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Whalen M, Bradley M, Hanson GC, Maliszewski B, Pandian V. Exploring perceptions of reporting violence against healthcare workers in the emergency department: A qualitative study. Int Emerg Nurs 2024; 76:101500. [PMID: 39126883 DOI: 10.1016/j.ienj.2024.101500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/09/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Violence against healthcare workers is a pervasive, yet in many cases, under-reported problem. This is due to various factors, including lack of time, support and a universal understanding of what constitutes a reportable event. This study explored facilitators and barriers to reporting workplace violence among emergency department nurses. METHODS In this descriptive, qualitative study, researchers conducted open-ended interviews with emergency nurses considered to be "high-" and "non-reporters" of violent events and analyzed for themes. RESULTS Participants cited consistent factors associated with less reporting, factors associated with more reporting and effectiveness of existing safety measures. CONCLUSIONS To encourage the reporting of violent events, frequently cited barriers and facilitators should be addressed. Strategies such as integrating reporting mechanisms into the health record, creating nuanced definitions of reportable events, and consistent education with positive feedback can promote reporting by staff. These efforts should be combined with prevention strategies to ensure we are collecting correct data about the success or failure of these programs.
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Affiliation(s)
- Madeleine Whalen
- The Johns Hopkins Hospital, 1800 Orleans St., Baltimore MD 21287, USA.
| | - Maia Bradley
- The Johns Hopkins Hospital, 1800 Orleans St., Baltimore MD 21287, USA.
| | - Ginger C Hanson
- Johns Hopkins University, School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205, USA.
| | | | - Vinciya Pandian
- Johns Hopkins University, School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205, USA.
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Supakul S, Yoshida M, Kosaka M, Murayama A, Tani Y, Bhandari D, Ozaki A, Tanimoto T. Characteristics of Vulnerable Foreigners in Need of Emergency Care Support in Japan: A Case Study of Thai Nationals from 2004 to 2020. J Immigr Minor Health 2024; 26:517-526. [PMID: 37982918 DOI: 10.1007/s10903-023-01566-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/21/2023]
Abstract
In Japan, a considerable number of foreigners encounter challenges in accessing appropriate healthcare services due to the lack of insurance coverage. However, the absence of a public database on these individuals makes it difficult to assess their health problems and healthcare access status. This study aims to investigate the characteristics of vulnerable Thai patients in Japan and to shed light on the specific challenges they face within Japan's healthcare system. A retrospective analysis was conducted using records of patients who required emergency healthcare support from the Royal Thai Embassy in Tokyo between 2004 and 2020. Descriptive statistical analyses were performed to examine the general characteristics, insurance status, and diseases of the patients. Additionally, patients were classified as either prolonged residents or brief residents based on their duration of stay in Japan until hospital admission (1 year or more or less than 1 year). A total of 74 patients were identified, with the majority (91.9%) lacking insurance coverage. Notably, there was an increase in the number of brief residents, including tourists, during the 2010s. Prolonged residents were more likely to experience chronic diseases, whereas brief residents were more prone to sustaining injuries. The patient records from the Thai Embassy consistently highlight the urgent requirement for emergency healthcare support within this population. However, the existing policies in Japan fall short in adequately addressing the healthcare access needs of this vulnerable population. Therefore, it is crucial to provide additional support and interventions to enhance their healthcare access.
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Affiliation(s)
- Sopak Supakul
- Graduate School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan.
| | - Makoto Yoshida
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
| | - Makoto Kosaka
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
| | - Anju Murayama
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
| | - Yuta Tani
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
| | - Divya Bhandari
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, 2-12-13-201 Takanawa, Minato-ku, Tokyo, Japan
- Navitas Clinic, Tokyo, Japan
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Supakul S, Jaroongjittanusonti P, Jiaranaisilawong P, Phisalaphong R, Tanimoto T, Ozaki A. Access to Healthcare Services among Thai Immigrants in Japan: A Study of the Areas Surrounding Tokyo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6290. [PMID: 37444137 PMCID: PMC10341320 DOI: 10.3390/ijerph20136290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/31/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
Numerous undocumented and uninsured foreigners living in Japan have faced barriers when trying to obtain appropriate healthcare services, which have occasionally led to issues with unpaid medical bills to medical institutions. Although information on health and socioeconomic status is essential to tackle such issues, relevant data has been unavailable due to difficulties in contacting this population. This study involved a cross-sectional survey using questionnaires concerning the general demographic characteristics, socioeconomic status, health profiles, information access, and knowledge/attitude/practice of health insurance of Thai nationals living in Japan. The study participants included Thai nationals who lived in Tokyo and the surrounding prefectures. The survey was conducted mainly at public religious events from September 2022 to December 2022. Overall, the questionnaires were obtained from 84 participants, though 67 participants were included in the final analysis after excluding missing variables. There were participants with unspecified visa status (32.8%) and uninsured status (40.3%). Among them, 86.4% expressed positive attitudes towards health insurance. However, multivariate multivariable regression analyses revealed the low insurance practice status among the unspecified visa group (aOR, 0.02; 95% CI, 0.00-0.13). Overall, the results reveal limited access to healthcare services in subgroups of Thai immigrants in Japan.
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Affiliation(s)
- Sopak Supakul
- Graduate School of Medicine, Keio University, Tokyo 160-8582, Japan
- Medical Governance Research Institute, Tokyo 108-0074, Japan
| | - Pichaya Jaroongjittanusonti
- Medical Governance Research Institute, Tokyo 108-0074, Japan
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | | | | | - Tetsuya Tanimoto
- Medical Governance Research Institute, Tokyo 108-0074, Japan
- Navitas Clinic, Tokyo 190-0012, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Tokyo 108-0074, Japan
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima 972-8322, Japan
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The Implications of the Emergency Medical Treatment and Labor Act and the No Surprises Act for Plastic and Reconstructive Surgeons. Plast Reconstr Surg 2023; 151:443-449. [PMID: 36696334 DOI: 10.1097/prs.0000000000009864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
SUMMARY The Emergency Medical Treatment and Labor Act (EMTALA) was enacted by Congress in 1986 to protect uninsured patients against economic discrimination. Although this law has been established for several decades, recent passage of the No Surprises Act may invoke new implications for the health care system under EMTALA. Therefore, it is worthwhile to review EMTALA's applications to the practice of plastic surgery and review EMTALA in the context of the recently passed No Surprises Act. First, providers are mandated by EMTALA to administer a medical screening examination to any patient presenting for emergent care. Second, providers must administer medical stabilization if the medical screening examination reveals an emergent condition. If the hospital lacks specialized capabilities to provide stabilizing care, they are required to transfer the patient to a facility that can provide care. Although EMTALA's provisions protect patients and provide them with leverage to obtain emergency care, the act has been associated with out-of-network, or "surprise," medical bills for the insured population and, ultimately, may be detrimental to plastic surgeons in emergency settings. The concerns related to EMTALA within plastic surgery involve the overburdening of surgeons at tertiary care centers because of uncompensated care and high rates of interfacility transfers. In addition, the recent passage of the No Surprises Act to end out-of-network emergency bills may further impact care provided by plastic surgeons in emergency settings under EMTALA's mandate. Potential methods to address these concerns include increasing on-call reimbursement rates and implementation of emergency department telemedicine services.
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Smith DJ, Mac V, Thompson LM, Plantinga L, Kasper L, Hertzberg VS. Using Occupational Histories to Assess Heat Exposure in Undocumented Workers Receiving Emergent Renal Dialysis in Georgia. Workplace Health Saf 2022; 70:251-258. [PMID: 35112607 DOI: 10.1177/21650799211060695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Immigrants often work in jobs that are known as dirty, demanding, and dangerous. Globally, the agricultural occupations have been associated with the emergence of chronic kidney disease of unknown etiology (CKDu) primarily in outdoor worker populations. The disease has also been reported in immigrants in the United States who work in agricultural occupations, but little research has been done outside of agricultural workers to determine whether immigrants who work other occupations are at risk for developing CKDu. METHODS This study assessed the self-reported occupational histories of undocumented immigrants receiving frequent, emergent-only dialysis in Atlanta, GA. We assessed demographics, employment status, and work history, using the Grady Dialysis Questionnaire and the Occupational/Environmental Health History Form. RESULTS Fifty undocumented immigrants receiving frequent, emergent-only hemodialysis were recruited for this study. The average age was 49.5 years (SD ± 11.5), and the majority (52%) were female and originated from Mexico (66%). A majority (74%) reported having worked in the past 5 years and 28% reported currently working. A total of 68 unique jobs were reported. In decreasing order of frequency, our sample worked in occupations with documented renal toxicant exposures, such as applying pesticides in landscaping, heat exposure in agriculture, construction, landscaping, and dry cleaning, and lead paint fumes in construction. DISCUSSION Occupational histories provide a greater understanding of the exposures and working conditions of those receiving frequent, emergent-only hemodialysis. This exploratory study suggests that further research is needed to investigate and assess whether renal toxicants are associated with occupations with high numbers of undocumented workers. APPLICATION TO PRACTICE A detailed and thorough occupational history should be conducted from those receiving frequent, emergent-only hemodialysis. Developing continuing education for nursing and medical staff in dialysis centers on taking an occupational history, mandatory State reporting requirements, and hazard communication training for workers should be considered. Collaborations between occupational health professionals, public health authorities, employers, dialysis providers, and clinicians who see undocumented workers is required to understand and develop appropriate prevention measures for this population.
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Affiliation(s)
- Daniel J Smith
- Emory University Nell Hodgson Woodruff School of Nursing
| | - Valerie Mac
- Emory University Nell Hodgson Woodruff School of Nursing
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Al-Balas QAE, Al-Balas HAE. The ethics of practicing defensive medicine in Jordan: a diagnostic study. BMC Med Ethics 2021; 22:87. [PMID: 34229676 PMCID: PMC8260347 DOI: 10.1186/s12910-021-00658-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/28/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Defensive medicine (DM) practice refers to the ordering or prescription of unnecessary treatments or tests while avoiding risky procedures for critically ill patients with the aim to alleviate the physician's legal responsibility and preserve reputation. Although DM practice is recognized, its dimensions are still uncertain. The subject has been highly investigated in developed countries, but unfortunately, many developing countries are unable to investigate it properly. DM has many serious ramifications, exemplified by the increase in treatment costs for patients and health systems, patients' exposure to risks, and negative effects on the psychological health of both health providers and recipients. Ultimately, the most serious consequence is the ethical consequences. METHODS This work is based on a review of the literature related to DM worldwide and a comparison with the available knowledge found in Jordan. It is qualitative with a descriptive nature, aiming to diagnose the current DM practice in Jordan. RESULTS This is the first published article that discusses DM in Jordan by diagnosing its ethical and economic consequences for the health system as well as for patients. Despite the knowledge of the reasons that support its practice, little is being done to solve this issue. The absence of agreeable medical malpractice law, the dearth of unified medical protocols, the overwhelming pressure imposed by patients on medical staff, and the deteriorating patient-physician relationship are some of the causes of DM practice. Surely, the solution to these issues is to focus on fortifying the ethical and humanitarian aspects on the side of both the physician and the patient to ensure positive collaboration. The ethical aim of the physician to treat the patient faithfully and do what is possible to help combined with the appreciation of the physician's efforts and the choice to not take advantage of the physician through litigation could be the most reasonable solution in the near future. CONCLUSION Jordan is suffering from DM due to the limited financial expenditure on the health sector and the impracticality of medical malpractice law. The authors highlight that the cardinal step in solving this dilemma is restoring the ethical dimension of the patient-physician relationship.
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Affiliation(s)
- Qosay A. E. Al-Balas
- grid.37553.370000 0001 0097 5797Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110 Jordan
| | - Hassan A. E. Al-Balas
- grid.37553.370000 0001 0097 5797Department of Radiology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110 Jordan ,grid.39382.330000 0001 2160 926XBaylor College of Medicine, Houston, TX USA
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The Emergency Nurses Association: 50 Years of Advocacy and Advancement. J Emerg Nurs 2021; 47:224-238.e1. [PMID: 33431138 DOI: 10.1016/j.jen.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/10/2020] [Accepted: 11/19/2020] [Indexed: 11/20/2022]
Abstract
To commemorate the 50th anniversary of the Emergency Nurses Association, this article describes the 3 most enduring and impactful policy initiatives in the organization's history. These initiatives were identified through a comprehensive review of the articles published in the Journal of Emergency Nursing as well as in other publications of the Emergency Nurses Association, including position statements and press releases. The top 3 policy issues throughout the Emergency Nurses Association's history were identified as provision of care for vulnerable populations, trauma and injury prevention, and patient quality and safety. The Emergency Nurses Association also worked hard to professionalize emergency nursing within the realms of nursing and emergency services during the first half of its history, and since then the Emergency Nurses Association has promoted issues related to the emergency nursing workforce and to ensuring a safe and sustainable environment in which nurses practice. This article includes critical constructs such as the professionalization of emergency nursing; advocating for vulnerable populations such as children, older adults, and people experiencing sexual violence or human trafficking; improvements in trauma care and injury prevention; promoting quality and safety through nursing certifications, efficient and accurate nurse triage, and disseminating best practices in evidence-based care; and supporting the nursing workforce by championing issues such as workplace violence, ED crowding, and healthy work environments.
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Brown HL. Emergency Care EMTALA Alterations During the COVID-19 Pandemic in the United States. J Emerg Nurs 2020; 47:321-325. [PMID: 33388166 PMCID: PMC7704064 DOI: 10.1016/j.jen.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/02/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022]
Abstract
The coronavirus 2019 pandemic has affected almost every aspect of health care delivery in the United States, and the emergency medicine system has been hit particularly hard while dealing with this public health crisis. In an unprecedented time in our history, medical systems and clinicians have been asked to be creative, flexible, and innovative, all while continuing to uphold the important standards in the US health care system. To continue providing quality services to patients during this extraordinary time, care providers, organizations, administrators, and insurers have needed to alter longstanding models and procedures to respond to the dynamics of a pandemic. The Emergency Medicine Treatment and Active Labor Act of 1986, or EMTALA, is 1 example of where these alterations have allowed health care facilities and clinicians to continue their work of caring for patients while protecting both the patients and the clinicians themselves from infectious exposures at the same time.
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