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Oliveira C, Barbosa B, Couto JG, Bravo I, Hughes C, McFadden S, Khine R, McNair HA. Advanced practice in radiotherapy across Europe: stakeholders' perceptions of implementation and evolution. Radiography (Lond) 2024; 30:896-907. [PMID: 38608565 DOI: 10.1016/j.radi.2024.03.013] [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: 11/03/2023] [Revised: 03/09/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Adapting radiotherapy services with workforce innovation using skills-mix or task-shifting optimises resources, supporting current and future demands. Advanced practitioners (APs) work at a different level of practice (beyond initial registration) across four pillars: clinical practice, leadership and management, education, and research. There is limited cross-country research on the advanced therapeutic radiographers/radiation therapists (TR/RTTs), particularly in Europe. This study aimed to investigate European radiotherapy stakeholders' perceptions regarding current and future advanced practice (AP). METHODS From June to September 2022, one-to-one online semi-structured interviews were conducted in English, and audio and video were recorded. Full verbatim audio files were independently transcribed and checked by interviewer and interviewees. Braun and Clarke's seven steps guided the thematic analysis (using NVivo). RESULTS Thirty-three interviewees working or studying in 16 European countries represented practitioners (n=14), managers (n=6), educators (n=4), professional bodies (n=4), students (n=3), and regulators (n=2). Four overarching themes emerged: "AP drivers and outcomes", "AP challenges vs enablers", "Current vs future AP", "Becoming and being advanced practitioner". Participants identified research as the neglected AP pillar due to a lack of protected time, limited staff skills, no research culture, no funding, workload, and clinical priorities. Interviewees highlighted the importance of consistency in job titles, harmonisation of education models and curricula, definition of AP requirements, and support for all AP pillars through job plans and workforce planning. CONCLUSION Neither the profession nor education of TR/RTTs are harmonised across Europe, which is highly reflected in advanced-level practice. Advanced TR/RTTs should work across all pillars, including research, and these should be embedded in master's programmes, including leadership. IMPLICATIONS FOR PRACTICE This study highlights a policy gap in the education and practice of APs in radiotherapy.
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Affiliation(s)
- C Oliveira
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Spain.
| | - B Barbosa
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Spain; Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), Portugal.
| | - J G Couto
- Radiography Department, Faculty of Health Sciences, University of Malta, Malta.
| | - I Bravo
- Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), Portugal.
| | - C Hughes
- School of Health Sciences, Ulster University, United Kingdom.
| | - S McFadden
- School of Health Sciences, Ulster University, United Kingdom.
| | - R Khine
- European Federation of Radiographer Societies, Utrecht, Netherlands; Institute of Health Sciences Education, Faculty of Medicine & Dentistry, Queen Mary, University of London, United Kingdom.
| | - H A McNair
- European Federation of Radiographer Societies, Utrecht, Netherlands; The Royal Marsden NHS Foundation Trust, Radiotherapy and the Institute of Cancer Research, Surrey, United Kingdom.
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Lee JT, Crettenden I, Tran M, Miller D, Cormack M, Cahill M, Li J, Sugiura T, Xiang F. Methods for health workforce projection model: systematic review and recommended good practice reporting guideline. HUMAN RESOURCES FOR HEALTH 2024; 22:25. [PMID: 38632567 PMCID: PMC11025158 DOI: 10.1186/s12960-024-00895-z] [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: 11/20/2023] [Accepted: 01/22/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Health workforce projection models are integral components of a robust healthcare system. This research aims to review recent advancements in methodology and approaches for health workforce projection models and proposes a set of good practice reporting guidelines. METHODS We conducted a systematic review by searching medical and social science databases, including PubMed, EMBASE, Scopus, and EconLit, covering the period from 2010 to 2023. The inclusion criteria encompassed studies projecting the demand for and supply of the health workforce. PROSPERO registration: CRD 42023407858. RESULTS Our review identified 40 relevant studies, including 39 single countries analysis (in Australia, Canada, Germany, Ghana, Guinea, Ireland, Jamaica, Japan, Kazakhstan, Korea, Lesotho, Malawi, New Zealand, Portugal, Saudi Arabia, Serbia, Singapore, Spain, Thailand, UK, United States), and one multiple country analysis (in 32 OECD countries). Recent studies have increasingly embraced a complex systems approach in health workforce modelling, incorporating demand, supply, and demand-supply gap analyses. The review identified at least eight distinct types of health workforce projection models commonly used in recent literature: population-to-provider ratio models (n = 7), utilization models (n = 10), needs-based models (n = 25), skill-mixed models (n = 5), stock-and-flow models (n = 40), agent-based simulation models (n = 3), system dynamic models (n = 7), and budgetary models (n = 5). Each model has unique assumptions, strengths, and limitations, with practitioners often combining these models. Furthermore, we found seven statistical approaches used in health workforce projection models: arithmetic calculation, optimization, time-series analysis, econometrics regression modelling, microsimulation, cohort-based simulation, and feedback causal loop analysis. Workforce projection often relies on imperfect data with limited granularity at the local level. Existing studies lack standardization in reporting their methods. In response, we propose a good practice reporting guideline for health workforce projection models designed to accommodate various model types, emerging methodologies, and increased utilization of advanced statistical techniques to address uncertainties and data requirements. CONCLUSIONS This study underscores the significance of dynamic, multi-professional, team-based, refined demand, supply, and budget impact analyses supported by robust health workforce data intelligence. The suggested best-practice reporting guidelines aim to assist researchers who publish health workforce studies in peer-reviewed journals. Nevertheless, it is expected that these reporting standards will prove valuable for analysts when designing their own analysis, encouraging a more comprehensive and transparent approach to health workforce projection modelling.
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Affiliation(s)
- John Tayu Lee
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia.
| | - Ian Crettenden
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - My Tran
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Daniel Miller
- Health Data Analytics Team, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Mark Cormack
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Megan Cahill
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Jinhu Li
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Tomoko Sugiura
- Health Data Analytics Team, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Fan Xiang
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
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Tohms A, Krutish A, Hartley JN. Refining the activities of genetic assistants: Development of task statements applicable across practice settings. Am J Med Genet A 2024; 194:e63487. [PMID: 38041235 DOI: 10.1002/ajmg.a.63487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/17/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
Although genetic (counseling) assistants (GAs) have been implemented in many institutions, their roles vary widely. Therefore, this study aimed to refine our knowledge of GA tasks across work settings and specialties. Tasks performed by GAs were extracted from peer-reviewed articles, publicly available theses, and job postings, then analyzed using directed content analysis. Briefly, task statements were coded using broad categories from previous studies, with new categories added as emergent. Coded tasks were combined and condensed to produce a final task list, which was reviewed by subject matter experts. Sixty-one task statements were extracted from previous studies and 335 task statements were extracted from job descriptions. Directed content analysis produced a list of 40 unique tasks under 10 categories (8 from original research and 2 from the data). This study design resulted in a refined list of GA tasks that may be applicable across work settings and specialties, which is an essential step towards defining the scope of GA work. Beyond the human resource applications of the refined task list, this work may also benefit genetics services by reducing role overlap, improving efficiencies, improving employee satisfaction, and informing the development/improvement of training and other educational materials.
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Affiliation(s)
- Ashley Tohms
- Faculty of Science, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Angela Krutish
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Childrens Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jessica N Hartley
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Childrens Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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Kechichian A, Pommier D, Druart L, Lowry V, Pinsault N, Desmeules F. "Cooperation between physicians and physios fosters trust you know": a qualitative study exploring patients' experience with first-contact physiotherapy for low back pain in French primary care. BMC PRIMARY CARE 2024; 25:69. [PMID: 38395795 PMCID: PMC10885482 DOI: 10.1186/s12875-024-02302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Physiotherapists working in collaboration with family physicians in French multidisciplinary primary healthcare clinics are now able to manage acute low back pain patients as first-contact practitioners in advanced practice roles. This includes medical act delegation such as making a medical diagnosis and prescribing medication. The aim of this study is to explore patients' experience and perceptions when attending a first-contact physiotherapist (FCP) in an advanced practice collaborative primary care model for acute low back pain (LBP). METHODS A qualitative study using semi-structured interviews was conducted. Patients that consulted a FCP for acute LBP care in new collaborative model were included. Interviews were transcribed verbatim and inductive thematic analysis was performed to generate themes related to patients' experience and perceptions. RESULTS Ten patients were interviewed (3 women, 7 men; mean age 36.5 ± 9.63 years). All LBP participants experienced important level of pain and disability. Four overarching themes related to patients' experience with the new FCP model were formalized: 1) "Going to see a physiotherapist who specializes in painful movements, well that makes sense to me", 2) "Physiotherapist offered to give me exercises to do at home to relieve the back pain", 3) "I went there feeling confident", 4) "The physiotherapist can do more than just send you to see more appropriate people". Participants highlighted the need to receive timely and high-quality care and were receptive with being autonomously managed by a FCP. Overall, patients' experiences with FCP model of care were positive. Participants were highly confident in the FCP's ability to perform delegated medical tasks including making a medical diagnosis and prescribing oral medication such as analgesic drugs. Patients felt that a greater expansion of FCPs' scope of practice was needed to improve the model. CONCLUSION Findings from this study can inform the implementation of FCP in countries where patients are not typically granted FCP by underlining that patients are favourable towards the advance practice model as such models support timely and high-quality care. Further research is needed to better determine the future advance practice physiotherapists' scope of practice in French primary and secondary care settings.
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Affiliation(s)
- Amélie Kechichian
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France.
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France.
| | - Dylan Pommier
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - Léo Druart
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - Véronique Lowry
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Nicolas Pinsault
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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Boukhalfa C, Ouakhzan B, Masbah H, Acharai L, Zbiri S. Investing in midwifery for sustainable development goals in low- and middle-income countries: a cost-benefit analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:1. [PMID: 38178078 PMCID: PMC10768217 DOI: 10.1186/s12962-023-00507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/23/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Maternal and neonatal mortality in low- and middle-income countries is frequently caused by inadequate management of obstetric and neonatal complications and a shortage of skilled health workers. The availability of these workers is essential for effective and high-quality healthcare. To meet the needs of sexual, reproductive, maternal, new-born, child, and adolescent health by 2030, more than one million health workers, including 900 000 midwives, are required globally. Despite this, uncertainty persists regarding the return on investment in the health workforce. METHODS The objective of this research was to determine the cost-benefit ratio of increasing investment in midwifery in Morocco from 2021 to 2030. A comparative analysis was conducted between scenarios "with" and "without" the additional investment. The costs and benefits were estimated using relevant data from national and international sources. RESULTS Following the International Confederation of Midwives' recommendations, it is advised that Morocco recruit 760 midwives annually to achieve 95% of universal health coverage. This increase in midwifery could result in saving 120 593 lives by 2030, including reducing maternal deaths by 3 201, stillbirths by 48 399, and neonatal deaths by 68 993. The estimated economic benefit of investing in midwives was US$ 10 152 287 749, while the total cost was US$ 638 288 820. Consequently, the cost-benefit ratio was calculated as 15.91, indicating that investing in midwifery would provide 16 times more benefits than costs. CONCLUSION Increasing investment in midwifery appears to be an efficient strategy for achieving comprehensive maternal and child health coverage in low- and middle-income countries.
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Affiliation(s)
- Chakib Boukhalfa
- National School of Public Health, Rue Lamfadel Cherkaoui, Madinat Al Irfane, Rabat, BP 6329, Morocco.
| | - Brahim Ouakhzan
- Human Resources Direction, Ministry of Health and Social Protection, Rabat, Morocco
| | - Hanane Masbah
- Human Resources Direction, Ministry of Health and Social Protection, Rabat, Morocco
| | | | - Saad Zbiri
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco.
- Laboratory of Public Health, Health Economics, and Health Management, Mohammed VI Center for Research and Innovation, Rabat, Morocco.
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Mostafa R, El-Atawi K. Strategies to Measure and Improve Emergency Department Performance: A Review. Cureus 2024; 16:e52879. [PMID: 38406097 PMCID: PMC10890971 DOI: 10.7759/cureus.52879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Emergency Departments (EDs) globally face escalating challenges such as overcrowding, resource limitations, and increased patient demand. This study aims to identify and analyze strategies to enhance the structural performance of EDs, with a focus on reducing overcrowding, optimizing resource allocation, and improving patient outcomes. Through a comprehensive review of the literature and observational studies, the research highlights the effectiveness of various approaches, including triage optimization, dynamic staffing, technological integration, and strategic resource management. Key findings indicate that tailored strategies, such as implementing advanced triage protocols and leveraging telemedicine, can significantly reduce wait times and enhance patient throughput. Furthermore, evidence suggests that dynamic staffing models and the integration of cutting-edge diagnostic tools contribute to operational efficiency and improved quality of care. These strategies, when combined, offer a multifaceted solution to the complex challenges faced by EDs, promising better patient care and satisfaction. The study underscores the need for a comprehensive approach, incorporating both organizational and technological innovations, to address the evolving needs of emergency healthcare.
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Affiliation(s)
- Reham Mostafa
- Department of Emergency Medicine, Al Zahra Hospital Dubai (AZHD), Dubai, ARE
| | - Khaled El-Atawi
- Pediatrics/ Neonatal Intensive Care Unit, Latifa Women and Children Hospital, Dubai, ARE
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Guerra-Paiva S, Lobão MJ, Simões DG, Fernandes J, Donato H, Carrillo I, Mira JJ, Sousa P. Key factors for effective implementation of healthcare workers support interventions after patient safety incidents in health organisations: a scoping review. BMJ Open 2023; 13:e078118. [PMID: 38151271 PMCID: PMC10753749 DOI: 10.1136/bmjopen-2023-078118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/30/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES This study aims to map and frame the main factors present in support interventions successfully implemented in health organisations in order to provide timely and adequate response to healthcare workers (HCWs) after patient safety incidents (PSIs). DESIGN Scoping review guided by the six-stage approach proposed by Arksey and O'Malley and by PRISMA-ScR. DATA SOURCES CINAHL, Cochrane Library, Embase, Epistemonikos, PsycINFO, PubMed, SciELO Citation Index, Scopus, Web of Science Core Collection, reference lists of the eligible articles, websites and a consultation group. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Empirical studies (original articles) were prioritised. We used the Mixed Methods Appraisal Tool Version 2018 to conduct a quality assessment of the eligible studies. DATA EXTRACTION AND SYNTHESIS A total of 9766 records were retrieved (last update in November 2022). We assessed 156 articles for eligibility in the full-text screening. Of these, 29 earticles met the eligibility criteria. The articles were independently screened by two authors. In the case of disagreement, a third author was involved. The collected data were organised according to the Organisational factors, People, Environment, Recommendations from other Audies, Attributes of the support interventions. We used EndNote to import articles from the databases and Rayyan to support the screening of titles and abstracts. RESULTS The existence of an organisational culture based on principles of trust and non-judgement, multidisciplinary action, leadership engagement and strong dissemination of the support programmes' were crucial factors for their effective implementation. Training should be provided for peer supporters and leaders to facilitate the response to HCWs' needs. Regular communication among the implementation team, allocation of protected time, funding and continuous monitoring are useful elements to the sustainability of the programmes. CONCLUSION HCWs' well-being depends on an adequate implementation of a complex group of interrelated factors to support them after PSIs.
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Affiliation(s)
- Sofia Guerra-Paiva
- Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA National School of Public Health, NOVA University Lisbon, Lisboa, Portugal
| | - Maria João Lobão
- Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA National School of Public Health, NOVA University Lisbon, Lisboa, Portugal
- Internal Medicine Department, Hospital de Cascais Dr Jose de Almeida, Alcabideche, Portugal
| | - Diogo Godinho Simões
- Public Health Unit of ACES Almada-Seixal, Almada, Portugal
- NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Joana Fernandes
- NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Helena Donato
- Documentation and Scientific Information Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Irene Carrillo
- Health Psychology, Miguel Hernandez University, Elche, Spain
- Health Psychology, FISABIO, Miguel Hernandez University, Elche, Spain
| | - José Joaquín Mira
- Health Psychology, Miguel Hernandez University, Elche, Spain
- Salud Alicante-Sant Joan Health District, Elche, Spain
| | - Paulo Sousa
- Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA National School of Public Health, NOVA University Lisbon, Lisboa, Portugal
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Antoniadou M, Mangoulia P, Myrianthefs P. Quality of Life and Wellbeing Parameters of Academic Dental and Nursing Personnel vs. Quality of Services. Healthcare (Basel) 2023; 11:2792. [PMID: 37893866 PMCID: PMC10606752 DOI: 10.3390/healthcare11202792] [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: 09/08/2023] [Revised: 10/03/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Quality of life (QOL) is based on one's perception of one's position in life with respect to one's goals, expectations, standards, and concerns. It is also influenced by one's culture and value system, workflow, and workplace situation; in turn, QOL influences the quality of service one is able to provide. In this study, we aim to report on dental and nursing academics' QOL and wellbeing at the end of the third year of the COVID-19 pandemic. There are several studies on the impact of the COVID-19 pandemic on health professionals (nurses and dentists), but it is important to investigate their quality of life three years later; furthermore, knowledge about academic staff is very limited. The World Health Organization Quality of Life-BREF Scale (WHOQOL-BREF) tool, recording the physical, psychological, social, and environmental dimensions of QOL, was used. The WHOQOL-BREF was modified using a spiritual coaching/mentoring approach in a two-step design and validation procedure. The modified SHQOL-BREF (Spiritual Healthcare version) designed for this study was uploaded and filled in online during April-June 2023. The staff (N = 120, 75% female) of the Departments of Dentistry (44.2%) and Nursing (55.8%) of the National and Kapodistrian University of Athens participated anonymously. QOL in terms of physical health was reported at a higher level (M = 72.2 points) compared to social relationships (M = 69 points), psychological health (M = 65 points), and environment (M = 59 points) (scores reported on a 0-100 scale). Overall, QOL was rated at 66 points, while satisfaction with one's health was at 72 points. Job satisfaction (M1 = 3.2) and spirituality (M2 = 3.0) were reported at a medium level on a five-point scale, while personal beliefs and values were reported at a high level (M3 = 4.0). The four areas of QOL are associated with job satisfaction, personal beliefs, and spirituality. Participant age presented a significant moderate-strong effect on physical health (F (3.97) = 2.89, p < 0.05, η2p = 0.08) and on the environment (F (3.97) = 2.80, p < 0.05, η2p = 0.08), and marital status had a significant effect on social relationships (F (1.97) = 9.66, p < 0.05, η2p = 0.09). Married participants reported consistently higher levels of QOL compared to single participants, for all age groups. The department had a significant moderate effect on social relationships (F (1.97) = 5.10, p < 0.05, η2p = 0.05), and education had a significant moderate-strong effect on psychological health (F (2.97) = 3.74, p < 0.05, η2p = 0.07). PhD-level participants in both departments presented higher levels of psychological health compared to those with lower educational levels. Also, participants from the Department of Dentistry reported higher levels of social relationship QOL in all educational groups compared to the Department of Nursing. Overall, according to our findings, PhD participants generally had better psychological health. Those under 40 years of age had higher levels of physical health and environmental quality of life, while married participants and those from the Department of Dentistry had higher levels of social interactions than those from the Department of Nursing. Strategic planning on sustainability and QOL initiatives should be introduced after the COVID-19 pandemic for dental and nursing academic personnel to promote resilience and QOL scores. Enhancing the QOL of academic staff is essential for developing health promotion activities at universities and can help boost performance among staff and students.
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Affiliation(s)
- Maria Antoniadou
- Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, Thivon 2 Street, Goudi, GR-11527 Athens, Greece
- Certified Systemic Analyst Professional, CSAP Executive Mastering Program in Systemic Management, University of Piraeus, GR-18534 Piraeus, Greece
| | - Polyxeni Mangoulia
- Department of Nursing, School of Health Sciences, Papadiamantopoulou 123 Street, Goudi, GR-11527 Athens, Greece; (P.M.); (P.M.)
| | - Pavlos Myrianthefs
- Department of Nursing, School of Health Sciences, Papadiamantopoulou 123 Street, Goudi, GR-11527 Athens, Greece; (P.M.); (P.M.)
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Bhati D, Deogade MS, Kanyal D. Improving Patient Outcomes Through Effective Hospital Administration: A Comprehensive Review. Cureus 2023; 15:e47731. [PMID: 38021686 PMCID: PMC10676194 DOI: 10.7759/cureus.47731] [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] [Received: 10/05/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
This comprehensive review delves into the critical role of effective hospital administration in shaping patient outcomes within the healthcare ecosystem. Exploration of key components, strategies, measurement methodologies, and future trends elucidates the multifaceted nature of hospital administration. Key findings underscore the profound impact of administrative decisions and practices on patient safety, satisfaction, and overall well-being. The review highlights the importance of patient-centred care and interdisciplinary collaboration for enhancing patient outcomes. It emphasises the significance of data-driven measurement and benchmarking, which are instrumental in assessing hospital performance and fostering continuous improvement. Looking ahead, emerging technologies, evolving healthcare policies, and persistent challenges are drivers of change in healthcare administration. However, amidst these transformations, the overarching message remains consistent: effective hospital administration is integral to improving patient outcomes. The conclusion calls for a collective commitment from healthcare leaders and policymakers to prioritise the development of capable administrators, invest in technology, promote value-based care, and address healthcare disparities. This collaborative effort ensures that the pursuit of better patient outcomes remains at the forefront of healthcare administration, ultimately shaping the future of healthcare for generations to come.
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Affiliation(s)
- Deepak Bhati
- Hospital Administration, School of Allied Health Sciences, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Meena S Deogade
- Ayurveda Pharmacology, All India Institute of Ayurveda, New Delhi, IND
| | - Deepika Kanyal
- Hospital Administration, School of Allied Health Sciences, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Maier CB, Winkelmann J, Pfirter L, Williams GA. Skill-Mix Changes Targeting Health Promotion and Prevention Interventions and Effects on Outcomes in all Settings (Except Hospitals): Overview of Reviews. Int J Public Health 2023; 68:1605448. [PMID: 37228895 PMCID: PMC10203245 DOI: 10.3389/ijph.2023.1605448] [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] [Received: 10/01/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Objectives: Skill-mix changes to step up health promotion and prevention are increasing, but there is limited evidence on their effects. Methods: Overview of reviews, based on a protocol. The search was carried out in six databases, screening was performed ensuring high interrater reliability. All countries, health professions and lay workers in all settings (except hospitals) were included, quality appraisals performed. Results: A total of 31 systematic reviews were included. Expanded roles performing outreach (e.g., home visits) had mostly positive effects on access and health outcomes, primarily for hard-to-reach groups. Task-shifting in colorectal or skin cancer screenings (performed by advanced practice nurses) were suggested effective; supporting roles (by community health workers) increased uptake in screenings, but based on limited evidence. Expanded roles of various professions focusing on lifestyle modification showed promising effects in most reviews, including weight, diet, smoking cessation and physical activity. Reviews on cost-effectiveness were based on limited evidence. Conclusion: Promising skill-mix changes included expanded roles providing lifestyle modifying interventions, task-shifting, and outreach roles for hard-to-reach groups, whereas evidence on costs was limited.
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Affiliation(s)
- Claudia Bettina Maier
- Department of Health Care Management, Faculty of Economics and Management, Technical University Berlin, Berlin, Germany
| | | | - Laura Pfirter
- Department of Health Care Management, Faculty of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Gemma A. Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, United Kingdom
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11
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Klonek F, Zhang F, Nguyen H, Johnson A, Liu Y, Parker S. The role of individual goal orientations in shaping skill utilization over time: a four-year longitudinal study. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2023. [DOI: 10.1080/1359432x.2022.2160325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Florian Klonek
- Curtin University, Future of Work Institute, Centre for Transformative Work Design, Perth, Australia
| | - Fangfang Zhang
- Curtin University, Future of Work Institute, Centre for Transformative Work Design, Perth, Australia
| | - Helena Nguyen
- The University of Sydney Business School, The University of Sydney, Sydney, Australia
| | - Anya Johnson
- The University of Sydney Business School, The University of Sydney, Sydney, Australia
| | - Yukun Liu
- School of Management, Zhejiang University, Hangzhou, China
| | - Sharon Parker
- Curtin University, Future of Work Institute, Centre for Transformative Work Design, Perth, Australia
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12
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Kpebo D, Ly A, Yameogo WME, Bijou S, Bertrand Ivlabèhirè M, Tougri H, Ndour M, Tetchi O, Sablé SP, Kouanda S. Assessment of Staffing Needs for Frontline Health Workers in Selected Maternal and Child Health Services in 3 Countries of Sub-Saharan West Africa: Cote d'Ivoire, Burkina Faso, and Niger. Health Serv Insights 2022; 15:11786329221139417. [PMID: 36568443 PMCID: PMC9780760 DOI: 10.1177/11786329221139417] [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: 06/16/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
Sub-Saharan African countries health systems are generally faced with shortages and inequitable distribution of qualified health workers. The application of provider-population ratio or fixed staff establishments, not considering variation in workload, given contextual variations in service utilization rates, cannot adequately match the human resource needs of different health facilities. The Workload Indicators of Staffing Need (WISN) method uses workload to determine staffing needs in a given facility. The aim of this study was to assess the current workload and staffing needs of maternal and child health services in 12 primary healthcare facilities from Burkina Faso, Niger, and Cote d'Ivoire. We employed the WISN methodology, using document reviews, in-depth interviews with health providers, and observations, to obtain the data needed for estimating the required number of staff in a given facility. Then, we calculated both the WISN difference (current-required staff), and the WISN ratio (current staff/required staff). Using the WISN ratio, we assessed the work pressure that health workers experience. The results showed a shortage of health workers in most services in Cote d'Ivoire and Niger (WISN ratio <1), in contrast to Burkina Faso where services were either adequately staffed or overstaffed (WISN ratio ⩾1). The workload pressure was generally high or very high in Cote d'Ivoire, while in Niger, it was very high in maternity services but rather low in dispensary ones. There was also a geographic discrepancy in health workers staffing, rural areas services being more understaffed, with a higher workload pressure as compared to urban areas ones. This study results strengthens the body of knowledge on the shortage of health workforce in sub-Saharan Africa French speaking countries. Policies and strategies to increase students training capacities and the application of regular WISN studies for a better staff distribution are necessary to address the human resource needs of health facilities in these countries.
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Affiliation(s)
- Denise Kpebo
- Public Health Department, Felix Houphouet Boigny University, Abidjan, Côte d’Ivoire,African Institute of Public Health, Ouagadougou, Burkina Faso,Denise Kpebo, Public Health Department, Felix Houphouet Boigny University, 01 BPV 34 Abidjan 01, Abidjan, Lagunes Region, Côte d’Ivoire. dkpebo@gmailcom
| | - Antarou Ly
- Institut de recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | | | | | | | - Halima Tougri
- Institut de recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | | | - Orsot Tetchi
- Public Health Department, Felix Houphouet Boigny University, Abidjan, Côte d’Ivoire
| | | | - Seni Kouanda
- African Institute of Public Health, Ouagadougou, Burkina Faso,Institut de recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
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13
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Nyawira L, Tsofa B, Musiega A, Munywoki J, Njuguna RG, Hanson K, Mulwa A, Molyneux S, Maina I, Normand C, Jemutai J, Barasa E. Management of human resources for health: implications for health systems efficiency in Kenya. BMC Health Serv Res 2022; 22:1046. [PMID: 35974324 PMCID: PMC9382760 DOI: 10.1186/s12913-022-08432-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Human resources for health consume a substantial share of healthcare resources and determine the efficiency and overall performance of health systems. Under Kenya’s devolved governance, human resources for health are managed by county governments. The aim of this study was to examine how the management of human resources for health influences the efficiency of county health systems in Kenya. Methods We conducted a case study using a mixed methods approach in two purposively selected counties in Kenya. We collected data through in-depth interviews (n = 46) with national and county level HRH stakeholders, and document and secondary data reviews. We analyzed qualitative data using a thematic approach, and quantitative data using descriptive analysis. Results Human resources for health in the selected counties was inadequately financed and there were an insufficient number of health workers, which compromised the input mix of the health system. The scarcity of medical specialists led to inappropriate task shifting where nonspecialized staff took on the roles of specialists with potential undesired impacts on quality of care and health outcomes. The maldistribution of staff in favor of higher-level facilities led to unnecessary referrals to higher level (referral) hospitals and compromised quality of primary healthcare. Delayed salaries, non-harmonized contractual terms and incentives reduced the motivation of health workers. All of these effects are likely to have negative effects on health system efficiency. Conclusions Human resources for health management in counties in Kenya could be reformed with likely positive implications for county health system efficiency by increasing the level of funding, resolving funding flow challenges to address the delay of salaries, addressing skill mix challenges, prioritizing the allocation of health workers to lower-level facilities, harmonizing the contractual terms and incentives of health workers, and strengthening monitoring and supervision.
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Affiliation(s)
- Lizah Nyawira
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benjamin Tsofa
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Anita Musiega
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Joshua Munywoki
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Rebecca G Njuguna
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Kara Hanson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Mulwa
- Directorate of Medical Services, preventive and promotive health, Ministry of Health, Nairobi, Kenya
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Isabel Maina
- Health Financing Department, Ministry of Health, Nairobi, Kenya
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College, the University of Dublin, Dublin, Ireland
| | - Julie Jemutai
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Institute of Healthcare Management, Strathmore Business School, Strathmore University, Nairobi, Kenya.
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14
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Akinpelu AO, Oyewole OO, Okunade O, Odunaiya N, Odole AC, Bamgboye EA. Nigerian physiotherapists’ perception of physiotherapy internship: perceived expectations, experience, and outcomes. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2022. [DOI: 10.1186/s43161-022-00080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Physiotherapy internship in Nigeria was inaugurated in 1994 to allow continuous learning in the clinical setting, connecting theoretical knowledge and workplace practice. The internship program has not been evaluated over the years. The aim of study was to assess physiotherapists’ perceptions of the internship in Nigeria in terms of expectations, experiences, and outcomes.
Methods
A mixed method design of a cross-sectional survey and focus group discussion (FGD) was utilized. An adapted questionnaire was used for the survey. Data was assessed using descriptive statistics and content thematic analysis.
Results
The mean age of the physiotherapists who participated in the survey (147 males; 116 females) and FGD (7 males; 2 females) were 27.4 ± 2.5 and 28.8 ± 2.3 years, respectively. Most participants in the survey perceived their internship experience as good (97.7%), the supervision received as adequate (76%), and the outcomes of internship in terms of usefulness as useful (76%). The overall perception of physiotherapy internship in Nigeria was rated as good by 51% and fair by 47% of participants. However, responders in the FGD reported negative experiences including inadequate or lack supervision. They also reported that they were not formally prepared for internship by their training institutions or receiving health institutions before beginning internship.
Conclusion
Physiotherapy internship in Nigeria was perceived as deficient in structural organization and supervision of the interns. The outcome of internship program was perceived as good even though the experiences were negative.
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15
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Krutish A, Balshaw RF, Jiang X, Hartley JN. Integrating genetic assistants into the workforce: An 18-year productivity analysis and development of a staff mix planning tool. J Genet Couns 2022; 31:1183-1192. [PMID: 35598107 DOI: 10.1002/jgc4.1589] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/28/2022] [Accepted: 05/01/2022] [Indexed: 11/12/2022]
Abstract
In recent years, genetic (counseling) assistants have been integrated in the genetics workforce, such that one-third of genetic counselors now report working with a genetic assistant. While several studies showed that adoption of the genetic assistant model leads to an increase in patient volume, the impact of this role substitution has not been studied quantitatively beyond the cancer genetics workforce. This study utilized 18 years of data from a publicly funded genetics clinic with multiple specialties and varying staff mix. Time series regression modeling was applied to describe the evolving impact of genetic assistants on genetic counselor and clinical geneticist productivity (measured as patient volume). The regression models suggest that the integration of genetic assistants led to a sustainable increase in genetic counselor patient volume, while clinical geneticist patient volume was unaffected. Importantly, the models also demonstrated an interaction between the number of genetic counselors and genetic assistants, whereby the impact of adding a genetic counselor was greater as more genetic assistants were employed in the clinic, and vice versa. The main regression model was used to create "ClinMix: A Genetics Staff Mix Planning Tool," an Excel application that allows users to explore how different staffing plans could affect patient volume, by applying the parameters estimated from this data or their own. We hope this report and the ClinMix tool can be employed by the genetics workforce to advocate for further implementation and evaluation of genetic assistant positions. Adoption of the genetic assistant model may provide clinics the support needed to meet increasing service delivery demands and subsequently foster genetic counselor practice at "top of scope."
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Affiliation(s)
- Angela Krutish
- Clinical Genetics Program, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.,Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert F Balshaw
- George and Fee Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Xuejing Jiang
- George and Fee Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jessica N Hartley
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
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16
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Spooner S, McDermott I, Goff M, Hodgson D, McBride A, Checkland K. Processes supporting effective skill-mix implementation in general practice: A qualitative study. J Health Serv Res Policy 2022; 27:269-277. [PMID: 35503531 PMCID: PMC9548943 DOI: 10.1177/13558196221091356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives Health policy and funding initiatives have addressed increasing workloads in
general practice through the deployment of clinicians from different
disciplinary backgrounds. This study examines how general practices in
England operate with increasingly diverse groups of practitioners. Methods Five general practices were selected for maximum variation of the duration
and diversity of skill-mix in their workforce. Individual interviews were
recorded with management and administrative staff and different types of
practitioner. Patient surveys and focus groups gathered patients’
perspectives of consulting with different practitioners. Researchers
collaborated during coding and thematic analysis of transcripts of audio
recordings. Results The introduction of a wide range of practitioners required significant
changes in how practices dealt with patients requesting treatment, and these
changes were not necessarily straightforward. The matching of patients with
practitioners required effective categorization of health care patients’
reported problem(s) and an understanding of practitioners’ capabilities. We
identified individual and organizational responses that could minimize the
impact on patients, practitioners and practices of imperfections in the
matching process. Conclusions The processes underpinning the redistribution of tasks from GPs to non-GP
practitioners are complex. As practitioner employment under the Primary Care
Network contracts continues to increase, it is not clear how the necessarily
fine-grained adjustments will be made for practitioners working across
multiple practices.
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Affiliation(s)
- Sharon Spooner
- Centre for Primary Care Research, 5292University of Manchester, UK
| | - Imelda McDermott
- Centre for Primary Care Research, 5292University of Manchester, UK
| | - Mhorag Goff
- Centre for Primary Care Research, 5292University of Manchester, UK
| | | | - Anne McBride
- Alliance Manchester Business School, 5292University of Manchester, UK
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17
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Tilahun B, Endehabtu BF, Gashu KD, Mekonnen ZA, Animut N, Belay H, Denboba W, Alemu H, Mohammed M, Abate B. Current and Future Needs for Human Resources for Ethiopia's National Health Information System: Survey and Forecasting Study. JMIR MEDICAL EDUCATION 2022; 8:e28965. [PMID: 35412469 PMCID: PMC9044145 DOI: 10.2196/28965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/17/2021] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Strengthening the national health information system is one of Ethiopia's priority transformation agendas. A well-trained and competent workforce is the essential ingredient to a strong health information system. However, this workforce has neither been quantified nor characterized well, and there is no roadmap of required human resources to enhance the national health information system. OBJECTIVE We aimed to determine the current state of the health information system workforce and to forecast the human resources needed for the health information system by 2030. METHODS We conducted a survey to estimate the current number of individuals employed in the health information system unit and the turnover rate. Document review and key-informant interviews were used to collect current human resources and available health information system position data from 110 institutions, including the Ministry of Health, federal agencies, regional health bureaus, zonal health departments, district health offices, and health facilities. The Delphi technique was used to forecast human resources required for the health information system in the next ten years: 3 rounds of workshops with experts from the Ministry of Health, universities, agencies, and regional health bureaus were held. In the first expert meeting, we set criteria, which was followed by expert suggestions and feedback. RESULTS As of April 2020, there were 10,344 health information system professionals working in the governmental health system. Nearly 95% (20/21) of district health offices and 86.7% (26/30) of health centers reported that the current number of health information system positions was inadequate. In the period from June 2015 to June 2019, health information technicians had high turnover (48/244, 19.7%) at all levels of the health system. In the next ten years, we estimate that 50,656 health information system professionals will be needed to effectively implement the Ethiopia's national health information system. CONCLUSIONS Current health information system-related staffing levels were found to be inadequate. To meet the estimated need of 50,656 multidisciplinary health information system professionals by 2030, the Ministry of Health and regional health bureaus, in collaboration with partners and academic institutions, need to work on retaining existing and training additional health information system professionals.
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Affiliation(s)
- Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhanu F Endehabtu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun D Gashu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zeleke A Mekonnen
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Health Systems Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Netsanet Animut
- Data Use Partnership Project, John Snow, Inc (JSI), Addis Ababa, Ethiopia
| | - Hiwot Belay
- Data Use Partnership Project, John Snow, Inc (JSI), Addis Ababa, Ethiopia
| | - Wubshet Denboba
- Data Use Partnership Project, John Snow, Inc (JSI), Addis Ababa, Ethiopia
| | - Hibret Alemu
- Data Use Partnership Project, John Snow, Inc (JSI), Addis Ababa, Ethiopia
| | - Mesoud Mohammed
- Policy, Planning, Monitoring and Evaluation Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Biruk Abate
- Policy, Planning, Monitoring and Evaluation Directorate, Ministry of Health, Addis Ababa, Ethiopia
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Nurse-led service delivery models in primary care: A scoping review protocol. BJGP Open 2022; 6:BJGPO.2021.0194. [DOI: 10.3399/bjgpo.2021.0194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 10/31/2022] Open
Abstract
BackgroundEnsuring equitable access to health care is reliant on the strengthening of primary care services. Increasing the utilisation of task-sharing and telehealth models is one strategy to improve patient access and outcomes in primary care. This protocol details the methodology of a proposed scoping review of nurse and midwife involvement in task-sharing and telehealth models in primary care.AimUndertaking this review will identify what models have been utilised in the primary care setting globally, the characteristics and health and economic outcomes of the models and whether these models are acceptable and feasible.Design and settingThis protocol was developed in line with Joanna Briggs Institute Methodology for Scoping Reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis protocols (PRISMA-P).Methods and analysisFive databases (Ovid MEDLINE, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library) will be searched for relevant studies published in English. Articles will be screened for inclusion in Covidence by three authors, with data extracted and synthesised using a chart designed for this review. Evidence will be mapped in both tabular and narrative forms to show characteristics, outcomes and acceptability of the models of care. Ethical approval is not required as data utilised is publicly available.ConclusionsUnderstanding how nurse and midwife-led models of care may operate is crucial to strengthening service provision in primary care. Evidence on nurse and midwife led primary care models will be collated and synthesised to inform future models
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Al-Dabbagh SA, Sulaiman HM, Abdulkarim NA. Workload assessment of medical doctors at primary health care centers in the Duhok governorate. HUMAN RESOURCES FOR HEALTH 2022; 19:117. [PMID: 35090488 PMCID: PMC8796551 DOI: 10.1186/s12960-021-00664-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND A shortage in human resources, particularly physicians, has become a challenge confronting health authorities in the Duhok governorate, as these resources are the key input for delivering health care. It has become necessary to identify the most appropriate scientifically sound method for having adequate staffing levels. This study aimed to forecast the required number of physicians to cope with the current workload at the main primary health care centers in the Duhok governorate. METHODS A cross-sectional study was adopted to collect data for 1 full year. Data collection included both primary and secondary data sources. A semi-structured questionnaire was developed to obtain information every month from health centers on activities related to training and leaves. Data analysis was performed using Workload Indicators of Staffing Need software. RESULTS Sixty-one primary health care centers met the final criteria for analysis. The study revealed physician shortages and inequity in the distribution of staffing. In these centers, 145 physicians lacked an adequate delivery of health services based on the workload imposed on them. The 'workload indicators of staffing need' ratio was 0.33, indicating high work pressure on medical doctors. Some centers offered more health care than others, but had fewer doctors based on the current staffing practices. CONCLUSIONS This study pointed out the importance for the public health sector and academic medical institutions to use Workload Indicators of Staffing Needs software in health policy administration to restructure their efforts to address the physician shortages and distribution imbalances at primary health care facilities.
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Affiliation(s)
- Samim Ahmed Al-Dabbagh
- Department of Family and Community Medicine, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq
| | - Hushyar Musa Sulaiman
- Planning and Health Resource Development at the Duhok Directorate General of Health, Duhok, Kurdistan Region, Iraq.
| | - Nazik Abdulrahman Abdulkarim
- Division of Scientific Research, Department of Planning at the Duhok Directorate General of Health, Duhok, Kurdistan Region, Iraq
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Novignon J, Aryeetey G, Nonvignon J, Malm K, Peprah NY, Agyemang SA, Amon S, Aikins M. Efficiency of malaria service delivery in selected district-level hospitals in Ghana. Health Syst (Basingstoke) 2021; 12:198-207. [PMID: 37234466 PMCID: PMC10208147 DOI: 10.1080/20476965.2021.2015251] [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: 02/10/2021] [Accepted: 11/26/2021] [Indexed: 10/19/2022] Open
Abstract
Malaria remains an important public health concern. Sub-Saharan African countries carry over 95% of the global burden. Unfortunately, there are also major resource constraints that have limited efforts to reduce the burden. Our study sought to estimate efficiency in the use of malaria resources and to identify potential determinants. We used primary data collected from district-level health facilities in three administrative regions in Ghana from 2014 to 2016. The Data Envelopment Analysis technique was used to estimate efficiency. The Malmquist productivity index was estimated and disaggregated to reflect the sources of productivity change. The findings show an average technical efficiency score of 0.61 with private facilities being more efficient. Productivity changes were driven by changes in technology/innovation advancements. Facility revenue mix and ownership type were important determinants of efficiency. The findings highlight the need to improve resource use in the delivery of specific services such as malaria.
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Affiliation(s)
- Jacob Novignon
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana
| | - Genevieve Aryeetey
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon
| | - Keziah Malm
- National Malaria Control programme, Ghana Health Service
| | | | - Samuel Agyei Agyemang
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon
| | - Samuel Amon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon
| | - Moses Aikins
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon
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An ontological analysis of the barriers to and facilitators of access to healthcare. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01265-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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22
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Artico M, Piredda M, D'Angelo D, Di Nitto M, Giannarelli D, Marchetti A, Facchinetti G, De Chirico C, De Marinis MG. Palliative care organization and staffing models in residential hospices: Which makes the difference? Int J Nurs Stud 2021; 126:104135. [PMID: 34923319 DOI: 10.1016/j.ijnurstu.2021.104135] [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: 02/05/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The number of patients using palliative care services, particularly residential hospices, is increasing. Policymakers are urging these services to reflect on the most effective organizational strategies for meeting patients' complex care needs. AIM To analyze the predictive power of staffing, structure and process indicators towards optimal control of patients' clinically significant symptoms over time. DESIGN Secondary analysis of data from a multicentre prospective longitudinal observational study (PRELUdiHO) collected between November 2017 and September 2018. SETTING/PARTICIPANTS Adult patients (n = 992) enrolled in 13 Italian residential hospices. METHODS Two generalized estimating equations logistic models were built, both with number of hospice beds and length of stay as independent variables as well as, in one case, patient-to-healthcare worker ratios, and, in the other, health professionals' qualification levels. Dependent variables were six not clinically significant (score<4) symptoms: pain, nausea, shortness of breath, feeling sad, feeling nervous, and 'how you feel overall', according to the Edmonton Symptom Assessment System revised (ESAS-r) scale. RESULTS The generalized estimating equations indicators on staff revealed the following 'optimal' model: Patient-to-Physician ratio (5.5:1-6.5:1); Patient-to-Nurse ratio (1.5:1-2.7:1); Patient-to-Nurse-Assistant ratio (4.1:1-6.3:1); with the most balanced staff composition including 19% physicians, 23% nurse assistants, and 58% registered nurses; hospice beds (12-25); length of stay (median = 12 days). This model predicted an up to four times greater likelihood of controlling all six ESAS-r symptoms over time. The generalized estimating equations model on the educational level of physicians and registered nurses showed that it was significantly associated with optimal patients' symptom control during the entire hospice stay. CONCLUSIONS This study showed the exact skill-mix composition and proportions of palliative care team able to ensure optimal control of patients' symptoms. The added value of physicians and nurses with a qualification in palliative care in terms of better patient outcomes reaffirmed the importance of education in guaranteeing quality care. Hospices with 12-25 beds, and recruitment methods guaranteeing at least 12-day stay ensured the most propitious organizational environment for optimal management of clinically significant symptoms. The transferability of these results mainly depends on whether the skills of health professionals in our `ideal' model are present in other contexts. Our results provide policymakers and hospice managers with specific, evidence-based information to support decision-making processes regarding hospice staffing and organization. Further prospective studies are needed to confirm the positive impact of this 'optimal' organizational framework on patient outcomes.
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Affiliation(s)
- Marco Artico
- Palliative Care Unit, Azienda ULSS4 Veneto Orientale, Piazza De Gasperi, 5, San Donà di Piave, Venezia 30027, Italy
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
| | - Daniela D'Angelo
- Center for Clinical Excellence and Quality of Care (CNEC), Istituto Superiore di Sanità (ISS), Via Regina Elena, 299, Rome 00161, Italy.
| | - Marco Di Nitto
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier, 1, Rome 00133, Italy.
| | - Diana Giannarelli
- Biostatistical Unit, National Cancer Institute "Regina Elena" - IRCCS, Via Chianesi, 53, Rome 00144, Italy.
| | - Anna Marchetti
- Palliative Care Center "Insieme per la cura", Via Alvaro del Portillo, 15, Rome 00128, Italy.
| | - Gabriella Facchinetti
- Palliative Care Center "Insieme per la cura", Via Alvaro del Portillo, 15, Rome 00128, Italy
| | - Cosimo De Chirico
- Palliative Care Unit, Azienda ULSS4 Veneto Orientale, Piazza De Gasperi, 5, San Donà di Piave, Venezia 30027, Italy.
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
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Kadam S, Panda B, Nallala S, Pati S, Hussain MA, Salunke S, Zodpey S. Repackaging Primary Healthcare in Odisha: Can ‘Task Shifting’ to AYUSH Doctors Address Human Resources Deficit? JOURNAL OF HEALTH MANAGEMENT 2021. [DOI: 10.1177/09720634211035194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Provision of primary healthcare in India received thrust of National Health Policy 2017. Vacancy, chronic absenteeism and non-availability of allopathic doctors is a chronic problem of the public health system. Engagement of alternative human resources could get the ailing health system rid of this shortage. AYUSH doctors in Odisha are involved in clinical and public health activities since 1970s. This study aims to examine perspectives of key stakeholders on ‘task shifting’ as a possible policy alternative. We reviewed the policies and guidelines of government of Odisha on human resources deployment, recruitment, retention and terms of reference of their engagement in the public health sector. Further, 76 AYUSH doctors and 30 key informants were interviewed. Ethical clearance was obtained beforehand. Most AYUSH doctors were involved in monitoring and supervising community-based public health programmes and village-level health service providers, respectively. Their involvement in the implementation of national health programmes was found to range from 8% to 62%. A sizeable proportion of AYUSH doctors had not been trained on management of national vector borne disease control, Tuberculosis control, immunisation (RI) and disease surveillance. More than 70% of respondents showed interest in implementing and managing public health programmes. Almost all key informants recommended for improved involvement of AYUSH doctors in public health activities. Inadequate logistics support, insufficient training on public health and unequal administrative authorities was perceived to be systemic bottlenecks. Job enrichment, management capacity development, and pre-deployment orientation of AYUSH doctors may precede the opportunity of ‘task-shifting’ of public health functions.
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Van Kraaij J, Lalleman P, Walravens A, Van Oostveen C. Differentiated nursing practice as a catalyst for transformations in nursing: A multiphase qualitative interview study. J Adv Nurs 2021; 78:165-175. [PMID: 34375011 PMCID: PMC9292649 DOI: 10.1111/jan.15001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/17/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
Aim To identify and follow‐up on the transition towards differentiated nursing practice among bachelor trained and vocationally trained nurses in Dutch hospitals. Design A multiphase general qualitative interview study. Methods Fifty semi‐structured interviews with project managers in charge of introducing differentiated nursing practice to their hospital were conducted. Purposive sampling was used, and data were collected in 2017, 2019 and 2020. A meta‐analysis was conducted after independent primary thematic analysis of each data collection. Results The introduction of differentiated nursing practice to Dutch hospitals was perceived as uncertain and ambiguous. Three themes were identified during the transition towards differentiated nursing practice: (1) call to action; (2) sitting and waiting; and (3) new beginnings and open ends. The change to differentiated nursing practice is not straightforward and these findings highlight the emerging awareness among project managers of the nature and complexity of the transition. During the study period, professionalization of the nursing profession was recognized as fundamental in hospital organizations. Conclusion Nursing cannot be separated from differentiated nursing practice. Visible leadership is important at all organizational levels and nurses’ opinions must be considered as nurses are essential to such changes in healthcare. Impact Differentiated nursing practice based on nursing education allows nurses to make the best use of their experience, skills and competencies, and could promote the provision of effective and high‐quality patient care. However, in many cases, a nurse's practice role is based on their nursing licensure instead of their educational background. The change to differentiated nursing practice in hospitals is not straightforward and the nature and complexity of the transition needs to be acknowledged. Nurses have an important role in healthcare transformation and need to be active in developing and formulating rather than just implementing the changes.
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Affiliation(s)
- Julia Van Kraaij
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Anoesjka Walravens
- Avans University of Applied Sciences 's Hertogenbosch, Breda, The Netherlands
| | - Catharina Van Oostveen
- Spaarne Gasthuis Hospital, Spaarne Gasthuis Academy, Haarlem, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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25
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Foley K, Attrill S, Brebner C. Co-designing a methodology for workforce development during the personalisation of allied health service funding for people with disability in Australia. BMC Health Serv Res 2021; 21:680. [PMID: 34243765 PMCID: PMC8272260 DOI: 10.1186/s12913-021-06711-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Internationally, health and social services are undergoing creative and extensive redesign to meet population demands with rationed budgets. This has critical implications for the health workforces that serve such populations. Within the workforce literature, few approaches are described that enable workforce development for health professions in the service contexts that emerge from large scale service redesign in times of industry shift. We contribute an innovative and robust methodology for workforce development that was co-designed by stakeholders in allied health during the personalisation of disability funding in Australia (the introduction of the National Disability Insurance Scheme). Methods In the context of a broad action research project, we used program logic modelling to identify and enact opportunities for sustainable allied health education and workforce integration amidst the changed service provision context. We engaged with 49 industry stakeholders across 92 research engagements that included interviews (n = 43), a workshop explicitly for model development (n = 8) and a Project Advisory Group (n = 15). Data from these activities were inductively coded, analysed, and triangulated against each other. During the program logic modelling workshop, we worked with involved stakeholders to develop a conceptual model which could be used to guide trial and evaluation of allied health education which was fit-for-purpose to emerging workforce requirements. Results Stakeholder interviews showed that drivers of workforce design during industry shift were that (1) service provision was happening in turbulent times; (2) new concerns around skills and professional engagement were unfolding for AHP in the NDIS; and (3) impacts to AHP education were being experienced. The conceptual model we co-designed directly accounted for these contextual features by highlighting five underpinning principles that should inform methodologies for workforce development and AHP education in the transforming landscape: being (1) pedagogically sound; (2) person- or family-centred; (3) NDIS compliant; (4) informed by evidence and (5) having quality for all. We use a case study to illustrate how the co-designed conceptual model stimulated agility and flexibility in workforce and service redesign. Conclusions Proactive and situated education of the emerging workforce during policy shift is essential to realise future health workforces that can appropriately and effectively service populations under a variety of changing service and funding structures – as well as their transitions. We argue that collaborative program logic modelling in partnership with key stakeholders including existing workforce can be useful for broad purposes of workforce (re)design in diverse contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06711-x.
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Sonderegger S, Bennett S, Sriram V, Lalani U, Hariyani S, Roberton T. Visualizing the drivers of an effective health workforce: a detailed, interactive logic model. HUMAN RESOURCES FOR HEALTH 2021; 19:32. [PMID: 33706778 PMCID: PMC7953552 DOI: 10.1186/s12960-021-00570-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND A strong health workforce is a key building block of a well-functioning health system. To achieve health systems goals, policymakers need information on what works to improve and sustain health workforce performance. Most frameworks on health workforce planning and policymaking are high-level and conceptual, and do not provide a structure for synthesizing the growing body of empirical literature on the effectiveness of strategies to strengthen human resources for health (HRH). Our aim is to create a detailed, interactive logic model to map HRH evidence and inform policy development and decision-making. METHODS We reviewed existing conceptual frameworks and models on health workforce planning and policymaking. We included frameworks that were: (1) visual, (2) comprehensive (not concentrated on specific outcomes or strategies), and (3) designed to support decision-making. We compared and synthesized the frameworks to develop a detailed logic model and interactive evidence visualization tool. RESULTS Ten frameworks met our inclusion criteria. The resulting logic model, available at hrhvisualizer.org , allows for visualization of high-level linkages as well as a detailed understanding of the factors that affect health workforce outcomes. HRH data and governance systems interact with the context to affect how human resource policies are formulated and implemented. These policies affect HRH processes and strategies that influence health workforce outcomes and contribute to the overarching health systems goals of clinical quality, responsiveness, efficiency, and coverage. Unlike existing conceptual frameworks, this logic model has been operationalized in a highly visual, interactive platform that can be used to map the research informing policies and illuminating their underlying mechanisms. CONCLUSIONS The interactive logic model presented in this paper will allow for comprehensive mapping of literature around effective strategies to strengthen HRH. It can aid researchers in communicating with policymakers about the evidence behind policy questions, thus supporting the translation of evidence to policy.
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Affiliation(s)
- Serena Sonderegger
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Sara Bennett
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Veena Sriram
- University of British Columbia, Vancouver, BC, Canada
| | - Ummekulsoom Lalani
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Shreya Hariyani
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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27
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Orenstein EW, Yun K, Warden C, Westerhaus MJ, Mirth MG, Karavite D, Mamo B, Sundar K, Michel JJ. Development and dissemination of clinical decision support across institutions: standardization and sharing of refugee health screening modules. J Am Med Inform Assoc 2021; 26:1515-1524. [PMID: 31373356 DOI: 10.1093/jamia/ocz124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We developed and piloted a process for sharing guideline-based clinical decision support (CDS) across institutions, using health screening of newly arrived refugees as a case example. MATERIALS AND METHODS We developed CDS to support care of newly arrived refugees through a systematic process including a needs assessment, a 2-phase cognitive task analysis, structured preimplementation testing, local implementation, and staged dissemination. We sought consensus from prospective users on CDS scope, applicable content, basic supported workflows, and final structure. We documented processes and developed sharable artifacts from each phase of development. We publically shared CDS artifacts through online dissemination platforms. We collected feedback and implementation data from implementation sites. RESULTS Responses from 19 organizations demonstrated a need for improved CDS for newly arrived refugee patients. A guided multicenter workflow analysis identified 2 main workflows used by organizations that would need to be supported by shared CDS. We developed CDS through an iterative design process, which was successfully disseminated to other sites using online dissemination repositories. Implementation sites had a small-to-modest analyst time commitment but reported a good match between CDS and workflow. CONCLUSION Sharing of CDS requires overcoming technical and workflow barriers. We used a guided multicenter workflow analysis and online dissemination repositories to create flexible CDS that has been adapted at 3 sites. Organizations looking to develop sharable CDS should consider evaluating the workflows of multiple institutions and collecting feedback on scope, design, and content in order to make a more generalizable product.
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Affiliation(s)
- Evan W Orenstein
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Katherine Yun
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clara Warden
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael J Westerhaus
- Department of Medicine, HealthPartners Center for International Health, Minneapolis, Minnesota, USA
| | - Morgan G Mirth
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dean Karavite
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Blain Mamo
- Minnesota Department of Public Health, Minneapolis, Minnesota, USA
| | - Kavya Sundar
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeremy J Michel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Pagaiya N, Noree T, Hongthong P, Gongkulawat K, Padungson P, Setheetham D. From village health volunteers to paid care givers: the optimal mix for a multidisciplinary home health care workforce in rural Thailand. HUMAN RESOURCES FOR HEALTH 2021; 19:2. [PMID: 33407550 PMCID: PMC7789652 DOI: 10.1186/s12960-020-00542-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/04/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND Thailand is a rapidly aging society, which places high demand on home health care services for the elderly. The shortage of health care workforce in rural areas is a crucial obstacle to the delivery of adequate home health care services. The appropriate skill-mix between multidisciplinary health team and care givers (CGs) is an attractive solution for improving home health care services in rural Thailand. This study assessed the potential of trained CGs to provide home health care services and projected what the optimal mix for a multidisciplinary home health care team in rural Thailand would be in 2030. METHODS Eleven pilot districts in Thailand were recruited for the study. Secondary data were collected along with surveys of home health care providers. A total of 130 care managers (nurses) and 351 care givers (CG) were recruited for the survey. Workload, skill-mix potential, and acceptance of care givers were assessed in the surveys. The results from secondary data and the survey were used to project the health workforce requirements in 2030. RESULTS It is projected that in 2030 the number of elderly living in rural areas will be 7,156,700 (27% of the projected rural population). Of this, 20.3% will be home-bound, 1.1% will be bed-ridden and 1.6% will need rehabilitation. The main members of the multidisciplinary health workforce involved in home health care were nurses, doctors, and physiotherapists. The home health care services that were provided by the multidisciplinary health workforce included patient assessment, development of a care plan and case conference, home visits, and teaching and supervision of CGs. The CGs were village health volunteers trained to carry out regular home visits to patients. The CGs provided assistance with the activities of daily living, basic health services, moral support to patients and relatives, and surveillance of the home environment during home visits. CGs were well accepted by both the health professionals and the patients. Projections showed that 16,094 nurses, 1,542 doctors, 1,022 physiotherapists and 50,148 CGs will be required in 2030 to meet the needs of the dependent elderly for home health care in rural Thailand. CONCLUSION With the increased need for home health care services in the future, appropriate team work between the members of the multidisciplinary health team and the CGs in the community is the appropriate solution for likely shortages of health professional workforce.
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Affiliation(s)
- Nonglak Pagaiya
- Faculty of Public Health, Khon Kaen University, 123 Mitraphap road, Muang, 40002 Khon Kaen Thailand
| | - Thinakorn Noree
- International Health Policy Program, Ministry of Public Health, Tiwanon road, Muang, 11000 Nonthaburi Thailand
| | - Penapa Hongthong
- International Health Policy Program, Ministry of Public Health, Tiwanon road, Muang, 11000 Nonthaburi Thailand
| | - Karnwarin Gongkulawat
- International Health Policy Program, Ministry of Public Health, Tiwanon road, Muang, 11000 Nonthaburi Thailand
| | - Pagaluk Padungson
- International Health Policy Program, Ministry of Public Health, Tiwanon road, Muang, 11000 Nonthaburi Thailand
| | - Dariwan Setheetham
- Faculty of Public Health, Khon Kaen University, 123 Mitraphap road, Muang, 40002 Khon Kaen Thailand
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Veenstra M, Gautun H. Nurses' assessments of staffing adequacy in care services for older patients following hospital discharge. J Adv Nurs 2020; 77:805-818. [PMID: 33222214 PMCID: PMC7894527 DOI: 10.1111/jan.14636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/21/2020] [Accepted: 10/22/2020] [Indexed: 11/28/2022]
Abstract
Aims To explore community nurses' assessments of staffing adequacy in care provision for older patients following hospital discharge and analyse the extent to which their assessments are associated with characteristics of the system level of municipality and vertical coordination between hospital and community care services. Design Nation‐wide cross‐sectional survey. Methods Web‐based survey conducted in 2017 among 3,461 nurses working with older persons (65+) in homecare services, residential care and nursing homes in Norway. Responses from individual homecare nurses were linked with municipal‐level register data (age structure, economic flexibility, service profiles). Stratified multilevel analyses were used to analyse the association of staffing adequacy with municipal characteristics and perceived quality of vertical coordination. Results Almost half of the nurses experienced inadequate staffing in general, whereas a similar share indicated that staffing was adequate. Nursing home nurses showed the least positive ratings of staffing adequacy. Most nurses indicated that there were too many unqualified care workers at their workplace. More positive assessments of staffing adequacy were associated with better vertical coordination. Average ratings of staffing adequacy were lower in larger municipalities and municipalities with an older population. Conclusion Healthcare providers, nurse managers and policy makers may benefit from a stronger focus on rebalancing skill‐mix and on new models of vertical coordination in addressing current and future nurse staffing shortages in care services for older people following hospital discharge. Impact statement This study adds to the scarce national and international research literature on nurse staffing in community care services, addressing the pressing challenges of staffing and skill‐ mix in long‐term care provision. Findings support the development of nurse‐led models of care coordination for older patients following hospital discharge and stimulate future research on the effects of recruitment and retainment strategies in different municipalities and different models of vertical coordination.
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Affiliation(s)
- Marijke Veenstra
- Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway
| | - Heidi Gautun
- Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway
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Kushemererwa D, Davis J, Moyo N, Gilbert S, Gray R. The Association between Nursing Skill Mix and Mortality for Adult Medical and Surgical Patients: Protocol for a Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228604. [PMID: 33228155 PMCID: PMC7699481 DOI: 10.3390/ijerph17228604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022]
Abstract
Skill mix refers to the number and educational experience of nurses working in clinical settings. Authors have used several measures to determine the skill mix, which includes nurse-to-patient ratio and the proportion of baccalaureate-prepared nurses. Observational studies have tested the association between nursing skill mix and patient outcomes (mortality). To date, this body of research has not been subject to systematic review or meta-analysis. The aim of this study is to systematically review and meta-analyse observational and experimental research that tests the association between nursing skill mix and patient mortality in medical and surgical settings. We will search four key electronic databases—MEDLINE [OVID], EMBASE [OVID], CINAHL [EBSCOhost], and ProQuest Central (five databases)—from inception. Title, abstract, and full-text screening will be undertaken independently by at least two researchers using COVIDENCE review management software. We will include studies where the authors report an association between nursing skill mix and outcomes in adult medical and surgical inpatients. Extracted data from included studies will consist measures of nursing skill mix and inpatient mortality outcomes. A meta-analysis will be undertaken if there are at least two studies with similar designs, exposures, and outcomes. The findings will inform future research and workforce planning in health systems internationally.
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Weber DL, Cubaka VK, Kallestrup P, Reventlow S, Schriver M. Rwandan primary healthcare providers' perception of their capability in the diagnostic practice. Afr J Prim Health Care Fam Med 2020; 12:e1-e10. [PMID: 33054271 PMCID: PMC7565005 DOI: 10.4102/phcfm.v12i1.2197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 05/15/2020] [Accepted: 05/29/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Skill-mix imbalance is a global concern for primary healthcare in low-income countries. In Rwanda, primary healthcare facilities (health centres, HCs) are predominantly led by nurses. They have to diagnose a multitude of health complaints. Whether they feel capable of undertaking this responsibility has yet to be explored. AIM This study explored how healthcare providers (HPs) at Rwandan HCs perceived their capability in the diagnostic practice. SETTING Rural and urban HCs in Muhanga district, Rwanda. METHOD Qualitative, semi-structured interviews with nurses and clinical officers, and observations of consultations were made. Findings were analysed thematically. RESULTS Rwandan HPs were confident in their competences to perform diagnostic procedures although nurses felt that the responsibilities lay beyond their professional training. Clinical officers believed that their professional training prepared them to function competently and autonomously in the diagnostic practice, although all HPs experienced a high dependency on medical history taking, physical examination and laboratory tests for reaching a diagnosis. Resource constraints (time, rooms and laboratory tests) were seen as a barrier to perform diagnostic tasks optimally, and HPs experienced in-service training and supervision as insufficient. They increased their diagnostic competences through work experience, self-learning and supportive peer collaboration. CONCLUSION Clinical officers perceived themselves as capable in the diagnostic practice. Nurses may compensate for insufficient school training through in-service learning opportunities and feel capable in the diagnostic practice. Formative mentorship schemes and tailored education may prove valuable, but further research on how to improve HPs' diagnostic capability in Rwanda's primary healthcare sector is needed.
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Affiliation(s)
- Ditte L Weber
- Department of Planning, Faculty of IT and Design, Aalborg University, Aalborg.
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Garzaro G, Clari M, Ciocan C, Grillo E, Mansour I, Godono A, Borgna LG, Sciannameo V, Costa G, Raciti IM, Bert F, Berchialla P, Coggiola M, Pira E. COVID-19 infection and diffusion among the healthcare workforce in a large university-hospital in northwest Italy. LA MEDICINA DEL LAVORO 2020; 111:184-194. [PMID: 32624560 PMCID: PMC7809947 DOI: 10.23749/mdl.v111i3.9767] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 11/17/2022]
Abstract
Backgroud: Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak, healthcare workers (HCWs) have been the workers most likely to contract the disease. Intensive focus is therefore needed on hospital strategies that minimize exposure and diffusion, confer protection and facilitate early detection and isolation of infected personnel. METHODS To evaluate the early impact of a structured risk-management for exposed COVID-19 HCWs and describe how their characteristics contributed to infection and diffusion. Socio-demographic and clinical data, aspects of the event-exposure (date, place, length and distance of exposure, use of PPE) and details of the contact person were collected. RESULTS The 2411 HCWs reported 2924 COVID-19 contacts. Among 830 HCWs who were at 'high or medium risk', 80 tested positive (9.6%). Physicians (OR=2.03), and non-medical services -resulted in an increased risk (OR=4.23). Patient care did not increase the risk but sharing the work environment did (OR=2.63). There was a significant time reduction between exposure and warning, exposure and test, and warning and test since protocol implementation. HCWs with management postitions were the main source of infection due to the high number of interactions. DISCUSSION A proactive system that includes prompt detection of contagious staff and identification of sources of exposure helps to lower the intra-hospital spread of infection. A speedier return to work of staff who would otherwise have had to self-isolate as a precautionary measure improves staff morale and patient care by reducing the stress imposed by excessive workloads arising from staff shortages.
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Affiliation(s)
- Giacomo Garzaro
- University of Torino, Department of Public Health and Pediatrics - Città della Salute e della Scienza di Torino University Hospital, Occupational Health Service.
| | - Marco Clari
- University of Torino, Department of Public Health and Pediatrics.
| | - Catalina Ciocan
- University of Torino, Department of Public Health and Pediatrics - Città della Salute e della Scienza di Torino University Hospital, Occupational Health Service.
| | - Eugenio Grillo
- University of Torino, Department of Public Health and Pediatrics.
| | - Ihab Mansour
- University of Torino, Department of Public Health and Pediatrics.
| | | | | | - Veronica Sciannameo
- University of Padova, Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health.
| | - Giuseppe Costa
- University of Torino, Department of Clinical and Biological Sciences.
| | - Ida Marina Raciti
- Città della Salute e della Scienza di Torino University Hospital, Molinette Hospital.
| | - Fabrizio Bert
- University of Torino, Department of Public Health and Pediatrics - Città della Salute e della Scienza di Torino University Hospital, Molinette Hospital.
| | - Paola Berchialla
- University of Torino, Department of Clinical and Biological Sciences.
| | - Maurizio Coggiola
- Città della Salute e della Scienza di Torino University Hospital, Occupational Health Service.
| | - Enrico Pira
- University of Torino, Department of Public Health and Pediatrics - Città della Salute e della Scienza di Torino University Hospital, Occupational Health Service.
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Rumisha SF, Kishimba RS, Mohamed AA, Urio LJ, Rusibayamila N, Bakari M, Mghamba J. Addressing the workforce capacity for public health surveillance through field epidemiology and laboratory training program: the need for balanced enhanced skill mix and distribution, a case study from Tanzania. Pan Afr Med J 2020; 36:41. [PMID: 32774617 PMCID: PMC7388632 DOI: 10.11604/pamj.2020.36.41.17857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 07/19/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Skill mix refers to the range of professional development and competencies, skills and experiences of staff within a particular working environment that link with specific outcome while responding to client needs. A balanced skill-mix and distribution of core human resources is important to strengthen decision-making process and rapid responses. We analysed graduates´ information of the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) between 2008-2016, distribution of skill-mix and the surveillance workforce-gaps within regions. Methods Trainees´ data of nine cohorts enrolled between 2008 and 2016 were extracted from the program database. Distribution by sex, region and cadres/profession was carried out. An indicator to determine enhanced-skill mix was established based on the presence of a clinician, nurse, laboratory scientist and environmental health officer. A complete enhanced skill-mix was considered when all four were available and have received FELTP training. Results The TFELTP has trained 113 trainees (male=71.7%), originated from 17 regions of Tanzania Mainland (65.4% of all) and Zanzibar. Clinicians (34.5%) and laboratory scientists (38.1%) accounted for the most recruits, however, the former were widely spread in regions (83% vs. 56%). Environmental health officers (17.7%) were available in 39% of regions. The nursing profession, predominantly lacking (6.2%) was available in 22% of regions. Only two regions (11.7%) among 17 covered by TFELTP presented complete skill-mix, representing 7.7% of Tanzanian regions. Seven regions (41%) had an average of one trainee. Conclusion The TFELTP is yet to reach the required skill-mix in many regions within the country. The slow fill-rate for competent and key workforce cadres might impede effective response. Strategies to increase program awareness at subnational levels is needed to improve performance of surveillance and response system in Tanzania.
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Affiliation(s)
- Susan Fred Rumisha
- National Institute for Medical Research, 3 Barack Obama Drive, Dar es Salaam, Tanzania.,Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | - Rogath Saika Kishimba
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Ahmed Abade Mohamed
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | - Loveness John Urio
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | - Neema Rusibayamila
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Muhammad Bakari
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Janneth Mghamba
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
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Cody R, Gysin S, Merlo C, Gemperli A, Essig S. Complexity as a factor for task allocation among general practitioners and nurse practitioners: a narrative review. BMC FAMILY PRACTICE 2020; 21:38. [PMID: 32066391 PMCID: PMC7025404 DOI: 10.1186/s12875-020-1089-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND General practitioner (GP) shortages and increasing demand for care led to the introduction of nurse practitioners (NPs) to primary care. Many concepts for task sharing among health professionals feature complexity. The aim of this narrative review was to examine how complexity is used as a factor for task allocation between GPs and NPs. METHODS According to the PRISMA statement, PubMed and CINAHL were searched systematically, and eligibility criteria were applied to detect literature concerning GPs and NPs in primary care and complexity in the context of task allocation. Relevant information was extracted, and a narrative analysis was performed. RESULTS Thirty-seven studies from seven countries were included, comprising quantitative, qualitative, and mixed methods. Complexity was used to describe patients, their needs, and health professionals' tasks. The understanding of the use of complexity as a factor for task allocation between NPs and GPs was based on the patient population (specific vs. unspecific), the setting (specific vs. unspecific), the numbers of health professionals involved (two vs. more than two), and the NP role (distinct model of care vs. no model). Despite similarities in these areas, the tasks which NPs perform range from providing minor to complex care. However, there is a slight trend towards NPs treating socially complex patients and GPs focusing on medically complex cases. CONCLUSION Complexity as a concept is prominent in primary care but remains broad and inconsistent as a factor for task allocation between NPs and GPs. This review can be used as a point of reference when practitioners are seeking methods for task allocation in a collaborative primary care setting.
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Affiliation(s)
- Robyn Cody
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Lucerne, Switzerland.
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
| | - Stefan Gysin
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Lucerne, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Christoph Merlo
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Lucerne, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Stefan Essig
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Lucerne, Switzerland
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Boman E, Levy‐Malmberg R, Fagerström L. Differences and similarities in scope of practice between registered nurses and nurse specialists in emergency care: an interview study. Scand J Caring Sci 2019; 34:492-500. [DOI: 10.1111/scs.12753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Erika Boman
- Department of Nursing and Health Sciences Faculty of Health and Social Sciences University of South‐Eastern Norway Drammen Norway
- Department of Nursing Åland University of Applied Sciences Mariehamn Finland
| | - Rika Levy‐Malmberg
- Department of Nursing and Health Sciences Faculty of Health and Social Sciences University of South‐Eastern Norway Drammen Norway
- Department of Health Care Novia University of Applied Sciences Vaasa Finland
| | - Lisbeth Fagerström
- Department of Nursing and Health Sciences Faculty of Health and Social Sciences University of South‐Eastern Norway Drammen Norway
- Department of Caring Science Faculty of Education and Welfare Studies Åbo Akademi University Vaasa Finland
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Chi DL, Hopkins S, Zahlis E, Randall CL, Senturia K, Orr E, Mancl L, Lenaker D. Provider and community perspectives of dental therapists in Alaska's Yukon-Kuskokwim Delta: A qualitative programme evaluation. Community Dent Oral Epidemiol 2019; 47:502-512. [PMID: 31464356 DOI: 10.1111/cdoe.12492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/17/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Dental therapists deliver preventive and basic restorative care and have been practicing since 2006 in Alaska's Yukon-Kuskokwim (YK) Delta. In this qualitative programme evaluation, we documented health providers' and community members' experiences with dental therapy. The goal of the evaluation was to develop a conceptual model of dental care delivery in Alaska Native Communities centred on dental therapists. METHODS We developed semi-structured interview scripts and used snowball sampling to recruit 16 health providers with experience providing care in the YK Delta and 125 community members from six YK Delta Communities in 2017 and 2018. The six communities were a stratified convenience sample based on community-level exposure to dental therapists (high, medium and no exposure). Interview data were digitally recorded, transcribed, verified for accuracy and coded inductively into conceptual domains using content analytic methods. RESULTS Providers believed individuals living in the YK Delta have benefited from clinic-based restorative care and community-based education provided by dental therapists. The restricted scope of dental therapy practice limits the complexity of care that may be offered to patients. However, community members expressed high satisfaction with the quality of care provided by dental therapists. Community members noted more widespread knowledge and evolving norms about oral health and believed dental therapists are helping to prevent disease and improve quality of life. Participants believed access to dental care for children has improved over the years, but felt that many adults in the YK Delta continue to have unmet needs. A potential barrier to sustained programme effectiveness is low retention of dental therapists in the region, driven primarily by reports that dental therapists feel overworked, stressed and geographically isolated. CONCLUSIONS Dental therapists have contributed to the dental care delivery system in Alaska's YK Delta. Future opportunities remain within the system to address the needs of adults, develop strategies to retain dental therapists in the region and incorporate evidence-based, prevention-oriented strategies to improve oral health behaviours and reduce oral diseases.
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Affiliation(s)
- Donald L Chi
- University of Washington School of Dentistry, Seattle, Washington.,University of Washington School of Public Health, Seattle, Washington
| | | | - Ellen Zahlis
- University of Washington School of Dentistry, Seattle, Washington
| | | | - Kirsten Senturia
- University of Washington School of Dentistry, Seattle, Washington.,University of Washington School of Public Health, Seattle, Washington
| | - Eliza Orr
- University of Washington School of Dentistry, Seattle, Washington
| | - Lloyd Mancl
- University of Washington School of Dentistry, Seattle, Washington
| | - Dane Lenaker
- Southeast Alaska Regional Health Consortium, Sitka, Alaska
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Thériault M, Dubois C, Borgès da Silva R, Prud’homme A. Nurse staffing models in acute care: A descriptive study. Nurs Open 2019; 6:1218-1229. [PMID: 31367448 PMCID: PMC6650648 DOI: 10.1002/nop2.321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 05/01/2019] [Accepted: 05/21/2019] [Indexed: 11/09/2022] Open
Abstract
AIMS To identify nurse staffing groups in acute care facilities. DESIGN This retrospective descriptive study used a configurational approach. METHODS Data from a two-month target period from January-March 2016 were collected for 40 facilities in four different hospitals in one of the largest regions of Quebec. Multiple factorial analysis and hierarchical ascendant classification were used to generate a limited number of nurse staffing groups. RESULTS/FINDINGS Four distinct nurse staffing groups emerged from this study. The least resourced model relied mainly on less qualified personnel and agency staff. The moderately resourced basic model was assessed as average across all staffing dimensions, but employed less overtime, relying mostly on auxiliary nurses. The moderately resourced professional group, also moderate in most variables, involved more overtime and fewer less qualified personnel. The most resourced group maximized highly qualified personnel and minimized instability in the nursing team. CONCLUSION This study covered multiple staffing groups with widely varying characteristics. Most groups entailed risks for quality of care at one or more levels. Few care units approached the theoretical staffing ideal.
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Affiliation(s)
- Marianne Thériault
- Faculty of NursingUniversity of MontrealMontrealQuebecCanada
- Public Health Research InstituteUniversity of MontrealMontrealQuebecCanada
| | - Carl‐Ardy Dubois
- Public Health Research InstituteUniversity of MontrealMontrealQuebecCanada
- Department of Management, Evaluation and Health PolicyUniversity of MontrealMontrealQuebecCanada
| | - Roxane Borgès da Silva
- Public Health Research InstituteUniversity of MontrealMontrealQuebecCanada
- Department of Management, Evaluation and Health PolicyUniversity of MontrealMontrealQuebecCanada
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Koopmans L, Damen N, Wagner C. Does diverse staff and skill mix of teams impact quality of care in long-term elderly health care? An exploratory case study. BMC Health Serv Res 2018; 18:988. [PMID: 30572880 PMCID: PMC6302304 DOI: 10.1186/s12913-018-3812-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 12/11/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Many European countries face challenges in long-term care for older people, such as the growing number of older people requiring care, the increasing complexity of their health care problems, and a decreasing workforce that is inadequately prepared. Optimizing the staff and skill mix of health care teams may offer part of the solution for these challenges. The aim of this study was to obtain insight into the development of teams in terms of staff and skill mix, and the influence of staff and skill mix on quality of care, quality of life, and job satisfaction. METHODS Seven teams in elderly care in the Netherlands participated in this exploratory case study. From April 2013 to January 2015, a researcher followed the development of the teams, performed observations at the workplace and held interviews with team members, team captains, and (representatives of) clients. Data-analyses were carried out in MAXQDA 11, by coding interviews and analyzing themes. RESULTS During the project, almost all teams became more diverse in terms of staff and skill mix. In general, there was a trend towards adding (more) higher-qualified health care workers (e.g. nurse) to the team, increasing communication with other disciplines, and enhancing skills of lower-qualified team members. A more diverse staff and skill mix had a positive effect on quality of care and quality of life of clients, and on job satisfaction, but only under certain contextual conditions. Important contextual conditions for successful functioning of a diverse team were a shared view of care by all team members, good communication, autonomy for professionals, and a safe team culture. CONCLUSION A more diverse staff and skill mix, in combination with positive contextual conditions, can result in improved quality of care, quality of life, and job satisfaction. However, a "one size fits all" blueprint for the optimal staff and skill mix, that suits each team and organization, does not exist. This depends on the context, and should be based on the needs of the clients and possible future changes in these needs.
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Affiliation(s)
- L Koopmans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands, currently working at TNO Healthy Living, Leiden, TNO Healthy Living, P.O. Box 3005, NL 2301, DA, Leiden, The Netherlands.
| | - N Damen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands, currently working at Elisabeth-TweeSteden Ziekenhuis (ETZ), Tilburg, The Netherlands
| | - C Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Spagnolo J, Champagne F, Leduc N, Melki W, Piat M, Laporta M, Bram N, Guesmi I, Charfi F. "We find what we look for, and we look for what we know": factors interacting with a mental health training program to influence its expected outcomes in Tunisia. BMC Public Health 2018; 18:1398. [PMID: 30572941 PMCID: PMC6302293 DOI: 10.1186/s12889-018-6261-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Primary care physicians (PCPs) working in mental health care in Tunisia often lack knowledge and skills needed to adequately address mental health-related issues. To address these lacunas, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to PCPs working in the Greater Tunis area between February and April 2016. While the mhGAP-IG has been used extensively in low- and middle-income countries (LMICs) to help build non-specialists' mental health capacity, little research has focused on how contextual factors interact with the implemented training program to influence its expected outcomes. This paper's objective is to fill that lack. METHODS We conducted a case study with a purposeful sample of 18 trained PCPs. Data was collected by semi-structured interviews between March and April 2016. Qualitative data was analyzed using thematic analysis. RESULTS Participants identified more barriers than facilitators when describing contextual factors influencing the mhGAP-based training's expected outcomes. Barriers were regrouped into five categories: structural factors (e.g., policies, social context, local workforce development, and physical aspects of the environment), organizational factors (e.g., logistical issues for the provision of care and collaboration within and across healthcare organizations), provider factors (e.g., previous mental health experience and personal characteristics), patient factors (e.g., beliefs about the health system and healthcare professionals, and motivation to seek care), and innovation factors (e.g., training characteristics). These contextual factors interacted with the implemented training to influence knowledge about pharmacological treatments and symptoms of mental illness, confidence in providing treatment, negative beliefs about certain mental health conditions, and the understanding of the role of PCPs in mental health care delivery. In addition, post-training, participants still felt uncomfortable with certain aspects of treatment and the management of some mental health conditions. CONCLUSIONS Findings highlight the complexity of implementing a mhGAP-based training given its interaction with contextual factors to influence the attainment of expected outcomes. Results may be used to tailor structural, organizational, provider, patient, and innovation factors prior to future implementations of the mhGAP-based training in Tunisia. Findings may also be used by decision-makers interested in implementing the mhGAP-IG training in other LMICs.
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Affiliation(s)
- Jessica Spagnolo
- School of Public Health, IRSPUM, Université de Montréal, Montréal, Québec H3N1X9 Canada
| | - François Champagne
- School of Public Health, IRSPUM, Université de Montréal, Montréal, Québec H3N1X9 Canada
| | - Nicole Leduc
- School of Public Health, Université de Montréal, Montréal, Québec Canada
| | - Wahid Melki
- Razi Hospital, University of Tunis El-Manar, Tunis, Tunisia
| | - Myra Piat
- Douglas Mental Health University Institute, McGill University, Montréal, Québec Canada
| | - Marc Laporta
- Montreal WHO-PAHO Collaborating Center for Research and Training in Mental Health, McGill University, Montréal, Québec Canada
| | - Nesrine Bram
- Razi Hospital, University of Tunis El-Manar, Tunis, Tunisia
| | - Imen Guesmi
- Center for School and University Medicine in Manouba, Manouba, Tunisia
| | - Fatma Charfi
- Mongi-Slim Hospital, University of Tunis El-Manar, Tunis, Tunisia
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Cunningham J, O'Toole T, White M, Wells JSG. Conceptualizing skill mix in nursing and health care: An analysis. J Nurs Manag 2018; 27:256-263. [PMID: 30238572 DOI: 10.1111/jonm.12673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 11/28/2022]
Abstract
AIM This paper aims to unpack the concept of "skill mix" into its constituent parts to achieve a better understanding and reduce confusion associated with the term. BACKGROUND Skill mix is a topic that is widely debated and is foremost on the health policy agenda due to specific local pressures within international health services. At present, however, there is large variation in terms of what is understood by the concept of "skill mix" and there is a paucity of research that attempts to analyse this concept. EVALUATION Using Rodgers' evolutionary method of concept analysis, this paper provides an analysis of definitions of skill mix, its attributes and associated terms in the literature. KEY ISSUE Definitions of skill mix are often vague and ambiguous and may refer to one or more attributes of skill mix. CONCLUSION A lack of understanding of the concept can lead to an ad hoc interpretation of policy recommendations related to skill mix at local level. IMPLICATIONS FOR NURSING MANAGEMENT A better understanding of the concept of "skill mix" and its attributes can assist both policy makers and stakeholders, including nurse management, to ensure that the potential of skill mix is maximized.
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Affiliation(s)
- Jennifer Cunningham
- Lecturer in Mental Health Nursing, Department of Nursing and Health Care, Waterford Institute of Technology, Waterford, Ireland
| | - Thomas O'Toole
- Head of School of Business, Waterford Institute of Technology, Waterford, Ireland
| | - Mark White
- Director of Nursing and Midwifery Planning and Development Unit, HSE South, Kilkenny, Ireland
| | - John S G Wells
- Head of School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
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Alotaibi A, Gholizadeh L, Al-Ganmi AHA, Perry L. Factors influencing nurses’ knowledge acquisition of diabetes care and its management: A qualitative study. J Clin Nurs 2018; 27:4340-4352. [DOI: 10.1111/jocn.14544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Abdulellah Alotaibi
- Faculty of Health; University of Technology Sydney (UTS); Broadway NSW Australia
- Faculty of Applied Health Science; Shaqra University; Dawami Saudi Arabia
| | - Leila Gholizadeh
- Faculty of Health; University of Technology Sydney (UTS); Broadway NSW Australia
| | - Ali Hussein Alek Al-Ganmi
- Faculty of Health; University of Technology Sydney (UTS); Broadway NSW Australia
- College of Nursing; University of Baghdad; Baghdad Iraq
| | - Lin Perry
- Faculty of Health; University of Technology Sydney (UTS); Broadway NSW Australia
- South Eastern Sydney Local Health District; Sydney NSW Australia
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Conceptual Models of Early and Involuntary Retirement among Canadian Registered Nurses and Allied Health Professionals. Can J Aging 2018; 37:294-308. [DOI: 10.1017/s0714980818000223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RESUMÉLa disponibilité des professionnels de la santé est fondamentale pour la santé de la population. Plusieurs tendances contribuent cependant à la pénurie de ces professionnels. Objet : Élaborer et valider des modèles conceptuels de retraite hâtive et de retraite involontaire pour les infirmières et les professionnels paramédicaux (PP). Méthode : Une revue de la littérature sur la retraite (n = 23 études) a été réalisée. Toutes les variables rapportées comme des facteurs prédictifs de la retraite hâtive ou de la retraite involontaire ont été incorporées dans un modèle. Pour atteindre une validité apparente, nous avons mené des entrevues avec des infirmières et des PP canadiens (n = 14). Résultats : Le modèle conceptuel de la retraite hâtive incluait huit catégories (38 facteurs): caractéristiques du lieu de travail, variables sociodémographiques, attitudes et croyances, contexte plus général, facteurs organisationnels, famille, mode de vie et santé, en lien avec le travail. Le modèle de la retraite involontaire incluait quatre catégories (8 facteurs): contexte plus général, variables sociodémographiques, mode de vie et santé, famille. Les responsabilités en matière de soins (facteur) ont été ajoutées compte tenu des résultats des entrevues. Discussion : Les infirmières et les PP tiennent compte de nombreux facteurs lorsqu’ils envisagent leur retraite. Certains seraient sensibles à l’intercession, ce qui permettrait d’étendre la vie professionnelle des infirmières et des PP plus âgés.
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Hatem M, Halabi-Nassif H, Maroun M. [Construction of a common vision of nurses and midwives training in Democratic Republic of the Congo.]. SANTE PUBLIQUE 2018; S1:89-100. [PMID: 30066553 DOI: 10.3917/spub.180.0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To present the activities that facilitate the development of a public policy by public health and higher and university education ministry stakeholders - based on a common vision of nurses and midwives training in Democratic Republic of the Congo (DRC). METHODS An operational research using different methods applied by experts called ?policy brokers? according to a framework covering the advocacy mechanisms (Advocacy Coalition Framework) designed to promote the development of a public policy. The population comprised 2 types of common interest groups (coalitions), derived from 3 systems (sociocultural-legal, educational, professional), involved in the choice of the ?secondary AND higher? or ?secondary OR higher? training profile for the concerned professionals. The methods comprised: workshops (discussion, training, restitution, validation, negotiation, scientific, reflection group meetings), training activities (programme development, training of nursing and midwives trainers-supervisors) and a variety of media coverage and marketing activities. RESULTS The nurses and midwives profiles required in the DRC have been established. The levels required for their training have been validated and defined by a common vision of the two ministries concerned. A formal consultation framework was set up to launch the required reform for the review of these two professional's profiles. CONCLUSION The public policy experts' activities based on the advocacy framework are complex, lengthy and time-consuming. In DRC, a Ministerial decree is currently being finalized to address the creation of a formal consultation framework concerning the training and utilisation of human health resources.
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Kriegel J, Riedl A, Tuttle-Weidinger L, Stöbich AM. Future strategic topics in the business model of hospitals in Austria. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2018. [DOI: 10.1080/20479700.2018.1429234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Johannes Kriegel
- Fakultät für Gesundheit und Soziales, FH-OÖ Studienbetriebs GmbH, Linz, Austria
| | - Anton Riedl
- University of Applied Sciences Upper Austria, School of Applied Health and Social Sciences, Linz, Austria
| | - Linda Tuttle-Weidinger
- University of Applied Sciences Upper Austria, School of Applied Health and Social Sciences, Linz, Austria
| | - Anna-Maria Stöbich
- University of Applied Sciences Upper Austria, School of Applied Health and Social Sciences, Linz, Austria
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Isaramalai SA, Hounsri K, Kongkamol C, Wattanapisitkul P, Tangadulrat N, Kaewmanee T, Yuenyongviwat V. Integrating participatory ergonomic management in non-weight-bearing exercise and progressive resistance exercise on self-care and functional ability in aged farmers with knee osteoarthritis: a clustered randomized controlled trial. Clin Interv Aging 2018; 13:101-108. [PMID: 29398910 PMCID: PMC5775746 DOI: 10.2147/cia.s144288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Ergonomic hazards are the most important cause of knee osteoarthritis (OA) in aged para rubber farmers. Ergonomic management comprising improvement of working conditions and muscle-strengthening exercise has been well documented in terms of workers' health benefit. However, those interventions were not adequate to sustain the advantage. Few studies have demonstrated the effect of integrating participatory ergonomic management (PEM) in non-weight-bearing exercise (NWE) and progressive resistance exercise (PRE), and none has focused on aged para rubber farmers with knee OA. Purpose This study investigated the effect of PEM-NWE, PEM-PRE, and standard treatment (ST) on self-care and functional ability in the aged population. Materials and methods A single-blinded, clustered randomized controlled trial was carried out. Participants (n=75) from three different communities in southern Thailand were randomly assigned to PEM-NWE, PEM-PRE, and ST. Self-care and functional ability (pain, stiffness, and physical function) were examined at baseline (B), during the intervention at Week 5 (W5), and after its completion at Week 9 (W9). Mean comparison of those outcomes over time was made using Generalized Linear Mixed Models (GLMMs). Results Compared to the standard treatment, the means of both groups, PEM-NWE and PEM-PRE, were significantly increased in self-care and functional ability. However, no significant difference between PEM-NWE and PEM-PRE was found. Conclusion Either or both interventions should be incorporated into nursing practice in order to promote occupational health and enhance quality of work life for Thai aged farmers. Further study on their cost-effectiveness is highly recommended.
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Affiliation(s)
| | - Kanokwan Hounsri
- Research Center for Caring System of Thai Elderly, Faculty of Nursing
| | - Chanon Kongkamol
- Research Unit of Holistic Health and Safety Management in Community, Faculty of Medicine
| | | | | | | | - Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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MacKinnon K, Butcher DL, Bruce A. Working to Full Scope: The Reorganization of Nursing Work in Two Canadian Community Hospitals. Glob Qual Nurs Res 2018; 5:2333393617753905. [PMID: 29410976 PMCID: PMC5794041 DOI: 10.1177/2333393617753905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 11/21/2022] Open
Abstract
Work relationships between registered nurses (RNs) and practical nurses (LPNs) are changing as new models of nursing care delivery are introduced to create more flexibility for employers. In Canada, a team-based, hospital nursing care delivery model, known as Care Delivery Model Redesign (CDMR), redesigned a predominantly RN-based staffing model to a functional team consisting of fewer RNs and more LPNs. The scope of practice for LPNs was expanded, and unregulated health care assistants introduced. This study began from the standpoint of RNs and LPNs to understand their experiences working on redesigned teams by focusing on discourses activated in social settings. Guided by institutional ethnography, the conceptual and textual resources nurses are drawing on to understand these changing work relationships are explicated. We show how the institutional goals embedded in CDMR not only mediate how nurses work together, but how they subordinate holistic standards of nursing toward fragmented, task-oriented, divisions of care.
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Affiliation(s)
| | | | - Anne Bruce
- University of Victoria, Victoria, British Columbia, Canada
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Barnes E, Bullock A, Allan M, Hodson K. Community pharmacists' opinions on skill-mix and delegation in England. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:398-406. [PMID: 29210132 DOI: 10.1111/ijpp.12419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 10/24/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Following the 2005 contractual framework amendment, the expanding role of community pharmacy team members required a shift in entrenched views on roles and duties. This study aimed to report on community pharmacists' opinions on skill mix and explore how they can be addressed so that skill mix may be optimised. METHODS An invitation to complete an online questionnaire was distributed via email, marked for the attention of the lead pharmacist. Following a low response, a paper-based questionnaire was sent to all community pharmacies in England (n = 11,816). Questions elicited data about the respondent, the pharmacy (including staffing profile) and opinions on skill mix. KEY FINDINGS A total of 1154 returns were received, representing a 10% response rate. Of these, most were pharmacy chains (76%; n = 877), with 5-9 staff (54%; n = 600); commonly open 40-49 hours (42%; n = 487), dispensing <6000 prescriptions per week (41%, n = 533). From 26 statements on skill mix, three factors were identified by principal-components factor analysis: 'working well', 'feeling the pressure' and 'open to development'. Characteristics associated with 'working well': pharmacy owners, single businesses, with pharmacy technician(s), dispensing fewer prescriptions and open shorter hours. Characteristics associated with 'feeling the pressure': pharmacy chains, open longer hours, large numbers of prescriptions and relief pharmacists. Characteristics associated with 'open to development': recently qualified, second pharmacists, working longer hours, chains and dispensing lower numbers of prescriptions. CONCLUSIONS Although limited by a low response, results suggest being in a position to influence (more experienced, business owners) may be associated with more positive opinions. Further training (including about legalities and leadership) could contribute to optimising skill mix in community pharmacies.
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Affiliation(s)
- Emma Barnes
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Margaret Allan
- Wales Centre for Pharmacy Professional Education (WCPPE), Cardiff University, Cardiff, UK
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
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Patel H, Gurumurthy P. Implementation and evaluation of medicine and therapeutic information service by clinical pharmacists in oncology care setting. J Oncol Pharm Pract 2017; 25:60-67. [DOI: 10.1177/1078155217727141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background This study was conducted to explore the role of clinical pharmacists in providing medicine and therapeutic information service in oncology care setting. Methods It was a prospective study conducted for a period of three years after implementation of medicine and therapeutic information service as an integral part of oncology pharmacy services. The medicine and therapeutic information queries were received during ward rounds, at ambulatory care and via telephone by clinical pharmacists. All the medicine and therapeutic information requests were reviewed and answered to the concerned requester(s). Answered medicine and therapeutic information requests were electronically documented in the hospital drug information database and analyzed further. Results A total of 484 medicine and therapeutic information requests were received by clinical pharmacists during period of August 2013 to June 2016. Majority of medicine and therapeutic information queries were requested by radiation oncologists (27.2%) followed by medical oncologists (26.4%), general physicians (14.04%), resident medical officers (11.7%), ambulatory care nurses (8.6%), in-patient nurses (5.1%) and patients and care takers (6.6%). Majority of the medicine and therapeutic information queries were asked for the purpose of improving patient care (48.3%) followed by to update knowledge (30.9%) and training sessions to nurses (6.6%). The most common categories of medicine and therapeutic information were adverse drug reactions and its management (21.4%) followed by dosage adjustments of chemotherapy and biologicals (15.5%), supportive care related (14.6%), contraindications (14%), drug–drug interactions (11.9%), management of co-morbidities (7.8%), chemotherapy selection in special populations (4.5%). Conclusion The provision of medicine and therapeutic information was found to be useful in providing medicine information to improve patient care and to update knowledge of health care professionals at the study hospital.
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Affiliation(s)
- Himanshu Patel
- Department of Pharmacy Practice, JSS College of Pharmacy, Jagadguru Sri Shivarathreeshwara University, Mysore, India
| | - Parthasarathi Gurumurthy
- Department of Pharmacy Practice, JSS College of Pharmacy, Jagadguru Sri Shivarathreeshwara University, Mysore, India
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Massimi A, De Vito C, Brufola I, Corsaro A, Marzuillo C, Migliara G, Rega ML, Ricciardi W, Villari P, Damiani G. Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis. PLoS One 2017; 12:e0173617. [PMID: 28282465 PMCID: PMC5345844 DOI: 10.1371/journal.pone.0173617] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 02/23/2017] [Indexed: 12/18/2022] Open
Abstract
The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context. The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs) and patients reported outcomes (PROs), with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP) and diastolic (DBP) blood pressure reduction (10 studies-3,881 patients) and HbA1c reduction (7 studies-2,669 patients) were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01--1.06), DBP -1.42 (95% CI -1.42--0.49) and HbA1c -0.15 (95% CI -0.32-0.01) in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP) or CVD (DBP), if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive.
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Affiliation(s)
- Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Ilaria Brufola
- School of Nursing, Università Cattolica del Sacro Cuore, Rome, Italy
- Institute of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alice Corsaro
- Institute of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Migliara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Luisa Rega
- School of Nursing, Università Cattolica del Sacro Cuore, Rome, Italy
- Institute of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Walter Ricciardi
- Institute of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Interprofessional enhanced skills training in periodontology: a qualitative study of one London pilot. BDJ Open 2017; 3:17001. [PMID: 29607074 PMCID: PMC5831016 DOI: 10.1038/bdjopen.2017.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 11/16/2016] [Accepted: 12/05/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES/AIMS: Health Education England (HEE) London developed an innovative 2-year pilot educational and training initiative for enhancing skills in periodontology for dentists and dental hygienists/therapists in 2011. This study explores the perceptions and experiences of those involved in initiating, designing, delivering and participating in this interprofessional approach to training. MATERIALS AND METHODS: Semi-structured qualitative interviews were conducted with a purposive sample of key stakeholders including course participants (dentists and dental hygienists and/or therapists), education and training commissioners, and providers towards the end of the 2-year programme. Interviews, based on a topic guide informed by health services and policy literature, were audio-recorded and transcribed verbatim. Data were analysed based on framework methodology, using QSR NVivo 9 software to manage the data. RESULTS: Twenty-two people were interviewed. Although certain challenges were identified in designing, and teaching, a course bringing together different professional backgrounds and level of skills, the experiences of all key stakeholders were overwhelmingly positive relating to the concept. There was evidence of ‘creative interprofessional learning’, which led to ‘enhancing team working’, ‘enabling role recognition’ and ‘equipping participants for delivery of new models of care’. Recommendations emerged with regard to future training and wider health policy, and systems that will enable participants on future enhanced skills courses in periodontology to apply these skills in clinical practice. CONCLUSION: The interprofessional approach to enhanced skills training in periodontology represents an important creative innovation to build capacity within the oral health workforce. This qualitative study has provided a useful insight into the benefits and tensions of an interprofessional model of training from the perspectives of different groups of key stakeholders and suggests its application to other areas of dentistry.
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