[Modalities of therapeutic patient education]

Today in France, one in three people live with an illness or disability throughout their lives. Due to the successive confinements linked to the health crisis, therapeutic patient education (TPE) programmes have often had to be adapted, notably through telephone follow-up and videoconferences. At the same time, the legislative framework has evolved, with the law of January 1st, 2021, which replaces the authorisation scheme for TPE programmes with a declaration scheme.

Understanding Public Health Adaptation to Climate Change: An Explorative Study on the Development of Adaptation Strategies Relating to the Oak Processionary Moth in The Netherlands

Understanding of public health adaptation (PHA) to climate change and implementation is limited. This study therefore focuses on one specific PHA issue: adaptation to the oak processionary moth (OPM). The aim is to examine the development of OPM adaptation in order to offer a problem description of the complexities involved in OPM adaptation. In this explorative case study, we investigate adaptation strategies based on semi-structured interviews with 26 actors involved in OPM adaptation in The Netherlands. The results indicate that the context of OPM adaptation is relatively complex, given the involvement of many interdependent actors. OPM adaptation was developed with limited knowledge and strategies were based on ad hoc approaches in which there was ambiguity about tasks and expertise. In addition, different actors have different perceptions and values concerning health, sustainability, risks and responsibilities influencing decision-making processes, while also posing a challenge to collaboration and the development of a coordinated approach. The generation of knowledge and its translation into practical strategies calls for interdisciplinary cooperation in knowledge development. PHA adaptation involves more than technical and organisational solutions alone. It also entails the development of a shared problem perception and solution space in which citizens are also engaged.

[A TPE programme for patients with neurodegenerative diseases and their carers]

The team of the geriatric department of the Grenoble-Alpes (38) University Hospital Center has created the Accompagner therapeutic education program to meet the needs of patients suffering from neurocognitive disorders in the context of a neurodegenerative disease and their families. Presentation and current organization of the workshops.

Can Working Conditions and Employees' Mental Health Be Improved via Job Stress Interventions Designed and Implemented by Line Managers and Human Resources on an Operational Level?

Organisational-level interventions are recommended for decreasing sickness absence, but knowledge of the optimal design and implementation of such interventions is scarce. We collected data on working conditions, motivation, health, employee turnover, and sickness absence among participants in a large-scale organisational-level intervention comprising measures designed and implemented by line managers and their human resources partners (i.e., operational-level). Information regarding the process, including the implementation of measures, was retrieved from a separate process evaluation, and the intervention effects were investigated using mixed-effects models. Data from reference groups were used to separate the intervention effect from the effects of other concurrent changes at the workplace. Overall, working conditions and motivation improved during the study for both the intervention and reference groups, but an intervention effect was only seen for two of 13 evaluated survey items: clearness of objectives (p = 0.02) and motivation (p = 0.06). No changes were seen in employees' perceived health, and there were no overall intervention effects on employee turnover or sickness absence. When using operational-level workplace interventions to improve working conditions and employees' health, efforts must be made to achieve a high measure-to-challenge correspondence; that is, the implemented measures must be a good match to the problems that they are intended to address.

[Dialysis at home]

Home dialysis is an effective and safe care strategy that promotes patients' quality of life. At the collective level, it responds to the medico-economic challenges of the French healthcare system. Although it has few contraindications, it remains under-used in France. Its implementation requires early information for patients and their families, as well as the organisation of personalised follow-up by a dedicated and trained team.

[The organisation of time and caregivers]

Caregivers put in place various mechanisms to manage their relationship with time. The time of silence and that of chronicity try to mask the confrontation with the finite nature of the human condition. Time in end-of-life care reminds them however that this life is finite.

The future of rehabilitation in the United Kingdom National Health Service: Using the COVID-19 crisis to promote change, increasing efficiency and effectiveness

THE PROBLEM

Rehabilitation services in the UK are inadequate, with insufficient capacity or flexibility to meet the needs of patients after Covid-19.

HISTORY

Rehabilitation developed in a piecemeal way, focused on specific problems: spinal cord injury, burns, polio, stroke, back pain, equipment and adaptations etc. Rehabilitation is also provided using other names (e.g. intermediate care). Patients with complex needs do not fit easily within this system.

SYSTEM FAILURE

After Covid-19, patients have problems that cross existing condition-specific and/or treatment-specific services. Covid-19 has exposed the lack of any coherent organisational principle underlying development or commissioning of rehabilitation services. Consequently, in order to have their needs met, patients either have to engage with two or more separate services or they receive good management for some problems and sub-optimal management for other problems.

THE GOALS

The multitude of small specific services need to coalesce into an integrated service able to meet all the needs of any patient referred. Second, rehabilitation needs to be fully integrated into all healthcare services.

A SOLUTION

The purpose of healthcare is to 'improve our health and well-being . . . to stay as well as we can to the end of our lives'. (NHS constitution) All healthcare services need to consider patients holistically, giving equal attention to disease, disability, and distress. Rehabilitation, acute care, mental health and palliative care services need to work in parallel to achieve this purpose. Healthcare providers, supported by commissioners and rehabilitation experts, could achieve structural and organisational change, meeting the needs of patients.

[Crisis management, highlighting new opportunities for organisation management in psychiatry]

The health crisis has radically changed psychiatric units. In order to react, a crisis unit was established, comprising the director, management team and medical staff. Its aim was to apply the necessary adaptation measures with regard to staff organisation and management. However, these measures have had a specifc and significant impact on patients' freedom to come and go, which must be medically justified. This crisis has highlighted more than ever the importance of coordination across the territory.

[The philosophical clinical approach to burnout in caregivers in the light of Covid-19]

The crisis caused by the Covid-19 pandemic has highlighted the risks of burnout in caregivers and more specifically the question of ethical suffering. A philosophical clinical approach to burnout enables it to be analysed as a form of existential suffering linked to our shared vulnerability, as well as to more socio-organisational failings.

Eulogy: Professor Milan Šamánek, DrSc, FESC (*09.05.1931 †29.04.2020) - legend from the East

This article is to commemorate and celebrate achievements of Professor Milan Šamánek who passed away on 29 April, 2020. Milan was an excellent and visionary paediatric cardiologist who helped to establish paediatric cardiology as a speciality in Czechoslovakia and several other east European countries in the late 1970s. Milan was also paramount for connecting the East and West, helping in no small way to establish the Association for European Paediatric Cardiology (AEPC) as the leading learned society in Europe.

Improving the Health of the Homeless and How to Achieve It within the New NHS Architecture

The publication of the National Health Service (NHS) Long Term Plan sees the creation of Primary Care Networks as the most appropriate solution to help improve overall health and address health inequalities. A key segment of society that suffers from poor health is the homeless. While the potential for the group to benefit from the NHS reform policy programme in England exists, it requires stronger collaborative working between the health and social care sectors Not least the new arrangements provide opportunities to tackle existing disease as well as the determinants of future ill health. However, if the policy vision is to be achieved, relations between the two sectors must occur and cross sector boundaries be broken down.

Reorganization of the imaging units in the context of the COVID-19 pandemic: experience of the Ibn Sina University Hospital in Rabat

The global health system is currently facing the new SARS-COV 2 pandemy. This exceptional situation requires, from our African health systems, to reorganize and readapt the usual protocols when they were carried out before the crisis and/or their urgent implementation otherwise. As imaging is one of the pillars of the diagnosis of infection with this emerging virus, it was essential to rethink the imaging department organization so as to dedicate a unit to COVID-19 activity while maintaining the usual emergency activity within the Ibn Sina university hospital in Rabat. The protection of exposed personnel and the bio-cleaning of radiology equipment and rooms also became an evidence. The active involvement of the administration, the Clinical Pharmacy Department and the Nosocomial Infections Control Committee is a key to the success of this reorganization.

Clinical forensic medicine in Eastern Denmark: Organisation and assessments

Internationally, clinical forensic medicine (CFM) is diverse in content and conduct, and forensic medical methods are not always evidence based. The first step towards evidence-based practice is to achieve a thorough knowledge of international diversity, which necessitates that CFM practitioners provide information about their national practice. This paper’s aim is to describe the organisation of CFM in Denmark, exemplified by the set-up in Eastern Denmark, and the types of assessments performed. In Denmark, forensic medicine is a board-certified specialty under the health authorities, with mandatory qualifications. The Danish Accreditation Fund accredits the Departments of Forensic Medicine as inspection bodies, according to an international European standard that is approved by Danish Standards. Mainly at police request, forensic doctors perform examinations of both victims and suspected perpetrators of perilous crimes. The examinations’ purposes are documentation and assessment of the findings and collection of biological evidence. The clinical forensic examinations do not include any treatment or medical follow-up. Thus, the forensic doctors must be neutral, objective and impartial. The clinical forensic examinations provide documentation of findings and conclusions not otherwise available for the police investigation and legal aftermath. Moreover, the accredited, standardised protocols ensure that the Departments of Forensic Medicine meet their obligations as inspection bodies, thus ensuring public confidence in the departments’ services.

Exploring Issues and Challenges of Leadership among Early Career Doctors in Nigeria Using a Mixed-Method Approach: CHARTING Study

(1) Background: leadership behaviour is a poorly explored phenomenon among early-career doctors (ECDs). Good leadership is vital in maximising the effective management of patients in a clinical setting. While a good number of studies, though with small sample surveys, have researched the role of leadership in clinical setting quantitatively, qualitative investigations are yet to be done in Nigeria. This study aims to explore the attitudes, skills, and experience of ECDs in Nigeria on issues pertaining to leadership in a medical setting, using a mixed-method approach. (2) Methods: we conducted two sessions of key informant focus group discussion (FGD) that involved 14 ECD leaders in Nigeria, exploring their leadership experience in a clinical setting. Furthermore, we used a self-administered questionnaire to quantitatively survey 474 ECDs from seven Nigerian teaching hospitals to explore their attitudes, skills, and experience on issues pertaining to medical leadership. (3) Results: taking on leadership roles is a common phenomenon (52.7%) among the surveyed ECDs; however, the medical leadership position can be very challenging for ECDs in Nigeria. Despite the fact that many (91.1%) of the surveyed ECDs perceived leadership skills as essential skills needed by a doctr, many (44.1%) of them were yet to be formally trained on medical leadership. About three out of every 10 (23.6%) of surveyed ECDs that have ever held leadership positions in a medical setting experienced major leadership challenges while in such office due to their lack of training on leadership skills. Leadership skill acquisition programmes are highly recommended to become an integral part of medical training programmes in Nigeria. (4) Conclusion: there is a need for a structured leadership skill acquisition programme for ECDs in Nigeria. This programme will help in the robust delivery of highly effective healthcare services in Nigeria, as effective leadership is crucial to patient care services.

[The refusal of care, complex situations]

Over the last three decades, the evolution of medical care and the reorganization of our health care system have completely changed the relationship between health care professionals, patients and their families. The demand for patient participation in the healthcare process has been growing, raising the question of patients' freedom of choice and increasingly questioning the areas where this would be denied.

COVID-19 por SARS-Cov2 también ha afectado a la Educación Médica

El virus, además de provocar una pandemia, con centenares de miles de enfermos y con decenas de miles de fallecidos, ha tenido la capacidad («el poder») de romper las prácticas educativas estándar.

Esto ha tenido, o puede tener, un beneficio: reconsiderar lo que es realmente importante y lo que no lo es tanto. Y eso tiene un gran valor para el docente y para el discente. Y también ha servido para reconocer y encontrar formas alternativas con las que se puede transmitir el saber. En definitiva, el profesor ha tenido la oportunidad de contribuir a crear un modelo educativo capaz de impulsar el desarrollo de nuevas formas y métodos de aprendizaje. Ciertas técnicas y recursos educativos han podido ser reconocidos como «presentes» o «ausentes» de nuestro sistema educativo.

Esto implica que ciertos recursos han de estar presentes, o que es preciso optimizar los que ya están disponibles para enseñar, para aprender, o para evaluar. La tecnología permite facilitar el contacto «directo» entre profesor y alumno, entre profesores, y entre alumnos. Pero sobra decir que la tecnología ha de estar disponible.

Rétrospective et perspectives

L’épidémie de Covid-19 qui a déferlé sur le monde en mars 2020 a paralysé les sociétés et placé les professionnels de santé au premier plan, en ville comme à l’hôpital. Les acteurs de la périnatalité ont dû s’adapter pour répondre avec efficacité aux besoins des femmes et des enfants, en toute sécurité. Les soignants ont rencontré moult difficultés, mais ils ont également inventé de nouvelles façons de travailler et appris à mieux collaborer. De cette crise, il faut tirer les leçons pour bâtir l’avenir.

["It will be important to avoid a rift opening up between nurses and advanced practice nurses"]

After a long process of negotiation, laws passed in 2018 mean that advanced practice has finally become a reality for nurses in French legislation. Benefits are expected for patients, doctors, caregivers, management, organisations and for the health system. However, it will be necessary to take into account certain limits, and practices are expected to evolve. This change highlights the evolution of nursing practices thanks to Evidence-Based Nursing. An interview with Christophe Debout, member of the advanced practice network training committee of the International Council of Nurses.

[Adult thermal burn dressings in three acts]

Dressings are a real challenge in the care of patients with thermal burns. They help to heal and prevent or treat possible skin infections. Paramedical teams must have a perfect strategy for organizing, managing pain and optimizing hygiene and asepsis rules. The purpose is to facilitate the understanding and implementation of this treatment by suggesting protocols that can be applied by all. It remains essential to mobilize specialized services to promote the evolution of burns.

Long-term care services and care workers in Hangzhou City, China: A cross-sectional survey

AIM

This study aims to investigate the organisation and the workforce profile in long-term care facilities in Hangzhou City, China.

BACKGROUND

Population ageing calls for an increase in the number of high-quality, long-term care services. Therefore, there is a pressing need to understand how these services are organized and the qualifications of their workforce.

METHODS

A cross-sectional questionnaire survey was conducted among 293 care workers in 21 certified long-term care facilities in Hangzhou City, China. Comparison between government-owned and private facilities was conducted.

RESULTS

In total, there were 8,898 beds, 5,468 residents and 887 care workers in the facilities surveyed. As the total bed occupancy rate was 61.5%, there appeared to be adequate facilities in the city. The ratio of care workers to residents was similar in both the government-owned and private facilities, 1 care worker to 6.16 residents. For dependent residents, this ratio was 1-3.50. Organisation of the care services in terms of shift pattern, in-job training and care worker's insurance was significantly different between the two types of facilities. Despite the government-owned facilities being better organized than the private ones, both types of aged care facilities had a 24-hr-long shift. Although their monthly wage was similar, care workers in the government-owned facilities received better job-related insurance, were younger, had longer years of aged care work experience, were better educated and held more aged care certificates and received more frequent in-job training than their counterparts in the private facilities.

CONCLUSION

The shift arrangement needs to be improved. The low education level, long working hours and low remuneration of care workers were barriers for the development of the long-term care services.

IMPLICATIONS FOR NURSING MANAGEMENT

In order to improve the quality of long-term care services in China, the organisation of work, qualifications and payment of care workers need to be improved.

[New governance and transformation of the hospital organisation]

The last decade has witnessed an increasing number of reforms of the French healthcare system. The main objectives are to control healthcare costs by reducing spending and pooling resources. This is not achieved without difficulties, the economic criteria sometimes overshadowing humanist and altruistic values. These changes influence the organisation of care, even in paediatrics.

[Evolution of practices in neonatology]

The care of newborns has benefited from significant progress over the last twenty years. The discovery of new treatments and technologies, the development of care centred on the infants and their family, ethical reflection, the organisation of support and training for professionals are just some examples. The place of the parents in decision-making processes however needs to be reinforced.

[Implementing isolation, reorganising care]

Isolation, protective or septic, requires firm commitment from the team and specific equipment. Pedagogical tools exist to train and inform the team. Communication with all the players, caregivers, patients and family, is essential. It cements the feeling of belonging to the department concerned. An internal medicine team from Auch general hospital shares its experience.

Surgical perioperative pathways-Patient experiences of unmet needs show that a person-centred approach is needed

AIM

To explore patients' and healthcare professionals' experiences of patients' surgical pathways in a perioperative setting.

BACKGROUND

Elective surgical pathways have improved over the past decades due to fast-track programmes, but patients desire more personalised and coordinated care and treatment. There is little knowledge of how healthcare professionals' collaboration and communication affect patients' pathways.

DESIGN

The overall framework was complex intervention method. A phenomenological-hermeneutic approach was used for data analyses. COREQ checklist was used as a guideline to secure accurate and complete reporting of the study.

METHODS

Field observations (120 hr) and semi-structured interviews (24 patients) were undertaken during 2016-2017. Healthcare professionals involved in the pathways were interviewed: (a) 13 single interviews and (b) 13 focus group interviews (37 healthcare professionals) were conducted. The Consolidated Criteria for Reporting Qualitative Research checklist was used.

RESULTS

Patients asked for individualised information adapted to their life and illness experiences. Furthermore, healthcare professionals need access to a quick overview of individual patients and their perioperative pathway in the electronic patient journal (EPJ). Agreements made with patients did not always reach the right receiver, there was poor interpersonal communication and the complex teamwork between many healthcare professionals made pathways incoherent and uncoordinated. Healthcare professionals who had the time to talk about other subjects than the disease with smiles and good humour gave patients a feeling of security.

CONCLUSION

Patients wanted to be treated as individuals, but often they received standard treatment. Healthcare professionals had the intention of treating patients individually, but the EPJ and information provided to patients were not easy to access.

RELEVANCE TO CLINICAL PRACTICE

Visible information about the patient's whole pathway could improve healthcare professionals' care and treatment. In addition, systematic feedback from patients' could make it possible to adjust information, care and treatment to achieve a more coherent pathway. Particular attention needs to be paid to how electronic healthcare systems can underpin relational coordination in pathways.

Valuing recovery-oriented practice at the interface between mental health services and communities: The role of organisational characteristics and environments

BACKGROUND

Implementing recovery-oriented mental health services is a policy priority in many countries. In addition, some governments have prioritised new forms of organising, financing and governing the provision of mental health services with a stronger focus on co-delivery and involving communities. Most research in the recovery field has focused on interventions. There is limited knowledge about the role of organisational characteristics and environments in which people experience recovery.

AIM

To understand the organisational characteristics of initiatives that implement recovery-oriented practice at the interface between mental health services and communities, as well as the mechanisms they employ to alter the conditions in which they operate.

METHOD

Semi-structured interviews and a focus group workshop with managers of five initiatives in England that implemented recovery-oriented practice at the interface between mental health services and communities.

RESULTS

Our cross-sector initiatives shared a range of characteristics and employed mechanisms that created favourable conditions for recovery-oriented practice: strong social value and process (rather than performance) orientation; participatory approaches and shared decision-making; flat hierarchies; creating and seizing business opportunities; utilising networking and (social) marketing opportunities; risk-taking; valuing and supporting all members of their organisations; entrepreneurial and value-driven leadership.

CONCLUSION

Recovery-oriented practice takes place in certain organisational environments that importantly influence an individual's recovery. Our research highlights the need to consider organisational characteristics when evaluating recovery interventions as well as a broader shift of research towards understanding the environments in which people experience recovery as members of society, and how those can be altered.