavirus from Mainland China, about 8,000 health care workers participated in a 5-day strike in early February 2020 in Hong Kong. Despite gaining 61% support from the public, dissenters criticised that the participants violated professional ethics and abandoned their accountabilities, which led to moral distress. However, the participants were guided by the four fundamental medical principles (autonomy, beneficence, non-maleficence, and justice) for public interest and health equity. Their concerns for occupational safety should not be ignored to maintain an effective health care system. In short, the strike adopted a bottom-up initiative and adhered to a public-centered perspective and community-driven ethical behaviors, through which the participants deliberated over professionalism, humanism and the imminence of public health, and the balance between them. Strikers showed care and concern for the safety of the community, sustainability of the health care system, and well-being of all people in Hong Kong.


Assuntos
COVID-19/prevenção & controle , Pessoal de Saúde/ética , Greve/ética , COVID-19/epidemiologia , Hong Kong , Humanos
8.
J Health Polit Policy Law ; 46(4): 653-676, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33493308

RESUMO

Little is known about how the health professions organize in low- and middle-income countries (LMICs). This is particularly troubling as health worker strikes in LMICs appear to be growing more frequent and severe. While some research has been conducted on the impact of strikes, little has explored their social etiology. This article draws on theory from organization and management studies to situate strike behavior in a historical process of sensemaking in Kenya. In this way, doctors seek to expand pragmatic, moral, and cognitive forms of legitimacy in response to sociopolitical change. During the first period (1963-2000), the legacy of colonial biomedicine shaped medical professionalism and tensions with a changing state following independence. The next period (2000-2010) was marked by the rise of corporate medicine as an organized form of resistance to state control. The most recent period (2010-2015) saw a new constitution and devolution of health services cause a fractured medical community to strike as a form of symbolic resistance in its quest for legitimacy. In this way, strike behavior is positioned as a form of legitimation among doctors competing over the identity of medicine in Kenya and is complicating the path to universal health coverage.


Assuntos
Setor de Assistência à Saúde/organização & administração , Mão de Obra em Saúde/organização & administração , Médicos/organização & administração , Greve , Setor de Assistência à Saúde/história , Mão de Obra em Saúde/história , História do Século XX , História do Século XXI , Humanos , Quênia , Médicos/história , Mudança Social/história
10.
BMC Pregnancy Childbirth ; 20(1): 708, 2020 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-33213399

RESUMO

BACKGROUND: Poor women in hard-to-reach areas are least likely to receive healthcare and thus carry the burden of maternal and perinatal mortality from complications of childbirth. This study evaluated the effect of an enhanced community midwifery model on skilled attendance during pregnancy/childbirth as well as on maternal and perinatal outcomes against the backdrop of protracted healthcare workers' strikes in rural Kenya. METHODS: The study used a quasi-experimental (one-group pretest-posttest) design. The study spanned three time periods: December 2016-February 2017 when doctors were on strike (P1), March-May 2017 when no healthcare providers were on strike (P2), and June-October 2017 when nurses/midwives were on strike (P3), which was also the period when the project enhanced the capacity of community midwives (CMs) to provide services at the community level. Analysis entailed comparison of frequencies/means of maternal and newborn health service utilization data across the three periods. RESULTS: The monthly average number of clients obtaining services from CMs across the three time periods was: first antenatal care (ANC) (P1-1.8, P2-2.3, P3-9.9), fourth ANC (P1-1.4, P2-1.0, P3-7.1), skilled birth (P1-1.5, P2-1.7, P3-13.1) and the differences in means were statistically significant (p < 0.05). Over the period, the monthly average number of clients obtaining services from health facilities was: first ANC (P1-55.7, P2-70.8, P3-4.0), fourth ANC (P1-29.6, P2-38.1, P3-1.2) and skilled birth (P1-63.1, P2-87.4, P3-5.6), p < 0.05. There were no statistically significant differences in the average number of clients obtaining services from CMs or health facilities between P1 and P2 (p > 0.05). There was, however, a statistically significant increase in the average number of clients obtaining services from CMs in P3 accompanied by a statistically significant decline in the average number of clients obtaining services from health facilities (p < 0.05). First ANC increased by 68%, fourth ANC by 75%, skilled births by 68%, and postnatal care by 33% in P3 (p < 0.0001). There was a non-significant decline in macerated stillbirths and neonatal deaths in P3. CONCLUSIONS: The findings underscore the importance of integrating community-level health service providers (CMs and health volunteers) into the primary health care system to complement service delivery according to their level of expertise, especially in low-resource settings.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Tocologia/organização & administração , Modelos Organizacionais , Cuidado Pré-Natal/organização & administração , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Quênia/epidemiologia , Mortalidade Materna , Tocologia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Morte Perinatal/prevenção & controle , Mortalidade Perinatal , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural/estatística & dados numéricos , Natimorto , Greve , Voluntários
14.
Nurs Outlook ; 68(4): 468-475, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32359777

RESUMO

BACKGROUND: In 2018 a nursing 'sympathy strike' occurred. Although unionized nurses were directed to participate, many expressed questions about what a strike or sympathy strike was. Literature revealed no seminal article to define the term. A concept analysis for the nursing workforce was created. METHOD: The Hybrid Method of Concept Analysis, (theoretical literature analysis, qualitative stakeholder interviews; applicability) was used. 33 articles and 7 books were reviewed. Nine interviews took place. RESULTS: The literature and interviews agreed on the definition, antecedents, and consequences of a nursing strike. Strikes in the United States were defined as "a last resort effort, after significant bargaining on the issue between nurses and management has not allowed for agreement, where a work stoppage occurs and nurses leave the bedside." Interviews alone introduced the concept of duty to patients. A model case, contrary case and borderline case are offered. CONCLUSION: This study contains recommendations for practice.


Assuntos
Sindicatos , Cuidados de Enfermagem/normas , Recursos Humanos de Enfermagem/psicologia , Recursos Humanos de Enfermagem/normas , Guias de Prática Clínica como Assunto , Greve , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
15.
BMC Health Serv Res ; 20(1): 469, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32456634

RESUMO

BACKGROUND: Health worker strikes are a significant threat to universal access to care globally and especially in sub Saharan Africa. Kenya's health sector has seen an increase in such industrial action. Globally there is limited data that has examined mortality related to such strikes in countries where emergency services were preserved. We sought to assess the mortality impact of an 100 day physician strike which was followed by 151 day nurses' strike and 20 day clinical officer strike in Kenya. METHODS: Monthly mortality data was abstracted from four public hospitals, Kenyatta National Referral Hospital, AIC Kijabe Hospital, Mbagathi Hospital and Siaya Hospital between December 2016 and March 2018. Differences in mortality were assessed using t-tests and multiple linear regression adjusting for facility, numbers of patients utilizing the hospital and department. RESULTS: There was a significant decline in the numbers of patients seen, comparing the non-strike and strike periods; beta (ß) coefficient - 649 (95% CI -950, - 347) p < 0.0001. The physicians' strike saw a significant decline in mortality (ß) coefficient - 19.0 (95%CI -29.2, - 8.87) p < 0.0001. Nurses and Clinical Officer strikes' did not significantly impact mortality. There was no mortality increase in the post-strike period beta (ß) coefficient 7.42 (95%CI -16.7, 1.85) p = 0.12. CONCLUSION: Declines in facility-based mortality during strike months was noted when compared to a non-striking facility, where mortality increased. The decline is possibly associated with the reduced patient volumes, and a possible change in quality of care. Public health facilities are congested and over-utilized by the local population majority of whom cannot afford even low cost private care. Health worker strikes in Kenya where the public health system is the only financially accessible option for 80% of the population pose a significant threat to universal access to care. Judicious investment in the health infrastructure and staffing may decrease congestion and improve quality of care with attendant mortality decline.


Assuntos
Mortalidade Hospitalar/tendências , Hospitais Públicos/estatística & dados numéricos , Recursos Humanos em Hospital , Greve/estatística & dados numéricos , Humanos , Quênia/epidemiologia , Enfermeiras e Enfermeiros , Médicos
18.
Int J Equity Health ; 19(1): 23, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041624

RESUMO

BACKGROUND: While health worker strikes are experienced globally, the effects can be worst in countries with infrastructural and resource challenges, weak institutional arrangements, underdeveloped organizational ethics codes, and unaffordable alternative options for the poor. In Kenya, there have been a series of public health worker strikes in the post devolution period. We explored the perceptions and experiences of frontline health managers and community members of the 2017 prolonged health workers' strikes. METHODS: We employed an embedded research approach in one county in the Kenyan Coast. We collected in-depth qualitative data through informal observations, reflective meetings, individual and group interviews and document reviews (n = 5), and analysed the data using a thematic approach. Individual interviews were held with frontline health managers (n = 26), and group interviews with community representatives (4 health facility committee member groups, and 4 broader community representative groups). Interviews were held during and immediately after the nurses' strike. FINDINGS: In the face of major health facility and service closures and disruptions, frontline health managers enacted a range of strategies to keep key services open, but many strategies were piecemeal, inconsistent and difficult to sustain. Interviewees reported huge negative health and financial strike impacts on local communities, and especially the poor. There is limited evidence of improved health system preparedness to cope with any future strikes. CONCLUSION: Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the strike, but were not sufficient to confer resilience to the shock of the prolonged strikes. To minimise the negative effects of strikes when they occur, careful monitoring and advanced planning is needed. Planning should aim to ensure that emergency and other essential services are maintained, threats between staff are minimized, health worker demands are reasonable, and that governments respect and honor agreements.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde , Mão de Obra em Saúde , Greve , Atenção à Saúde , Feminino , Planejamento em Saúde , Humanos , Quênia , Masculino , Enfermeiras e Enfermeiros , Pobreza , Saúde Pública , Setor Público , Características de Residência
19.
Curr Opin Anaesthesiol ; 33(2): 203-210, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31904696

RESUMO

PURPOSE OF REVIEW: This review analyzed legal and ethical issues surrounding recent doctor and healthcare worker (HCW) strikes and considered whether HCW strikes are legally and morally justifiable, underlying causes, and impact of such strikes on healthcare service delivery. RECENT FINDINGS: Recent reports show that doctor and HCW strikes are an ongoing phenomenon globally, occurring in both developed and developing countries. The main reasons for HCW strikes are failed employer-employee negotiations regarding fair wages and working conditions, policy issues, infrastructural deficiencies in poorer countries, and concerns by HCWs regarding personal security in the workplace. The main impact of HCW strikes is disruption of healthcare service delivery, such as canceled outpatients' appointments, hospital admissions, and elective surgeries. There was no clear evidence of increased patients' mortality during strikes, except in isolated cases, where emergency services were also withdrawn during strikes. SUMMARY: Doctors and HCWs strikes are lawful deadlock-breaking mechanisms when collective bargaining negotiations have reached an impasse. Doctors' strikes appear to create an ethical conflict with the Hippocratic tradition and obligation to place patients' best interests as the primary moral consideration in medical practice. However, the rise of consumerism in healthcare, and loss of power by doctors, many of whom now work as employees, subject to regulations imposed by different stakeholders, including governments, health-maintenance organizations, and healthcare insurers, has impacted on modern medical practice. Therefore, doctors, like other employees may occasionally resort to strikes to extract concessions from employers. Mortality is rarely increased during HCW strikes, especially where emergency healthcare services are provided.


Assuntos
Pessoal de Saúde , Médicos , Greve/ética , Greve/legislação & jurisprudência , Ética Médica , Humanos , Obrigações Morais
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