Core Values that Influence the Patient-Healthcare Professional Power Dynamic: Steering Interaction towards Partnership

Collaborative practice with parents in occupational therapy for children: A scoping review

INTRODUCTION

In childhood intervention, parent-therapist collaboration is central to the family-centred approach. Despite long-standing discussion in occupational therapy literature, the field faces challenges, including inconsistent terminology and difficulties in translating theory into practice. This paper represents the first part of a comprehensive scoping review study aimed at developing foundational concepts for collaborative practices with parents in occupational therapy for children. Therefore, this paper focusses on mapping existing practices, types, and approaches articulated in the literature.

METHODS

We searched English-language sources published worldwide from 1998 to 2022 discussing collaborative practices with parents in occupational therapy for children aged 0-10 with any diagnosis, including multidisciplinary practices. Seven databases were searched. Data from peer-reviewed indexed literature, theses and dissertations, and book chapters were extracted and analysed through basic numerical and descriptive analyses before being synthesised into similar categories. The Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic reviews and Meta-Analysis-extension for Scoping Reviews were used.

RESULTS

The scoping review yielded 299 papers. Parent-therapist collaboration was prominent in clinics, family homes, schools, and hospitals, particularly during therapy implementation, goal setting, and planning. Most reported practice types included 'interventions with parent engagement', 'parent-directed interventions', and 'parent education'. 'Family-centred', 'occupational-focussed', and 'client-therapist collaborative' approaches were frequently mentioned. There were inconsistencies in the terms used to describe collaborative practice characteristics.

CONCLUSION

Over the past 24 years, the collaborative practice literature has expanded and evolved, with parent-therapist collaboration observed across various occupational therapy settings. Inconsistencies in this collaboration across different therapeutic stages were revealed, which could impact intervention success and sustainability. Further research is needed to explore parent-therapist collaboration mechanisms within and across stages. This scoping review also underscores the need for a common framework to guide practice and research.

PLAIN LANGUAGE SUMMARY

This literature review explores how occupational therapists and parents work together in childhood intervention. Collaboration is essential for understanding and meeting children's needs within their family and community settings. However, occupational therapists and parents face challenges in applying family-centred practices and using a common language to bridge theory with practice. To address these challenges, we examined 299 papers published between 1998 and 2022 to understand how collaborative practices with parents have been described in the literature. Our review revealed that therapists and parents collaborate across various settings, such as clinics, schools, homes, and hospitals, mainly during therapy sessions, goal setting, and planning interventions. Collaborative practices take different forms. For instance, therapists often encourage parents to actively engage and take the lead in therapy, requiring therapists to recognise and respect parents' priorities and learning preferences. They often develop strategies together to support the child within family routines. While we found several studies on therapist-parent collaboration, the review outlined inconsistencies in how this practice was described and applied, which could affect its success. Therefore, more research is needed to understand the best ways in which collaboration can occur at each stage of therapy. The need for a core guideline for collaborative practice with parents in occupational therapy was also observed. While therapist-parent collaboration is used in occupational therapy for children, there is a clear need to minimise inconsistencies and gaps found in the literature, as well as to ensure a common language to promote intervention quality and success.

Exploring herbal remedy utilization for wound healing: Patterns, patient preferences, and implications for nursing practice

PURPOSE

The utilization of herbal remedies for wound healing is a notable aspect of traditional medicine practices. Understanding herbal use among patients yields insights for nursing care enhancement. This study aimed to investigate the utilization of herbal remedies for wound healing among diabetic patients.

METHODS

A total of 453 participants were enrolled, with demographic data, including age, sex, occupation, education level, residence, ethnic group, distance from health service, herbal use duration, and wound duration presented. Descriptive statistics were used to analyze the data, including means, standard deviations, ranges, and percentages.

FINDINGS

The average participant age was 55.39 years, with most being non-civil servant workers (60.3%) and having a low education level (67.1%). Indian almond wood (9.7%) and green betel (6.8%) were the most commonly used herbs for wound healing. Family members were the primary source of information (29.1%), and 43.7% obtained herbs from personal gardens. Although 94.2% of participants did not disclose herbal use to health liaisons, 53.4% used herbs specifically for wound healing. Users reported both positive and negative effects on wounds from various herbs, indicating variability in experiences. However, the consistency of herb usage by individual patients was uncertain.

CONCLUSIONS

The study identified diverse herbal remedies used for wound healing among patients, driven by familial recommendations. Usage pattern diversity and effects signal necessity for researching herb safety and efficacy. Clarifying the impact of consistent herb usage on wound healing is essential for understanding patients' preferences and practices.

IMPLICATIONS FOR CLINICAL PRACTICE

These findings emphasize the importance of open communication between patients and healthcare providers regarding herbal remedy use. Nurses should acknowledge patients' preferences for traditional healing practices while ensuring they receive evidence-based care. Patient-centered herbal strategies enhance nursing practice, fostering holistic wound care. Further research can guide nursing interventions, facilitate informed decision-making, and improve patient outcomes.

Exploring the medical decision-making patterns and influencing factors among the general Chinese public: a binary logistic regression analysis

OBJECTIVE

With the ongoing evolution of the healthcare system and shifts in cultural paradigms, there is a pressing need to delve into the medical decision-making behaviors of general Chinese public and understand their underlying motivations. This research seeks to elucidate the prevailing tendencies in these decision-making processes and to empirically validate the pivotal factors that shape their choices, offering valuable insights for healthcare policymakers and institutions.

METHOD

A comprehensive survey was administered to 2,696 Chinese residents to examine their medical decision-making patterns. These patterns were classified into two primary categories: Unilateral Decision-making (Doctor-dominant, Family-centric, and Patient-driven subtypes) and Collaborative Decision-making (Doctor-led, Doctor-Patient, Patient-Family, and Doctor-Patient-Family subtypes). Binary logistic regression analysis was employed to empirically pinpoint the significant factors influencing these decision-making frameworks.

RESULTS

The study's analysis reveals distinct preferences in medical decision-making among Chinese residents. In the Collaborative Decision-making category, chosen by 70.81% of participants, the subtypes are as follows: Doctor-led (29.90%), Doctor-Patient (13.54%), Patient-Family (2.93%), and Doctor-Patient-Family (24.44%). The Unilateral Decision-making, preferred by 29.19%, includes Doctor-dominant (23.22%), Family-centric (1.74%), and Patient-driven (4.23%) models. The preference for Collaborative Decision-making is associated with higher educational levels, specific marital statuses (particularly married but childless), and choices of rural residents' basic medical insurance or occupational basic medical insurance. In contrast, Unilateral Decision-making correlates with males, individuals with religious beliefs, certain occupational roles (like civil servants), and holders of commercial or publicly funded medical insurance.

CONCLUSION

This study elucidates the complex interplay of socio-cultural and individual determinants shaping medical decision-making in China. The findings reveal a marked inclination towards collaborative models, closely linked to educational level, marital status, and specific insurance types, reflecting an evolving trend towards participatory healthcare. Simultaneously, the persistence of unilateral models, influenced by gender, religious beliefs, and occupational roles, highlights the heterogeneity within Chinese healthcare preferences. These insights are crucial for policymakers and healthcare practitioners, underscoring the need for adaptable, culturally attuned healthcare frameworks that cater to this diversity, thereby enhancing patient engagement and healthcare efficacy.

How Can Organizations Support a Culture of Care?

Providing care is central to the operations of health care organizations. This article discusses how organizations can create a culture of care. It also identifies key elements that health care organizations can implement to build a culture that nurtures both patients and employees. Additionally, the article examines the benefits of implementing practices that demonstrate compassion toward both employees and patients. This article explores the significance of creating and supporting a culture of care for both patients and employees in health care organizations. Finally, the article identifies prevalent practices that contribute to a culture of care.

Tailoring Sexual Health Research Practices to Meet the Needs of Adolescent Girls in Low- and Middle-Income Countries: Findings from Mexico

Sexual and reproductive health (SRH) research is essential for the development of population-tailored evidence-based policies and programs that support sexual health among adolescent girls. However, ethical challenges create barriers to girls' participation in low- and middle-income countries (LMICs). From February to September 2019, girls aged 16-20 (n = 30) who participated in the Jovenes Sanos study in Tijuana, Baja California (ClinicalTrials: NCT03660514) responded to in-depth interviews (IDs) on the perceived risks and benefits of participating in studies which address gender-based violence, unintended pregnancy, and STIs. Emergent themes indicated the need to ensure that consent and incentive procedures are tailored to the developmental level of participants, while highlighting the importance of researcher-participant relationships, and demonstrating how research can serve as an opportunity to empower girls to express their sexual health medical needs. Understanding adolescent girls' voices is a critical step in ensuring that consent to participate SRH research is tailored to the developmental needs of participants, is culturally competent, and has a participant-centered approach.

Perceptions of healthcare professionals regarding labour induction and augmentation: A qualitative systematic review

BACKGROUND

Labour induction and augmentation procedures are commonly used in maternity units with or without medical indications. Research shows that healthcare professionals play a significant role in women's childbirth decisions.

AIM

To consolidate healthcare professionals' perceptions about labour induction and augmentation.

METHODS

Seven electronic databases were searched from their inception dates till January 2023: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest Dissertations, and Theses Global. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Sandelowski and Barroso's guidelines guided this review. Included studies' quality was appraised by the Critical Appraisal Skills Program tool. Data were thematically synthesised. Review findings were assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach.

FINDINGS

Three main themes were identified from the 17 included studies: 1) Making sense of the phenomenon, 2) Two sides of the coin, and 3) The enlightened path ahead.

DISCUSSION

Healthcare professionals' labour induction and augmentation decisions were affected by personal (knowledge and moral philosophies), and external factors (women, community members, colleagues, and healthcare institutions). Some clinicians were unfamiliar with the proper labour induction/augmentation procedures, while others were worried about their decisions and outcomes.

CONCLUSION

Suggestions for improvement include conducting labour induction/augmentation training for clinicians, having sufficient resources in facilities, and developing appropriate labour induction/augmentation clinical guidelines. Women and their partners, community members, and traditional healers could benefit from receiving labour induction/augmentation education. To improve health outcomes, healthcare professionals could deliver woman-centred care and collaborate.

Mistreatment in health care among women in Appalachia

Good quality patient care requires health care providers to respect the humanity and autonomy of their patients. However, this is not achieved in all settings. This study used cross-sectional survey data including open-ended text responses to explore negative experiences with health care providers among women in Appalachia. We used the Heath Stigma & Discrimination Framework (HSDF) to identify how stigma is created and perpetuated through interactions with health care providers. Survey data from 628 women collected through purposive sampling identified that two out of three participants had had a bad encounter with a provider that made them not want to return for care. One in six participants had a negative experience specifically while seeking contraception. Using the domains of the HSDF framework, qualitative answers to open-ended questions illuminated how health care providers, influenced by social and cultural norms related to religiosity, patriarchal views, poverty, poor health infrastructure, and the opioid crisis, created and perpetuated stigma through dehumanising treatment, low-quality care, and health care misogyny. Because stigma is a driver of health inequity, these findings highlight the important and sometimes problematic role that health care providers can play when they create a barrier to future care through poor treatment of patients.

Mask Mirroring: A Novel Approach to Healthcare Empathy in the COVID-19 Era

The COVID-19 pandemic has brought forth substantial changes to societal norms and global health infrastructure, one of the most impactful being mask wearing. With varying attitudes toward mask usage in a post-pandemic environment, this paper introduces the concept of "mask mirroring" in healthcare settings. This strategy involves healthcare providers reciprocating the mask-wearing behavior of their patients, intending to respect patients' choices and alleviate their potential concerns and anxieties. It is hypothesized that mask mirroring could serve as a symbol of empathy and solidarity, enhancing the doctor-patient rapport and facilitating effective healthcare delivery. In addition, it could reduce the transmission of respiratory infections, fostering a safer healthcare environment. Importantly, mask mirroring addresses the power dynamics between healthcare providers and patients, allowing patients' preferences and comfort to be prioritized. The implementation of this concept requires clear communication about its purpose and symbolism, striking a balance between reassurance and respect for differing viewpoints. The ultimate aim of mask mirroring is to promote patient-centric care, reflecting our commitment to understanding and empathizing with patients' concerns in a world recovering from COVID-19.

Indigenous Cultural Safety Trainings for Healthcare Professionals Working in Ontario, Canada: Context and Considerations for Healthcare Institutions

Background

Racism and discrimination are realities faced by Indigenous peoples navigating the healthcare system in Canada. Countless experiences of injustice, prejudice, and maltreatment calls for systemic action to redress professional practices of health care professionals and staff alike. Research points to Indigenous cultural safety training in healthcare systems to educate, train, and provide non-Indigenous trainees the necessary skills and knowledge to work with and alongside Indigenous peoples using cultural safe practices grounded in respect and empathy.

Objective

We aim to inform the development and delivery of Indigenous cultural safety training within and across healthcare settings in the Canadian context, through repository of Indigenous cultural safety training examples, toolkits, and evaluations.

Methods

An environmental scan of both gray (government and organization-issued) and academic literature is employed, following protocols developed by Shahid and Turin (2018).

Synthesis

Indigenous cultural safety training and toolkits are collected and described according to similar and distinct characteristics and highlighting promising Indigenous cultural safety training practices for adoption by healthcare institutions and personnel. Gaps of the analysis are described, providing direction for future research. Final recommendations based on overall findings including key areas for consideration in Indigenous cultural safety training development and delivery.

Conclusion

The findings uncover the potential of Indigenous cultural safety training to improve healthcare experiences of all Indigenous Peoples. With the information, healthcare institutions, professionals, researchers, and volunteers will be well equipped to support and promote their Indigenous cultural safety training development and delivery.

Theory Integration for Examining Health Care Discrimination among Minoritized Older Adults with Chronic Illness

Prevalence of chronic illnesses, including type 2 diabetes (T2DM), is increasing disproportionately among Latinx adults in the United States. Health care inequities such as health care discrimination contribute to the disparities in this population. Academic and clinical nurses must address health care discrimination from a strong theoretical framework. In this article, we integrate the minority stress theory and ecosocial theory of disease distribution to offer a whole-person model that identifies the concepts most relevant to Latinx older adults who function at multiple levels of intersectionality. This paper uses T2DM as an exemplar of chronic illness. The integrated model depicts possible pathways of physiological and psychological embodiment of lived experiences of minoritized older persons managing chronic illness who are living in a society deeply embedded with structural racism and oppression. This model may guide future research aimed at elucidating the social and structural determinants that impact health-related outcomes among Latinx older adults.

"Listen to me, learn from me": a priority setting partnership for shaping interdisciplinary pain training to strengthen chronic pain care

ABSTRACT

What are the care-seeking priorities of people living with chronic pain and carers and how can these shape interdisciplinary workforce training to improve high-value pain care? Phase 1: Australian people living with chronic pain (n = 206; 90% female) and carers (n = 10; 40% female) described their pain care priorities (eDelphi, round 1). A coding framework was inductively derived from 842 pain care priorities (9 categories, 52 priorities), including validation; communication; multidisciplinary approaches; holistic care; partnerships; practitioner knowledge; self-management; medicines; and diagnosis. Phase 2: In eDelphi round 2, panellists (n = 170; valid responses) rated the importance (1 = less important; 9 = more important) of the represented framework. In parallel, cross-discipline health professionals (n = 267; 75% female) rated the importance of these same priorities. Applying the RAND-UCLA method (panel medians: 1-3: "not important," 4-6: "equivocal," or 7-9: "important"), "important" items were retained where the panel median score was >7 with panel agreement ≥70%, with 44 items (84.6%) retained. Specific workforce training targets included the following: empathic validation; effective, respectful, safe communication; and ensuring genuine partnerships in coplanning personalised care. Panellists and health professionals agreed or strongly agreed (95.7% and 95.2%, respectively) that this framework meaningfully reflected the importance in care seeking for pain. More than 74% of health professionals were fairly or extremely confident in their ability to support care priorities for 6 of 9 categories (66.7%). Phase 3: An interdisciplinary panel (n = 5) mapped an existing foundation-level workforce training program against the framework, identifying gaps and training targets. Recommendations were determined for framework adoption to genuinely shape, from a partnership perspective, Australian interdisciplinary pain training.

Patient Perspective: Importance and How to Elicit

The authors present models for patient care, reflecting on its modernization. A review of technology including electronic health records is provided, noting its benefits and constraints on the patient-clinician relationship. Keeping in mind the fact that patients are the "end users" of health care systems, several approaches to improving patient experience are shared.