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Kang KT, Chang RE, Lin MT, Chen YC. Pay-for-performance in Taiwan: A systematic review and meta-analysis of the empirical literature. Public Health 2024; 236:328-337. [PMID: 39299087 DOI: 10.1016/j.puhe.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/27/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVES This study aimed to assess the impact of pay-for-performance (P4P) programmes on healthcare in Taiwan. STUDY DESIGN This was a systematic review and meta-analysis. METHODS A systematic literature search was performed using the PubMed, Medline, Embase, Cochrane review, Scopus, Web of Science and PsycINFO databases up to July 2023. Meta-analysis of the available outcomes was conducted using a random-effects model. RESULTS The search yielded 85 studies, of which 58 investigated the programme for diabetes mellitus (DM), eight looked at the programme for chronic kidney disease (CKD), and the remaining studies examined programmes for breast cancer, tuberculosis, schizophrenia and chronic obstructive pulmonary disease. The DM P4P programme was a cost-effective strategy associated with reduced hospitalisation and subsequent complications. The CKD P4P was associated with a lower risk of dialysis initiation. The P4P programme also improved outcomes in breast cancer, cure rates in tuberculosis, reduced admissions for schizophrenia and reduced acute exacerbation in chronic obstructive pulmonary disease. The meta-analysis revealed that the P4P programme for DM (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.48-0.73) and CKD (OR = 0.73; 95% CI = 0.67-0.81) significantly reduced mortality risk. However, participation rate in the DM P4P programme was only 19% in 2014. CONCLUSIONS P4P programmes in Taiwan improve quality of care. However, participation was voluntary and the participation rate was very low, raising the concern of selective enrolment of participants (i.e. 'cherry-picking' behaviour) by physicians. Future programme reforms should focus on well-designed features with the aim of reducing healthcare disparities.
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Affiliation(s)
- Kun-Tai Kang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ray-E Chang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan; Department of Information Systems and Operations Management, College of Business Administration, University of Texas at, Arlington, USA.
| | - Ming-Tzer Lin
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Cheng Chen
- Division of Nephrology, Department of Internal Medicine, Changhua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
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Tu B, Yang Y, Cao Q, Wu G, Li X, Zhuang Q. Knowledge mapping of job burnout and satisfaction of medical staff and a cross-sectional investigation of county-level hospitals in Southern China. Heliyon 2024; 10:e33747. [PMID: 39027609 PMCID: PMC11255490 DOI: 10.1016/j.heliyon.2024.e33747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 06/15/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024] Open
Abstract
Background Job burnout is a worldwide public health problem that has rarely been addressed among rural medical staff, particularly in county-level hospitals. Hence, we conducted a bibliometric study to gain global insights and research trends and a cross-sectional study to assess the current situation among medical staff of county-level hospitals in Southern China. By conducting these studies, we aim to identify factors associated with burnout among medical staff of county-level hospitals in China and provide recommendations for improvement. Methods Relevant literature on job burnout among medical personnel was searched using the Web of Science Core Collection (WoSCC). CiteSpace was employed for an in-depth cluster analysis to determine research trends and identify the study population. Subsequently, a cross-sectional survey was randomly conducted in three county-level hospitals in Hunan Province of Southern China. Job burnout and satisfaction were assessed using the Maslach Burnout Inventory MBI-Human Services Survey (MBI-HSS) and Job Satisfaction Questionnaire in a total of 362 valid questionnaires collected. The influence factors of the prevalence of job burnout were investigated using logistic regression. Results In this bibliometric study, 1626 articles were retrieved from 1999 to 2022. China lags behind the United States (US) in both the number and quality of publications in the field of medical staff burnout compared with the US. However, there is a lack of comparative research on job burnout across different job types. County-level medical staff articles are more in line with research hotspots in the field. In total, 362 valid questionnaires were obtained. The total incidence of job burnout among rural medical staff was 27.3 %. Nurses (p < 0.01, OR = 5.95), doctors (p < 0.01, OR = 6.43), and those with administrative jobs (p < 0.01, OR = 7.79) were more likely to experience burnout than those with technical jobs. Medical staff aged 40-49 years (p < 0.01, OR = 0.22) and 50-59 years (p < 0.05, OR = 0.14) were less likely to experience burnout than those aged 20-29 years. Job rewards satisfaction showed a positive correlation with job burnout (p < 0.01, OR = 1.32), but negative correlations with personal development satisfaction (p < 0.05, OR = 0.81) and work internal environment satisfaction (p < 0.05, OR = 0.81). Conclusion Better working environments, more accessible resources, and higher job rewards contribute to job satisfaction and reduce job burnout among the medical staff of county-level hospitals in China.
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Affiliation(s)
- Baoren Tu
- Transplantation Center, the 3rd Xiangya Hospital, Central South University, Changsha, China
- Research Center of National Health Ministry on Transplantation Medicine, Changsha, China
| | - Yi Yang
- Transplantation Center, the 3rd Xiangya Hospital, Central South University, Changsha, China
- Research Center of National Health Ministry on Transplantation Medicine, Changsha, China
| | - Qingtai Cao
- Transplantation Center, the 3rd Xiangya Hospital, Central South University, Changsha, China
- Research Center of National Health Ministry on Transplantation Medicine, Changsha, China
| | - Guanghan Wu
- The People's Hospital of Jianghua County, China
| | - Xijun Li
- The First People's Hospital of Jianghua County, China
| | - Quan Zhuang
- Transplantation Center, the 3rd Xiangya Hospital, Central South University, Changsha, China
- Research Center of National Health Ministry on Transplantation Medicine, Changsha, China
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Almino RHSC, Pereira da Silva AB, Dantas ALDM, de Menezes HF, da Costa Prado NC, Stefany da Costa Santos R, Manso RKGDS, Targino Ferreira T, da Silva RAR. Middle-Range Theory of Occupational Stress in Health Professionals. SAGE Open Nurs 2024; 10:23779608241236290. [PMID: 38464600 PMCID: PMC10924540 DOI: 10.1177/23779608241236290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 01/19/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Occupational stress affects health professionals; however, no literature was found on the middle-range theory for this outcome in health professionals. Methods Methodological study for the theoretical validation of a nursing diagnosis using the theoretical framework of Walker and Avant and the Betty Neuman systems models. The research was conducted in five stages: comprehension of the system model; selection and review of studies; development of the conceptual-theoretical-empirical structure; elaboration of a diagram and proposition of a nursing diagnosis; and evaluation of the empirical adequacy of the theory and validity of the system model. These steps were conducted using a scoping review and a sample of 138 articles selected in the Scopus, Web of Science, MEDLINE/PubMed, CINAHL, PsycINFO, LILACS, Science Direct, Cochrane Library, and Google Scholar databases. A data extraction instrument was developed, and study variables (attributes, antecedents, and clinical consequences) were analyzed using descriptive statistics (absolute and relative frequencies) and presented in tables. Results The middle-range theory comprised 16 concepts, 20 propositions, and one diagram. A total of 15 related factors, 29 defining characteristics, six at-risk populations, and one associated condition were indicated to propose the nursing diagnosis for occupational stress. Conclusion The middle-range theory supported elaborating elements to propose a nursing diagnosis for occupational stress.
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Affiliation(s)
- Romanniny Hévillyn Silva Costa Almino
- Brazilian Hospital Services Company, Natal, Rio Grande do Norte, Brazil
- Federal Institute of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Ana Beatriz Pereira da Silva
- Brazilian Hospital Services Company, Natal, Rio Grande do Norte, Brazil
- Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Anna Lívia de Medeiros Dantas
- Brazilian Hospital Services Company, Natal, Rio Grande do Norte, Brazil
- Department of Nursing, Postgraduate Program in Nursing, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | | | - Nanete Caroline da Costa Prado
- Department of Nursing, Postgraduate Program in Nursing, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Rebecca Stefany da Costa Santos
- Department of Nursing, Postgraduate Program in Nursing, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Roberta Keile Gomes de Sousa Manso
- Brazilian Hospital Services Company, Natal, Rio Grande do Norte, Brazil
- Department of Nursing, Postgraduate Program in Nursing, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Thais Targino Ferreira
- Department of Nursing, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Richardson Augusto Rosendo da Silva
- Department of Nursing, Postgraduate Program in Nursing, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
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Rotteau L, Othman D, Dunbar-Yaffe R, Fortin C, Go K, Mayo A, Pelc J, Wolfstadt J, Guo M, Soong C. Physician engagement in organisational patient safety through the implementation of a Medical Safety Huddle initiative: a qualitative study. BMJ Qual Saf 2023; 33:33-42. [PMID: 37468150 DOI: 10.1136/bmjqs-2022-015725] [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: 11/03/2022] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Efforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians' strong professional identification, physician-led strategies may offer a novel strategic approach to enhancing physician engagement. It remains unclear what role medical leadership can play in leading programmes to enhance physician engagement. In this study, we explore physicians' experience of participating in a Medical Safety Huddle initiative and how participation influences engagement with organisational quality and safety efforts. METHODS We conducted a qualitative study of the Medical Safety Huddle initiative implemented across six sites. The initiative consisted of short, physician focused and led, weekly meetings aimed at reviewing, anticipating and addressing patient safety issues. We conducted 29 semistructured interviews with leaders and participants. We applied an interpretive thematic analysis to the data using self-determination theory as an analytic lens. RESULTS The results of the thematic analysis are organised in two themes, (1) relatedness and meaningfulness, and (2) progress and autonomy, representing two forms of intrinsic motivation for engagement that we found were leveraged through participation in the initiative. First, participation enabled a sense of community and a 'safe space' in which professionally relevant safety issues are discussed. Second, participation in the initiative created a growing sense of ability to have input in one's work environment. However, limited collaboration with other professional groups around patient safety and the ability to consistently address reported concerns highlights the need for leadership and organisational support for physician engagement. CONCLUSION The Medical Safety Huddle initiative supports physician engagement in quality and safety through intrinsic motivation. However, the huddles' implementation must align with the organisation's multipronged patient safety agenda to support multidisciplinary collaborative quality and safety efforts and leaders must ensure mechanisms to consistently address reported safety concerns for sustained physician engagement.
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Affiliation(s)
- Leahora Rotteau
- Centre for Quality Improvment and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Dalia Othman
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Richard Dunbar-Yaffe
- Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
| | - Chris Fortin
- Division of Physical Medicine and Rehabilitation, Sinai Health System, Toronto, Ontario, Canada
| | - Katharyn Go
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Amanda Mayo
- Centre for Quality Improvment and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jordan Pelc
- Division of Hospital Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Jesse Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Sinai Health System, Toronto, Ontario, Canada
| | - Meiqi Guo
- Division of Physical Medicine and Rehabilitation, University Health Network, Toronto, Ontario, Canada
| | - Christine Soong
- Centre for Quality Improvment and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of General Internal Medicine, Sinai Health System, Toronto, Ontario, Canada
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Slavkovic M, Eric D, Miric M, Simonovic M. Leveraging a Synergy in Motivation to Effect Job Satisfaction of Healthcare Professionals in Public Blood Bank Units: A Cross-Sectional Study. J Multidiscip Healthc 2023; 16:3203-3214. [PMID: 37927556 PMCID: PMC10625382 DOI: 10.2147/jmdh.s433813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
Background Superior patient care requires a team of medical professionals who are motivated and satisfied with their jobs. However, in an occupational setting characterized by prolonged work hours and excessive stress, managers face increased challenges in their attempts to motivate employees and sustain high levels of job satisfaction. Aim This study investigates whether, and to what extent, extrinsic and intrinsic motivation might predict job satisfaction. It also examines how specific categorical variables moderate these correlations. Design The present study offers an empirical investigation of a path model that establishes a relationship between motivation and job satisfaction in healthcare professionals in public blood bank units. A PLS SEM was conducted on a sample of 218 individuals employed in public blood bank units in the Republic of Serbia. Results The findings provide valuable insights into the causal relationship among observed variables under different sample characteristics, such as gender, age, job position, and employment status. The findings also indicate that extrinsic motivation is a significant predictor of intrinsic motivation (ß=0.742, t=18.933, p<0.001) and job satisfaction (ß=0.211, t=2.035, p<0.05). Simultaneously, intrinsic motivation acts as a mediator within this correlation (ß=0.186, t=2.688, p<0.05). The results of the multigroup analysis reveal that categorical variables such as gender, age, job position, and employment status have a moderating effect on certain previously established relationships. Conclusion Increasing job satisfaction among healthcare professionals requires a balanced motivational complex encompassing both extrinsic and intrinsic motivators. Customized motivational tactics should be employed for certain cohorts of healthcare staff, considering their gender, age, job position, and employment status. Our findings expand the body of knowledge concerning the mechanisms underlying the relationship between motivation and job satisfaction in the healthcare industry. Additionally, the results offer relevant practical implications for healthcare managers in designing effective motivational and job satisfaction strategies.
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Affiliation(s)
- Marko Slavkovic
- Department of Management and Business Economics, Faculty of Economics, University of Kragujevac, Kragujevac, 34000, Serbia
| | - Dragan Eric
- National Health Care Institute for Ministry of Internal Affairs Employees, Belgrade, 11000, Serbia
| | - Marija Miric
- Department of Management and Business Economics, Faculty of Economics, University of Kragujevac, Kragujevac, 34000, Serbia
| | - Marija Simonovic
- Blood Bank, University Clinical Center, Kragujevac, 34000, Serbia
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Shi X, Xiong D, Zhang X, Han M, Liu L, Wang J. Analysis of factors influencing the job satisfaction of medical staff in tertiary public hospitals, China: A cross-sectional study. Front Psychol 2023; 14:1048146. [PMID: 36818068 PMCID: PMC9932040 DOI: 10.3389/fpsyg.2023.1048146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Since the outbreak of the novel coronavirus pneumonia (COVID-19), China has entered normalization phase of its epidemic prevention and control measures that emphasizes 'precise prevention and control,' 'dynamic zeroing', and 'universal vaccination'. However, medical staff continue to face physical and mental stress. The present study aimed to investigate the job satisfaction of medical staff in China, as well as any associated factors. Methods 2,258 medical staff completed a questionnaire specially designed for this study. Independent samples t-tests, one-way analysis of variance, and binary logistic regression were used to analyze associated factors. Results Overall, 48.4% of the participants expressed satisfaction with their job; the highest-scoring dimension was interpersonal relationships (3.83 ± 0.73), while the lowest scoring dimension was salary and benefits (3.13 ± 0.94). The logistic regression model indicated that job satisfaction among medical staff is associated with being aged 40-49 years [odds ratio (OR) = 2.416] or > 50 years (OR = 2.440), having an above-undergraduate education level (OR = 1.857), holding a position other than doctor [i.e., nurse (OR = 3.696) or 'other' (OR = 2.423)], having a higher income (OR = 1.369), and having fewer monthly overtime shifts (OR = 0.735-0.543). Less than half of the medical staff expressed satisfaction with their job, indicating that the overall level is not high. Discussion This research enriches the study of medical workers' job satisfaction during periods when epidemic prevention and control has become familiar and routine. To improve medical workers' job satisfaction, administrators should seek to enhance medical staff's remuneration, reduce their work pressure, and meet their needs (where reasonable).
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Affiliation(s)
- Xiang Shi
- School of Health Management, Anhui Medical University, Hefei, Anhui, China
| | - Dekai Xiong
- School of Health Management, Anhui Medical University, Hefei, Anhui, China
| | - Xingmin Zhang
- School of Health Management, Anhui Medical University, Hefei, Anhui, China
| | - Miaomiao Han
- School of Health Management, Anhui Medical University, Hefei, Anhui, China
| | - Liu Liu
- Department of Scientific Research, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China,*Correspondence: Liu Liu, ✉
| | - Jinian Wang
- Department of Education, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,Jinian Wang, ✉
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Morishita K, Katase K, Ishikane M, Otomo Y. Motivating factors for frontline healthcare workers during the COVID-19 pandemic: A survey in Japan. CURRENT PSYCHOLOGY 2022; 43:1-9. [PMID: 36618542 PMCID: PMC9803592 DOI: 10.1007/s12144-022-04177-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
Healthcare workers (HCWs), who are at the frontline of the COVID-19 pandemic, treated COVID-19 patients under many types of stress for over a year. As an external motivating factor, incentives could be important for HCWs dealing with COVID-19. However, there has been no research regarding the change in the consciousness of HCWs during the unrelenting waves of COVID-19. Therefore, we conducted a survey of HCWs during different waves of COVID-19 (the second and fourth waves in Japan). An open web-based survey was conducted among HCWs who wore PPE while treating COVID-19 patients. The first survey of HCWs in Japan was conducted from August 27 to September 9, 2020, while the second survey was conducted from April 7 to May 10, 2021, during the second and fourth waves, respectively. The first and second surveys had 157 and 125 participants, respectively. There were no significant differences in the characteristics of the participants in the first and second survey groups regarding the types of occupation, age, sex, or full-time status. The percentage of HCWs who required financial incentives to maintain motivation remained high (88.5% vs. 82.7%). In addition, most frontline HCWs hope for regular SARS-CoV-2 PCR testing, which will be provided free of charge, as a necessary incentive. External motivating factors, such as financial and other incentives, were important to maintain the motivation of HCWs during the second and fourth waves of the COVID-19 pandemic in Japan. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-022-04177-6.
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Affiliation(s)
- Koji Morishita
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510 Japan
| | - Kozo Katase
- Section of Research Development, Department of Public Health, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510 Japan
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Shin H, Kim KH, Kim JS, Kwak YH. Nurses' duty to care during the COVID-19 pandemic: a cross-sectional survey. BMC Nurs 2022; 21:293. [PMID: 36324125 PMCID: PMC9628139 DOI: 10.1186/s12912-022-01064-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Background Despite the increased demand for nurses worldwide, discussion of nurses’ duty to care is lacking. This study aimed to examine nurses’ duty to care during the coronavirus disease 2019 (COVID-19) pandemic and to identify the influencing factors. Methods This was a cross-sectional descriptive research study that used a structured online questionnaire. Registered Korean nurses answered a demographic questionnaire and the Nash Duty to Care Scale. Results Age and employment at tertiary hospitals increased nurses’ duty to care. Male sex, a highly educated status, and employment at tertiary hospitals increased the perceived risk. Male sex and employment at tertiary or general hospitals increased confidence in the employer, while a high level of education and a longer total clinical career decreased the same. Age and a higher monthly wage increased perceived obligation. Age, lack of religious beliefs, and clinical experience of 3–7 years increased professional preparedness. Conclusion Without enough nursing manpower, the disaster response system could prove to be inefficient. Considering that adequate nurse staffing is essential in disaster management, it is crucial to ensure that nurses have a will to provide care in the case of disaster. In the future, a more active discussion on nurses’ duty to care and additional research on factors that may hinder and facilitate the same are needed.
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Affiliation(s)
- Hyerine Shin
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, 06974, Seoul, Republic of Korea
| | - Kyung Hee Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, 06974, Seoul, Republic of Korea.
| | - Ji-Su Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, 06974, Seoul, Republic of Korea
| | - Yeun-Hee Kwak
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, 06974, Seoul, Republic of Korea
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Weng TL, Chu FY, Li CL, Chen TJ. Choices of Specialties and Training Sites among Taiwanese Physicians Graduating from Polish Medical Schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063727. [PMID: 35329418 PMCID: PMC8950236 DOI: 10.3390/ijerph19063727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 02/05/2023]
Abstract
Taiwanese students who graduated from Polish medical schools (P-IMGs) accounted for the second-largest group of international medical graduates in Taiwan. In 2009, domestic medical students in Taiwan staged mass demonstrations against P-IMG’s exemption from the qualifying test before the licensing exam. Although medical circles in Taiwan might still hold prejudices against P-IMGs, little is known about their career development. This study will analyze P-IMGs’ choices of specialties and training sites from 2000 to 2020 using data from the membership section of the Taiwan Medical Journal, the monthly official publication of the Taiwan Medical Association. Of 372 P-IMGs, 34.2% chose internal medicine and 17.1% surgery. Although academic medical centers offered 76% of all available trainee positions in a year, only 49.3% of P-IMGs received training there. By contrast, 20.9% of P-IMGs were trained at nonmetropolitan hospitals that altogether accounted for only 5.8% of trainee positions. In conclusion, P-IMGs had their residency training at less favorable specialties and sites. Their long-term career development deserves further study.
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Affiliation(s)
- Tzu-Ling Weng
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Feng-Yuan Chu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Chiao-Lin Li
- Department of Family Medicine, Taipei City Hospital Yangming Branch, Taipei 111, Taiwan;
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Correspondence:
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Gharebaghi R, Heidary F, Pourezzat AA. Serial Deaths of Young Trainee Physicians in Iran During COVID-19 Pandemic; Messages to Policy Makers. FRONTIERS IN HEALTH SERVICES 2022; 2:777065. [PMID: 36925768 PMCID: PMC10012792 DOI: 10.3389/frhs.2022.777065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Reza Gharebaghi
- International Virtual Ophthalmic Research Center (IVORC), Austin, TX, United States
| | - Fatemeh Heidary
- International Virtual Ophthalmic Research Center (IVORC), Austin, TX, United States
| | - Ali Asghar Pourezzat
- Department of Public Administration, Faculty of Management and Faculty of Governance, University of Tehran, Tehran, Iran
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11
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Intriago M, Maldonado G, Soriano E, Toro C, Moreno L, Ríos C. Burnout in Rheumatologists in Latin America. J Clin Rheumatol 2022; 28:1-6. [PMID: 34670993 DOI: 10.1097/rhu.0000000000001795] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rheumatology is considered a low-risk specialty, but studies have shown a prevalence of burnout between 42% and 51%. OBJECTIVES The aim was to determine the prevalence of burnout in rheumatologists in Latin America and the factors associated with it. METHODS Cross-sectional study based on a survey completed through Google Forms platform that was sent by the national rheumatology associations of Latin America. Burnout was assessed with the Maslach Burnout Inventory. Data were analyzed using the statistical program SPSS v.22. RESULTS Two hundred ninety-seven rheumatologists from 15 countries were included, mainly Argentina (28.3%), Brazil (26.3%), and Mexico (12.8%). The majority were women 62%, 42.4% worked in public hospitals with an average of 40.1 ± 14.2 hours per week; 31.3% did research, 13.1% clinical trials, 56.6% teaching, and 42.8% administrative work; 36% received an annual income less than $25,000; 56.6% had burnout in at least 1 dimension. Only 20.2% thought they had burnout, 9.1% were currently receiving professional help, and 15.8% had sought help in the past; 72.1% said they were willing to participate in a program to reduce burnout. The rheumatologists with burnout were younger than those without burnout (46.5 vs 49.9 years, p = 0.015). CONCLUSIONS Burnout affects near half of rheumatologists in Latin America and was associated with younger age, long working hours, low satisfaction, less happiness, higher Patient Health Questionnaire-9, suicidal thoughts, anxiety, income, presence of comorbidities, and low self-esteem.
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Affiliation(s)
- Maria Intriago
- From the Jackson Memorial Hospital, University of Miami, Miami, FL
| | | | | | - Carlos Toro
- Centro de Referencia en Osteoporosis y Reumatología, Cali, Colombia
| | - Letty Moreno
- Centro de Reumatología y Rehabilitación, Guayaquil
| | - Carlos Ríos
- Universidad Espiritu Santo, Samborondón, Ecuador
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Lemmen CHC, Yaron G, Gifford R, Spreeuwenberg MD. Positive Health and the happy professional: a qualitative case study. BMC FAMILY PRACTICE 2021; 22:159. [PMID: 34303359 PMCID: PMC8308069 DOI: 10.1186/s12875-021-01509-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary care professionals (PCPs) face mounting pressures associated with their work, which has resulted in high burn-out numbers. Increasing PCPs' job satisfaction is proposed as a solution in this regard. Positive Health (PH) is an upcoming, comprehensive health concept. Among others, this concept promises to promote PCPs' job satisfaction. However, there is limited research into PH's effects on this topic. This study, therefore, aims to provide insight into how adopting PH in a general practice affects PCPs' job satisfaction. METHODS An ethnographic case study was conducted in a Dutch general practice that is currently implementing PH. Data collected included 11 semi-structured interviews and archival sources. All data were analyzed thematically. RESULTS Thematic analysis identified three themes regarding PCPs' adoption of PH and job satisfaction, namely [1] adopting and adapting Positive Health, [2] giving substance to Positive Health in practice, and [3] changing financial and organizational structures. Firstly, the adoption of PH was the result of a match between the practice and the malleable and multi-interpretable concept. Secondly, PH supported PCPs to express, legitimize, and promote their distinctive approach to care work and its value. This strengthened them to further their holistic approach to health and stimulate autonomy in practice, with respect to both patients and professionals. Thirdly, the concept enabled PCPs to change their financial and organizational structures, notably freeing time to spend on patients and on their own well-being. This allowed them to enact their values. The changes made by the practice increased the job satisfaction of the PCPs. CONCLUSIONS PH contributed to the job satisfaction of the PCPs of the general practice by functioning as an adaptable frame for change. This frame helped them to legitimize and give substance to their vision, thereby increasing job satisfaction. PH's malleability allows for the frame's customization and the creation of the match. Simultaneously, malleability introduces ambiguity on what the concept entails. In that regard, PH is not a readily implementable intervention. We recommend that other organizations seeking to adopt PH consider whether they are willing and able to make the match and explore how PH can help substantiate their vision.
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Affiliation(s)
- Caro H C Lemmen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, PO-Box 6220MD, Maastricht, 6229 GT, The Netherlands
| | - Gili Yaron
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, PO-Box 6220MD, Maastricht, 6229 GT, The Netherlands.
| | - Rachel Gifford
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, PO-Box 6220MD, Maastricht, 6229 GT, The Netherlands
| | - Marieke D Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, PO-Box 6220MD, Maastricht, 6229 GT, The Netherlands
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Mitchell P, Cribb A, Entwistle V, Singh G. Pushing poverty off limits: quality improvement and the architecture of healthcare values. BMC Med Ethics 2021; 22:91. [PMID: 34256744 PMCID: PMC8278597 DOI: 10.1186/s12910-021-00655-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people's lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative (PSI) into paediatric practice using the discourse and methodology of healthcare quality improvement (QI). DISCUSSION Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty 'off limits.' We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. CONCLUSIONS We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods.
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Affiliation(s)
- Polly Mitchell
- Centre for Public Policy Research, School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK.
| | - Alan Cribb
- Centre for Public Policy Research, School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK
| | - Vikki Entwistle
- Health Services Research Unit and School of Divinity, History and Philosophy, University of Aberdeen, 3rd floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Guddi Singh
- Mary Sheridan Centre for Child Health, Guy's and St. Thomas' NHS Foundation Trust, 5 Dugard Way, London, SE11 4TH, UK
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Lee A, Abdulhussein D, Fallaha M, Buckeldee O, Morrice R, Leedham-Green K. Whole consultation simulation in undergraduate surgical education: a breast clinic case study. BMC MEDICAL EDUCATION 2021; 21:305. [PMID: 34049545 PMCID: PMC8164306 DOI: 10.1186/s12909-021-02757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Safe and effective clinical outcomes (SECO) clinics enable medical students to integrate clinical knowledge and skills within simulated environments. This realistic format may better prepare students for clinical practice. We aimed to evaluate how simulated surgical clinics based on the SECO framework aligned with students' educational priorities in comparison with didactic tutorials. METHODS We delivered two breast surgery SECO-based simulated clinics to Year 3 students during their surgical attachments at a London teaching hospital. All students attended a didactic breast surgery tutorial the previous week. Pre- and post-session surveys and post-session debriefs were used to explore learning gain, processes, preferences and impacts on motivation to learn. Data were analysed using inductive thematic analysis to categorise student views into themes. RESULTS Seventeen students enrolled in the simulated clinics and debriefs. Students expressed that passing examinations was a key extrinsic motivating factor, although the SECO-based format appeared to shift their motivation for learning towards aspiring to be clinically competent. Self-reported confidence in clinical skills such as history taking and examination improved significantly. Active learning methods were valued. Students expressed a preference for simulated clinics to complement, but not replace, tutorial-based learning. CONCLUSION The SECO-based simulated clinic promoted a shift towards intrinsic motivation for learning by allowing students to recognise the importance of preparing for clinical practice in addition to passing examinations. Integration of surgical simulated clinics into the undergraduate curriculum could facilitate acquisition of clinical skills through active learning, a method highly valued by students.
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Affiliation(s)
- Alice Lee
- Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK.
| | - Dalia Abdulhussein
- Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK
| | - Mohammad Fallaha
- Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK
| | - Olivia Buckeldee
- Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Rory Morrice
- Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Kathleen Leedham-Green
- Medical Education Research Unit, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
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