Search results for: maternity care
2889 Improving Patient Outcomes for Aspiration Pneumonia
Authors: Mary Farrell, Maria Soubra, Sandra Vega, Dorothy Kakraba, Joanne Fontanilla, Moira Kendra, Danielle Tonzola, Stephanie Chiu
Abstract:
Pneumonia is the most common infectious cause of hospitalizations in the United States, with more than one million admissions annually and costs of $10 billion every year, making it the 8th leading cause of death. Aspiration pneumonia is an aggressive type of pneumonia that results from inhalation of oropharyngeal secretions and/or gastric contents and is preventable. The authors hypothesized that an evidence-based aspiration pneumonia clinical care pathway could reduce 30-day hospital readmissions and mortality rates, while improving the overall care of patients. We conducted a retrospective chart review on 979 patients discharged with aspiration pneumonia from January 2021 to December 2022 at Overlook Medical Center. The authors identified patients who were coded with aspiration pneumonia and/or stable sepsis. Secondarily, we identified 30-day readmission rates for aspiration pneumonia from a SNF. The Aspiration Pneumonia Clinical Care Pathway starts in the emergency department (ED) with the initiation of antimicrobials within 4 hours of admission and early recognition of aspiration. Once this is identified, a swallow test is initiated by the bedside nurse, and if the patient demonstrates dysphagia, they are maintained on strict nothing by mouth (NPO) followed by a speech and language pathologist (SLP) referral for an appropriate modified diet recommendation. Aspiration prevention techniques included the avoidance of straws, 45-degree positioning, no talking during meals, taking small bites, placement of the aspiration wrist band, and consuming meals out of the bed in a chair. Nursing education was conducted with a newly created online learning module about aspiration pneumonia. The authors identified 979 patients, with an average age of 73.5 years old, who were diagnosed with aspiration pneumonia on the index hospitalization. These patients were reviewed for a 30-day readmission for aspiration pneumonia or stable sepsis, and mortality rates from January 2021 to December 2022 at Overlook Medical Center (OMC). The 30-day readmission rates were significantly lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011). When evaluating the mortality rates in the pre and post intervention cohort the authors discovered the mortality rates were lower in the post intervention cohort (23.7% vs 22.4%, p = 0.61) Mortality among non-white (self-reported as non-white) patients were lower in the post intervention cohort (34.4% vs. 21.0% , p = 0.05). Patients who reported as a current smoker/vaper in the pre and post cohorts had increased mortality rates (5.9% vs 22%). There was a decrease in mortality for the male population but an increase in mortality for women in the pre and post cohorts (19% vs. 25%). The authors attributed this increase in mortality in the post intervention cohort to more active smokers, more former smokers, and more being admitted from a SNF. This research identified that implementation of an Aspiration Pneumonia Clinical Care Pathway showed a statistically significant decrease in readmission rates and mortality rates in non-whites. The 30-day readmission rates were lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011).Keywords: aspiration pneumonia, mortality, quality improvement, 30-day pneumonia readmissions
Procedia PDF Downloads 572888 Understanding Help Seeking among Black Women with Clinically Significant Posttraumatic Stress Symptoms
Authors: Glenda Wrenn, Juliet Muzere, Meldra Hall, Allyson Belton, Kisha Holden, Chanita Hughes-Halbert, Martha Kent, Bekh Bradley
Abstract:
Understanding the help seeking decision making process and experiences of health disparity populations with posttraumatic stress disorder (PTSD) is central to development of trauma-informed, culturally centered, and patient focused services. Yet, little is known about the decision making process among adult Black women who are non-treatment seekers as they are, by definition, not engaged in services. Methods: Audiotaped interviews were conducted with 30 African American adult women with clinically significant PTSD symptoms who were engaged in primary care, but not in treatment for PTSD despite symptom burden. A qualitative interview guide was used to elucidate key themes. Independent coding of themes mapped to theory and identification of emergent themes were conducted using qualitative methods. An existing quantitative dataset was analyzed to contextualize responses and provide a descriptive summary of the sample. Results: Emergent themes revealed that active mental avoidance, the intermittent nature of distress, ambivalence, and self-identified resilience as undermining to help seeking decisions. Participants were stuck within the help-seeking phase of ‘recognition’ of illness and retained a sense of “it is my decision” despite endorsing significant social and environmental negative influencers. Participants distinguished ‘help acceptance’ from ‘help seeking’ with greater willingness to accept help and importance placed on being of help to others. Conclusions: Elucidation of the decision-making process from the perspective of non-treatment seekers has implications for outreach and treatment within models of integrated and specialty systems care. The salience of responses to trauma symptoms and stagnation in the help seeking recognition phase are findings relevant to integrated care service design and community engagement.Keywords: culture, help-seeking, integrated care, PTSD
Procedia PDF Downloads 2292887 Endoscopic Ultrasound-Guided Choledochoduodenostomy in an Advanced Extrahepatic Cholangiocarcinoma
Authors: Diego Carrasco, Catarina Freitas, Hugo Rio Tinto, Ricardo Rio Tinto, Nuno Couto, Joaquim Gago, Carlos Carvalho
Abstract:
Introduction: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) to drain the gallbladder can be a palliative care procedure for non-surgical oncologic patients with cholelithiasis and cholangitis process. Case description: A 59-years old Caucasian male diagnosed with extrahepatic cholangiocarcinoma with multiple liver, lung and peritoneum metastasis, unresponsive to treatment with gemcitabine/cisplatin, presented in the institution with fever, hypotension, and severe upper right abdominal pain secondary to cholelithiasis and cholangitis process. The patient was admitted and started on large spectrum antibiotics plus fluid-challenge. Afterward, a percutaneous transhepatic biliary drainage (PTBD) was performed to drain the gallbladder. This procedure temporarily stabilized the patient. However, the definitive solution required gallbladder removal. Since the patient exhibited an advanced oncologic disease and poor response to the chemotherapy, he was not a candidate for surgical intervention. Diagnostic Pathways: A self-expanding metal stent was placed from the duodenum into the bile duct by endoscopic ultrasound-guided. The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure. Conclusion and Discussion: The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure and successfully reversed the cholangitis process. EUS-CD is an effective and safe technique and can be used as a palliative care procedure for non-surgical oncologic patients.Keywords: palliative care, cholangiocarcinoma, choledochoduodenostomy, endoscopic ultrasound-guided
Procedia PDF Downloads 1802886 Dueling Burnout: The Dual Role Nurse
Authors: Melissa Dorsey
Abstract:
Moral distress and compassion fatigue plague nurses in the Cardiothoracic Intensive Care Unit (CTICU) and cause an unnecessary level of turnover. Dueling Burnout describes an initiative that was implemented in the CTICU to reduce the level of burnout the nurses endure by encouraging dual roles with collaborating departments. Purpose: Critical care nurses are plagued by burnout, moral distress, and compassion fatigue due to the intensity of care provided. The purpose of the dual role program was to decrease these issues by providing relief from the intensity of the critical care environment while maintaining full-time employment. Relevance/Significance: Burnout, moral distress, and compassion fatigue are leading causes of Cardiothoracic Critical Care (CTCU) turnover. A contributing factor to burnout is the workload related to serving as a preceptor for a constant influx of new nurses (RN). As a result of these factors, the CTICU averages 17% nursing turnover/year. The cost, unit disruption, and, most importantly, distress of the clinical nurses required an innovative approach to create an improved work environment and experience. Strategies/Implementation/Methods: In May 2018, a dual role pilot was initiated for nurses. The dual role constitutes .6 full-time equivalent hours (FTE) worked in CTICU in combination with .3 FTE worked in the Emergency Department (ED). ED nurses who expressed an interest in cross-training to CTICU were also offered the dual role opportunity. The initial hypothesis was that full-time employees would benefit from a change in clinical setting leading to increased engagement and job satisfaction. The dual role also presents an opportunity for professional development through the expansion of clinical skills in another specialty. Success of the pilot led to extending the dual role to areas beyond the ED. Evaluation/Outcomes/Results: The number of dual role clinical nurses has grown to 22. From the dual role cohort, only one has transferred out of CTICU. This is a 5% turnover rate for this group of nurses as compared to the average turnover rate of 17%. A role satisfaction survey conducted with the dual role cohort found that because of working in a dual role, 76.5% decreased their intent to leave, 100% decreased their level of burnout, and 100% reported an increase in overall job satisfaction. Nurses reported the ability to develop skills that are transferable between departments. Respondents emphasized the appreciation gained from working in multiple environments; the dual role served to transform their care. Conclusions/Implications: Dual role is an effective strategy to retain experienced nurses, decrease burnout and turnover, improve collaboration, and provide flexibility to meet staffing needs. The dual role offers RNs an expansion of skills, relief from high acuity and orientee demands, while improving job satisfaction.Keywords: nursing retention, burnout, pandemic, strategic staffing, leadership
Procedia PDF Downloads 1732885 Determining the Factors Affecting Social Media Addiction (Virtual Tolerance, Virtual Communication), Phubbing, and Perception of Addiction in Nurses
Authors: Fatima Zehra Allahverdi, Nukhet Bayer
Abstract:
Objective: Three questions were formulated to examine stressful working units (intensive care units, emergency unit nurses) utilizing the self-perception theory and social support theory. This study provides a distinctive input by inspecting the combination of variables regarding stressful working environments. Method: The descriptive research was conducted with the participation of 400 nurses working at Ankara City Hospital. The study used Multivariate Analysis of Variance (MANOVA), regression analysis, and a mediation model. Hypothesis one used MANOVA followed by a Scheffe post hoc test. Hypothesis two utilized regression analysis using a hierarchical linear regression model. Hypothesis three used a mediation model. Result: The study utilized mediation analyses. Findings supported the hypotheses that intensive care units have significantly high scores in virtual communication and virtual tolerance. The number of years on the job, virtual communication, virtual tolerance, and phubbing significantly predicted 51% of the variance of perception of addiction. Interestingly, the number of years on the job, while significant, was negatively related to perception of addiction. Conclusion: The reasoning behind these findings and the lack of significance in the emergency unit is discussed. Around 7% of the variance of phubbing was accounted for through working in intensive care units. The model accounted for 26.80 % of the differences in the perception of addiction.Keywords: phubbing, social media, working units, years on the job, stress
Procedia PDF Downloads 472884 Association of Fetal Abdominal Circumference and Birthweight in Maternal Hyperglycemia
Authors: Silpa Mariyam John, S. Baburaj, Prajit Geevarghese
Abstract:
Diabetes accelerates pregnancy and can cause adverse effects on the fetus. Studies have shown that fetal abdominal circumference measured in ultrasound is an early parameter for the assessment of macrosomia. The objective of the study is to compare the fetal abdominal circumferences between diabetes and non-diabetic mothers. It was a comparative cross-sectional study conducted in a tertiary care hospital in Trivandrum, Kerala, with a sample size calculated as 95 for each group. All mothers taking antenatal care and delivering at the hospital were included after obtaining consent. The mothers and their newborns were divided into 2 groups (diabetic and non-diabetic). Relevant fetal biometry values were collected from medical records, and birth weight was measured by a calibrated electronic weighing machine after birth. The data were entered in MS EXCEL and analyzed. It was found that there is a significant relationship between the fetal abdominal circumference and birthweight in diabetic mothers during the first and third trimesters.Keywords: newborn, diabetes, abdominal circumference, ultrasound
Procedia PDF Downloads 482883 Informal Carers in Telemonitoring of Users with Pacemakers: Characteristics, Time of Services Provided and Costs
Authors: Antonio Lopez-Villegas, Rafael Bautista-Mesa, Emilio Robles-Musso, Daniel Catalan-Matamoros, Cesar Leal-Costa
Abstract:
Objectives: The purpose of this trial was to evaluate the burden borne by and the costs to informal caregivers of users with telemonitoring of pacemakers. Methods: This is a controlled, non-randomised clinical trial, with data collected from informal caregivers, five years after implantation of pacemakers. The Spanish version of the Survey on Disabilities, Personal Autonomy, and Dependency Situations was used to get information on clinical and social characteristics, levels of professionalism, duration and types of care, difficulties in providing care, health status, economic and job aspects, impact on the family or leisure due to informal caregiving for patients with pacemakers. Results: After five years of follow-up, 55 users with pacemakers finished the study. Of which, 50 were helped by a caregiver, 18 were included in the telemonitoring group (TM) and 32 in the conventional follow-up group (HM). Overall, females represented 96.0% of the informal caregivers (88.89% in TM and 100.0% in HM group). The mean ages were 63.17 ± 15.92 and 63.13 ± 14.56 years, respectively (p = 0.83) in the groups. The majority (88.0%) of the caregivers declared that they had to provide their services between 6 and 7 days per week (83.33% in TM group versus 90.63% in HM group), without significant differences between both groups. The costs related to care provided by the informal caregivers were 47.04% higher in the conventional follow-up group than in the TM group. Conclusions: The results of this trial confirm that there were no significant differences between the informal caregivers regarding to baseline characteristics, workload and time worked in both groups of follow-up. The costs incurred by the informal caregivers providing care for users with pacemakers included in telemonitoring group are significantly lower than those in the conventional follow-up group. Trial registration: ClinicalTrials.gov NCT02234245. Funding: The PONIENTE study, has been funded by the General Secretariat for Research, Development and Innovation, Regional Government of Andalusia (Spain), project reference number PI/0256/2017, under the research call 'Development and Innovation Projects in the Field of Biomedicine and Health Sciences', 2017.Keywords: costs, disease burden, informal caregiving, pacemaker follow-up, remote monitoring, telemedicine
Procedia PDF Downloads 1342882 Epidemiological and Clinical Study of Childhood Hansens in a Tertiary Care Hospital
Authors: M. Shahana
Abstract:
Introduction: Leprosy (Hansens) is one of the major health problems in the developing countries. Sixty percent of the world leprosy cases are in India. According to the 2006 census India has about 54% of the total new cases detected globally. The National Leprosy Elimination Programme in 2012 has reported 9.7% of childhood leprosy. There are only few studies related to paediatric leprosy. Aim: To study the epidemiology and various clinical presentations of leprosy in the paediatric age group. Material and Methods: A 4-year prospective study was done in the out-patient department of dermatology in a tertiary care hospital. All the patients were screened for leprosy and children with a confirmed diagnosis of leprosy were taken up for the study. Results: Total of 321 cases of Hansens were recorded during this period out of which 41 were children. The male to female ratio was 2.72:1. A positive family history was found in 18%. Most of them presented with single hypopigmented hypoanesthetic patch. Conclusions: Children presented with more of Borderline tuberculoid type and reactions or deformities were less common.Keywords: Hansens, hypoaneasthetic patch, leprosy, reactions
Procedia PDF Downloads 1822881 Baseline Data from Specialist Obesity Clinic in a Large Tertiary Care Facility, Karachi, Pakistan
Authors: Asma Ahmed, Farah Khalid, Sahlah Sohail, Saira Banusokwalla, Sabiha Banu, Inaara Akbar, Safia Awan, Syed Iqbal Azam
Abstract:
Background and Objectives: The level of knowledge regarding obesity as a disease condition and health-seeking behavior regarding its management is grossly lacking. We present data from our multidisciplinary obesity clinic at the large tertiary care facility in Karachi, Pakistan, to provide baseline profiles and outcomes of patients attending these clinics. Methods: 260 who attended the obesity clinic between June 2018 to March 2020 were enrolled in this study. The analysis included descriptive and ROC analysis to identify the best cut-offs of theanthropometric measurements to diagnose obesity-related comorbid conditions. Results: The majority of the studied population were women (72.3%) and employed(43.7%) with a mean age of 35.5 years. Mean BMIwas 37.4, waist circumference was 112.4 cm, visceral fat was 11.7%, and HbA1C was 6.9%. The most common comorbidities were HTN & D.M (33 &31%, respectively). The prevalence of MetS was 16.3% in patients and was slightly higher in males. Visceral fat was the main factor in predicting D.M (0.750; 95% CI: 0.665, 0.836) and MetS (0.709; 95% CI: 0.590, 0.838) compared to total body fat, waist circumference, and BMI. The risk of predicting DM &MetS for the visceral fat above 9.5% in women had the highest sensitivity (80% for D.M & 79% for MetS) and an NPV (92.75% for D.M & 95% for MetS). Conclusions: This study describes and establishes characteristics of these obese individuals, which can help inform clinical practices. These practices may involve using visceral fat for earlier identification and counseling-based interventions to prevent more severe surgical interventions down the line.Keywords: obesity, metabolic syndrome, tertiary care facility, BMI, waist circumference, visceral fat
Procedia PDF Downloads 1542880 The Turkish Version of the Carer’s Assessment of Satisfaction Index (CASI-TR): Its Cultural Adaptation, Validation, and Reliability
Authors: Cemile Kütmeç Yilmaz, Güler Duru Asiret, Gulcan Bagcivan
Abstract:
The aim of this study was to evaluate the reliability and validity of the Turkish version of the Carer’s Assessment of Satisfaction Index (CASI-TR). The study was conducted between the dates of June 2016 and September 2017 at the Training and Research Hospital of Aksaray University with the caregiving family members of the inpatients with chronic diseases. For this study, the sample size was calculated as at least 10 individuals for each item (item number (30)X10=300). The study sample included 300 caregiving family members, who provided primer care for at least three months for a patient (who had at least one chronic disease and received inpatient treatment in general internal medicine and palliative care units). Data were collected by using a demographic questionnaire and CASI-TR. Descriptive statistics, and psychometric tests were used for the data analysis. Of those caregivers, 76.7% were female, 86.3% were 65 years old and below, 43.7% were primary school graduates, 87% were married, 86% were not working, 66.3% were housewives, and 60.3% defined their income status as having an income covering one’s expenses. Care recipients often had problems in terms of walking, sleep, balance, feeding and urinary incontinence. The Cronbach Alpha value calculated for the CASI-TR (30 items) was 0,949. Internal consistency coefficients calculated for subscales were: 0.922 for the subscale of ‘caregiver satisfaction related to care recipient’, 0.875 for the subscale of ‘caregiver satisfaction related to themselves’, and 0.723 for the subscale of ‘dynamics of interpersonal relations’. Factor analysis revealed that three factors accounted for 57.67% of the total variance, with an eigenvalue of >1. assessed in terms of significance, we saw that the items came together in a significant manner. The factor load of the items were between 0.311 and 0.874. These results show that the CASI-TR is a valid and reliable scale. The adoption of the translated CASI in Turkey is found reliable and valid to assessing the satisfaction of caregivers. CASI-TR can be used easily in clinics or house visits by nurses and other health professionals for assessing caregiver satisfaction from caregiving.Keywords: carer’s assessment of satisfaction index, caregiver, validity, reliability
Procedia PDF Downloads 2022879 Dependence of Premature Births from Periodontal Status of Pregnant Women
Authors: Sonila Robo, Ilma Robo, Eduart Kapaj, Saimir Heta
Abstract:
Background: Early birth is 37 weeks or less, pregnancy maturity! Clinically active presence, or positive culture of vaginal secretions, means excessive production of cytokines and prostaglandins also encountered in amniotic fluid. Bacterial vaginosis appears with their clinical outbreak in a combination of bacteria. Some of these bacteria are basic members in the creation of bacterial plaque. Objective: The purpose of this study is to find the link between the presence of specific bacteria in the mouth, bacterial vaginosis as one of the causes of premature birth, and the latter. Methods: The study was applied to 30 pregnant women in the burden pathology ward at Fier maternity, divided into two groups. The first group consisting of 20 women in the 2-month period, August-September. The number of women in the ward was 10 days maximum! All women were treated with cortisone and serum IV, magnesium sulphate, antibiotic prophylaxis! Results: 55% of women were under the age of 25 and 45% of women were over the age of 25. The age effect is mentioned for classifying the diseases that causes Actinomyces. Under the age of 25, a teenager and a 25-year-old are chronically ill. The final index was G2! All females were positive for the presence of salicylic acid in saliva and vaginal secretions. Conclusions:Premature birth is a complex process with some gynecological reasons, but in high percentage of cases there is coverage with the presence of infection by Actinomyces Actinomycetemcomitans in the oral cavity, which depending on the age causes two different types of periodontitis with special characteristics.Keywords: early birth, periodontal status, bacterial vaginosis, actinomyces actinomycetemcomitans
Procedia PDF Downloads 822878 Addressing Ophthalmic and Vascular Diabetic Complications in South Asians
Authors: Haaris Khan, Farhad Udwadia
Abstract:
South Asians are the fastest-growing immigrant population in Canada and are 3-4 times more likely to develop diabetes. In a primary care setting, language barriers continue to persist as a prominent obstacle when delivering crucial health information. Given the abundance of languages in the South Asian community and the varying levels of English fluency, there is compelling evidence that these language barriers can adversely impact health outcomes. The microvascular and macrovascular complications of poor diabetic management are well established and universally recognized. However, these are often difficult concepts to grasp for even individuals fluent in English. In order to lessen the burden of language barriers, we developed a comprehensive guide in various languages that discuss the complications and screening guidelines for diabetic and prediabetic patients. The guide is presented in the form of a pamphlet, with an electronic version being constructed as well, that provides basic information on diabetic retinopathy, neuropathy and nephropathy as well as the screening recommendations. We also conducted a review of the literature around the topic and incorporated our findings into our project. Our goal is for primary care physicians to have this resource and to be able to provide the link or pamphlet to patients in need. Our presentation also provides a comprehensive overview of some of the other barriers that individuals in the South Asian community face when seeking care. Given the staggering number of individuals in the South Asian community with diabetes and the morbidity and mortality associated with diabetes and its complications, effective community-specific strategies are needed to mitigate the potential consequences of poor diabetes management.Keywords: diabetes, patient education, ophthalmology, vascular surgery
Procedia PDF Downloads 2042877 Role of ASHA in Utilizing Maternal Health Care Services India, Evidences from National Rural Health Mission (NRHM)
Authors: Dolly Kumari, H. Lhungdim
Abstract:
Maternal health is one of the crucial health indicators for any country. 5th goal of Millennium Development Goals is also emphasising on improvement of maternal health. Soon after Independence government of India realizing the importance of maternal and child health care services, and took steps to strengthen in 1st and 2nd five year plans. In past decade the other health indicator which is life expectancy at birth has been observed remarkable improvement. But still maternal mortality is high in India and in some states it is observe much higher than national average. Government of India pour lots of fund and initiate National Rural Health Mission (NRHM) in 2005 to improve maternal health in country by providing affordable and accessible health care services. Accredited Social Heath Activist (ASHA) is one of the key components of the NRHM. Mainly ASHAs are selected female aged 25-45 years from village itself and accountable for the monitoring of maternal health care for the same village. ASHA are trained to works as an interface between the community and public health system. This study tries to assess the role of ASHA in utilizing maternal health care services and to see the level of awareness about benefits given under JSY scheme and utilization of those benefits by eligible women. For the study concurrent evaluation data from National Rural health Mission (NRHM), initiated by government of India in 2005 has been used. This study is based on 78205 currently married women from 70 different districts of India. Descriptive statistics, chi2 test and binary logistic regression have been used for analysis. The probability of institutional delivery increases by 2.03 times (p<0.001) while if ASHA arranged or helped in arranging transport facility the probability of institutional delivery is increased by 1.67 times (p<0.01) than if she is not arranging transport facility. Further if ASHA facilitated to get JSY card to the pregnant women probability of going for full ANC is increases by 1.36 times (p<0.05) than reference. However if ASHA discuses about institutional delivery and approaches to get register than probability of getting TT injection is 1.88 and 1.64 times (p<0.01) higher than that if she did not discus. Further, Probability of benefits from JSY schemes is 1.25 times (p<0.001) higher among women who get married after 18 years. The probability of benefits from JSY schemes is 1.25 times (p<0.001) higher among women who get married after 18 year of age than before 18 years, it is also 1.28 times (p<0.001) and 1.32 times (p<0.001) higher among women have 1 to 8 year of schooling and with 9 and above years of schooling respectively than the women who never attended school. Those women who are working have 1.13 times (p<0.001) higher probability of getting benefits from JSY scheme than not working women. Surprisingly women belongs to wealthiest quintile are .53times (P<0.001) less aware about JSY scheme. Results conclude that work done by ASHA has great influence on maternal health care utilization in India. But results also show that still substantial numbers of needed population are far from utilization of these services. Place of delivery is significantly influenced by referral and transport facility arranged by ASHA.Keywords: institutional delivery, JSY beneficiaries, referral faculty, public health
Procedia PDF Downloads 3202876 Diabetes Care in Detention Settings: A Systematic Review
Authors: A. Papachristou, A. Ntikoudi, L. Makris, V. Saridakis
Abstract:
Introduction: More than 10 million people are imprisoned or detained worldwide. Figures from 2011-12 show that prison inmates are more likely than the general population to suffer from chronic or infectious diseases, while most inmates are overweight or obese, and more than a quarter have high blood pressure. In 2011/12, the proportion of prisoners reporting diabetes or hyperglycemia was 899 per 10,000 prisoners, almost double the 2004 figure (483 per 10,000). It is important to ensure that this population has access to the same standard of care as people outside prisons, as access to services should be need-based. Diabetes is a public health problem associated with increased morbidity and mortality worldwide. According to the International Diabetes Federation (IDF) in 2017, approximately 425 million people worldwide had diabetes. This number is expected to increase to 629 million by 2045. Poor management of diabetes in prisons can lead to poor blood sugar control and increase the risk of complications. Aim: The aim of this review was to systematically evaluate all the available literature on diabetes care in custodial settings. Methods: An extensive literature search was conducted through electronic databases (PubMed, Scopus and CINAHL) with the terms ‘custody’, ‘diabetes Mellitus, ‘detention centers and ‘chronic disease’. Articles published in English until September 2022, were included; no other criteria on publication dates were set. Results: Most of the studies mentioned a diabetes prevalence of approximately 10%, among other common chronic. Hypertension, obesity, smoking, sedentary lifestyle were the most common comorbidities associated with diabetes. Conclusion: Good glycemic control is fundamental to managing diabetes, and while many prisoners enter prison poorly, access to regular medication and meals, as well as exercise, offers the potential for improvement. Not being able to get help as quickly as in the past can be extremely stressful, and some prisoners may deliberately raise their blood sugar levels to avoid the risk of developing hypoglycemia, especially if they know they have had previous episodes of nocturnal hypoglycemia. Thus, appropriate training and resources are critical to providing quality care to incarcerated people with diabetes.Keywords: custody, diabetes mellitus, detention centers, chronic disease
Procedia PDF Downloads 922875 European Union Health Policy and the Response to COVID-19 Pandemic: Building a European Health Union
Authors: Aikaterini Tsalampouni
Abstract:
The European Union has long been the most developed model of economic and political integration that has brought a common market, a common currency and a standardization of national policies in certain areas in consistent with EU values and principles. To this direction, there is a parallel process of social integration that effect public policy decisions of member states. Even though social policy, i.e. social protection and moreover healthcare policy, still remains in state's responsibility to develop, EU applies different mechanisms in order to influence health policy systems, since from a more federalist point of view, EU ought to expand its regulatory and legislative roles in as many policy areas as possible. Recently, the pandemic has become a turning point for health care provision and at the same time has also highlighted the need to strengthen the EU’s role in coordinating health care. This paper analyses the EU health policy in general, as well as the response to COVID-19 pandemic with an attempt to identify indications of interaction between EU policies and the promotion of sustainable and resilient health systems. More analytically, the paper investigates the EU binding legal instruments, non-binding legal instruments, monitoring and assessment instruments and instruments for co-financing concerning health care provision in member states and records the evolution of health policies before and during the COVID-19 pandemic. The paper concludes by articulating some remarks regarding the improvement of health policy in EU. Since the ability to deal with a pandemic depends on continuous and increased investment in health systems, the involvement of the EU can lead to a policy convergence, necessary for the resilience of the systems, maintaining at the same time, a strong health policy framework in Europe.Keywords: EU health policy, EU response to COVID-19, European Health Union, health systems in Europe
Procedia PDF Downloads 1072874 Children in Conflict: Institutionalization as a Rehabilitative Mechanism in Jammu and Kashmir
Authors: Moksha Singh
Abstract:
The proponents of deinstitutionalization, including Goffman and others, in their works, have regarded institutions (orphanages to be specific) as regulated social arrangements that negatively impinge upon a resident’s development. They, therefore, propose alternative forms of care. However, even after five decades of this critique institutionalization remains the only hope for children with social, physical and mental disabilities in larger parts of the developing world such as the conflict affected state of Jammu and Kashmir in India. This paper is based on the experiences of children who lost their parents to insurgency and counter-insurgency operations and the rehabilitation process. This study is qualitative in nature and adopts descriptive-cum-exploratory research design. Using theoretical sampling, six orphanages and thirty one child residents who lost their parent(s) in the course of the armed conflict in the state of Jammu and Kashmir in India were studied in the year 2009-2010. It included interviews, observation, life histories and introspective accounts of the orphans and the management. The results were drawn through the qualitative examination, understanding, and interpretation of the primary and secondary data. The findings suggested that rehabilitation of these conflict-affected children is taking place mainly through residential child care facilities run by non-governmental bodies. Alternative forms of rehabilitation are not functional in the state because of various geopolitical and socio-cultural complexities. Even after five years of arriving at these conclusions and more, the state of Jammu and Kashmir still lacks a comprehensive rehabilitation plan for these children. This has further encouraged a mushroomed growth of legal and illegal institutions. Some of these institutions compromise the standard norms of functioning and yet remain the only hope for thousands rendered orphan. These institutions, therefore, are there to stay as other alternative forms of care are not available in the state. A comprehensive intervention policy is needed based on the cultural specifics of the state and incorporation of views of institutions offering aid, the state and the children. The paper introduces Small Group Residential Care Model through which it is expected that the restoration process can be made smooth and effective.Keywords: armed conflict, children's rights, institutionalization, orphanages, rehabilitation
Procedia PDF Downloads 2402873 National Health Insurance: An Exploratory Study of Patient Satisfaction
Authors: Nihayatul Munaa, Nyoman A. Damayanti
Abstract:
This study seeks to understand what factors might influence a patient’s perception of health care under national health insurance in early implementation. In Indonesia, National Health Insurance was first implemented in 2014 and planned to achieve universal health coverage by 2019. However, the little understanding of this new policy lead to increase of complaint in hospital as a health care provider. This is a observational descriptive study with cross sectional design method. Data was collected through in-depth interview with 96 patient from Jemursari Islamic Hospital of Surabaya (Rumah Sakit Islam Jemursari Surabaya) who participate in National Health Insurance. Subject was selected by simple random sampling. The findings demonstrated that from five categories, 82,3% patient was satisfied in reliability aspect and 85,4% in assurance aspect, while in tangible, responsiveness and empathy aspect > 90% patient was satisfied. Meanwhile, in Indonesia, the minimum service standard of healthcare of patient satisfaction is 90%.Keywords: patient’s satisfaction, national health insurance, hospital, complaint
Procedia PDF Downloads 1872872 Innovation in the Provision of Medical Services in the Field of Qualified Sports and Services Related to the Therapy of Metabolism Disorders and the Treatment of Obesity
Authors: Jerzy Slowik, Elzbieta Grochowska-Niedworok
Abstract:
The analysis of the market needs and trends in both treatment and prophylaxis shows the growing need to implement comprehensive solutions that would enable safe contact of the beneficiaries with the therapeutic and diagnostic support group. Based on the evaluation of the medical and sports industry services market, projects co-financed by the EFRR in the form of comprehensive care systems using IT tools for patients under treatment in the field of obesity and metabolism using the system were implemented under the Regional Operational Program of the Silesian Voivodeship for 2014-2020. SFAO 1.0 (Support for the Fight Against Obesity) number of the WND-RPSL project. 01.02.00-24-06EA / 16) as well as for competitors in qualified sports SK system (qualified sports) project number WND-RPSL. 01.02.00-24-0630 / 17-002. The service provided in accordance with SFAO 1.0 has shown a wide range of therapy possibilities - from monitoring the body's reactions during sports activities of healthy people to remote care for sick patients. As a result of the introduction of an innovative service, it was possible to increase the effectiveness of the therapy, which was manifested in the reduction of the starting doses of drugs by 10%, improvement of the efficiency of the respiratory and blood circulation system, and a 10% increase in bone density. Innovation in the provision of medical services in the field of qualified sports SK was a response to the needs of the athletes and their parents, coaches, physiotherapists, dieticians, and doctors who take care of people actively practicing qualified sports. The creation of the platform made it possible to constantly monitor the trainers necessary for both the proper training process and the control over the health of patients. Monitoring the patient's health by a specialized team in the field of various specialties allows for the proper targeting of the treatment and training process due to the increase in the availability of medical counseling. Specialists taking care of the patient can provide additional advice and modify the medical treatment of the patient on an ongoing basis, which is why we are dealing with a holistic approach.Keywords: innovation of medical services, sport, obesity, innovation
Procedia PDF Downloads 1232871 The Spatial Equity Assessment of Community-Based Elderly Care Facilities in Old Neighborhood of Chongqing
Authors: Jiayue Zhao, Hongjuan Wu, Guiwen Liu
Abstract:
Old neighborhoods with a large elderly population depend on community-based elderly care facilities (community-based ECFs) for aging-in-place. Yet, due to scarce and scattered land, the facilities face inequitable distribution. This research uses spatial equity theory to measure the spatial equity of community-based ECFs in old neighborhoods. Field surveys gather granular data and methods, including coverage rate, Gini coefficient, Lorenz curve, and G2SFCA. The findings showed that coverage is substantial but does not indicate supply is a match to demand, nor does it imply superior accessibility. The key contributions are that structuring spatial equity framework considering elderly residents’ travel behavior. This study is dedicated to the international literature on spatial equity from the perspective of travel behavior and could provide valuable suggestions for the urban planning of old neighborhoods.Keywords: community-based ECFs, elderly residents’ travel behavior, old neighborhoods, spatial equity
Procedia PDF Downloads 392870 An Empirical Examination of Ethnic Differences in the Use and Experience of Child Healthcare Services in New Zealand
Authors: Terryann Clark, Kabir Dasgupta, Sonia Lewycka, Gail Pacheco, Alexander Plum
Abstract:
This paper focused on two main research aims using data from the Growing Up in New Zealand (GUINZ) birth cohort: 1. To examine ethnic differences in life-course trajectories in the use and experience of healthcare services in early childhood years (namely immunisation, dental checks and use of General Practitioners (GPs)) 2. To quantify the contribution of relevant explanatory factors to ethnic differences. Current policy in New Zealand indicates there should be, in terms of associated direct costs, equitable access by ethnicity for healthcare services. However, empirical evidence points to persistent ethnic gaps in several domains. For example, the data highlighted that Māori have the lowest immunisation rates, across a number of time points in early childhood – despite having a higher antenatal intention to immunise relative to NZ European. Further to that, NZ European are much more likely to have their first-choice lead maternity caregiver (LMC) and use child dental services compared to all ethnicities. Method: This research explored the underlying mechanisms behind ethnic differences in the use and experience of child healthcare services. First, a multivariate regression analysis was used to adjust raw ethnic gaps in child health care utilisation by relevant covariates. This included a range of factors, encompassing mobility, socio-economic status, mother and child characteristics, household characteristics and other social aspects. Second, a decomposition analysis was used to assess the proportion of each ethnic gap that can be explained, as well as the main drivers behind the explained component. The analysis for both econometric approaches was repeated for each data time point available, which included antenatal, 9 months, 2 years and 4 years post-birth. Results: The following findings emerged: There is consistent evidence that Asian and Pacific peoples have a higher likelihood of child immunisation relative to NZ Europeans and Māori. This was evident at all time points except one. Pacific peoples had a lower rate relative to NZ European for receiving all first-year immunisations on time. For a number of potential individual and household predictors of healthcare service utilisation, the association is time-variant across early childhood. For example, socio-economic status appears highly relevant for timely immunisations in a child’s first year, but is then insignificant for the 15 month immunisations and those at age 4. Social factors play a key role. This included discouragement or encouragement regarding child immunisation. When broken down by source, discouragement by family has the largest marginal effect, followed by health professionals; whereas for encouragement, medical professionals have the largest positive influence. Perceived ethnically motivated discrimination by a health professional was significant with respect to both reducing the likelihood of achieving first choice LMC, and also satisfaction levels with child’s GP. Some ethnic gaps were largely unexplained, despite the wealth of factors employed as independent variables in our analysis. This included understanding why Pacific mothers are much less likely to achieve their first choice LMC compared to NZ Europeans; and also the ethnic gaps for both Māori and Pacific peoples relative to NZ Europeans concerning dental service use.Keywords: child health, cohort analysis, ethnic disparities, primary healthcare
Procedia PDF Downloads 1442869 Medical Decision-Making in Advanced Dementia from the Family Caregiver Perspective: A Qualitative Study
Authors: Elzbieta Sikorska-Simmons
Abstract:
Advanced dementia is a progressive terminal brain disease that is accompanied by a syndrome of difficult to manage symptoms and complications that eventually lead to death. The management of advanced dementia poses major challenges to family caregivers who act as patient health care proxies in making medical treatment decisions. Little is known, however, about how they manage advanced dementia and how their treatment choices influence the quality of patient life. This prospective qualitative study examines the key medical treatment decisions that family caregivers make while managing advanced dementia. The term ‘family caregiver’ refers to a relative or a friend who is primarily responsible for managing patient’s medical care needs and legally authorized to give informed consent for medical treatments. Medical decision-making implies a process of choosing between treatment options in response to patient’s medical care needs (e.g., worsening comorbid conditions, pain, infections, acute medical events). Family caregivers engage in this process when they actively seek treatments or follow recommendations by healthcare professionals. Better understanding of medical decision-making from the family caregiver perspective is needed to design interventions that maximize the quality of patient life and limit inappropriate treatments. Data were collected in three waves of semi-structured interviews with 20 family caregivers for patients with advanced dementia. A purposive sample of 20 family caregivers was recruited from a senior care center in Central Florida. The qualitative personal interviews were conducted by the author in 4-5 months intervals. The ethical approval for the study was obtained prior to the data collection. Advanced dementia was operationalized as stage five or higher on the Global Deterioration Scale (GDS) (i.e., starting with the GDS score of five, patients are no longer able survive without assistance due to major cognitive and functional impairments). Information about patients’ GDS scores was obtained from the Center’s Medical Director, who had an in-depth knowledge of each patient’s health and medical treatment history. All interviews were audiotaped and transcribed verbatim. The qualitative data analysis was conducted to answer the following research questions: 1) what treatment decisions do family caregivers make while managing the symptoms of advanced dementia and 2) how do these treatment decisions influence the quality of patient life? To validate the results, the author asked each participating family caregiver if the summarized findings accurately captured his/her experiences. The identified medical decisions ranged from seeking specialist medical care to end-of-life care. The most common decisions were related to arranging medical appointments, medication management, seeking treatments for pain and other symptoms, nursing home placement, and accessing community-based healthcare services. The most challenging and consequential decisions were related to the management of acute complications, hospitalizations, and discontinuation of treatments. Decisions that had the greatest impact on the quality of patient life and survival were triggered by traumatic falls, worsening psychiatric symptoms, and aspiration pneumonia. The study findings have important implications for geriatric nurses in the context of patient/caregiver-centered dementia care. Innovative nursing approaches are needed to support family caregivers to effectively manage medical care needs of patients with advanced dementia.Keywords: advanced dementia, family caregiver, medical decision-making, symptom management
Procedia PDF Downloads 1172868 Clinical Profile and Outcome of Type I Diabetes Mellitus at a Tertiary Care-Centre in Eastern Nepal
Authors: Gauri Shankar Shah
Abstract:
Objectives: The Type I diabetes mellitus in children is frequently a missed diagnosis and children presents in emergency with diabetic ketoacidosis having significant morbidity and mortality. The present study was done to find out the clinical presentation and outcome at a tertiary-care centre. Methods: This was retrospective analysis of data of Type I diabetes mellitus reporting to our centre during last one year (2012-2013). Results: There were 12 patients (8 males) and the age group was 4-14 years (mean ± 3.7). The presenting symptoms were fever, vomiting, altered sensorium and fast breathing in 8 (66.6%), 6 (50%), 4 (33.3%), and 4 (33.3%) cases, respectively. The classical triad of polyuria, polydypsia, and polyphagia were present only in two patients (33.2%). Seizures and epigastric pain were found in two cases each (33.2%). The four cases (33.3%) presented with diabetic ketoacidosis due to discontinuation of insulin doses, while 2 had hyperglycemia alone. The hemogram revealed mean hemoglobin of 12.1± 1.6 g/dL and total leukocyte count was 22,883.3 ± 10,345.9 per mm3, with polymorphs percentage of 73.1 ± 9.0%. The mean blood sugar at presentation was 740 ± 277 mg/ dl (544–1240). HbA1c ranged between 7.1-8.8 with mean of 8.1±0.6 %. The mean sodium, potassium, blood ph, pCO2, pO2 and bicarbonate were 140.8 ± 6.9 mEq/L, 4.4 ± 1.8mEq/L, 7.0 ± 0.2, 20.2 ± 10.8 mmHg, 112.6 ± 46.5 mmHg and 9.2 ± 8.8 mEq/L, respectively. All the patients were managed in pediatric intensive care unit as per our protocol, recovered and discharged on intermediate insulin given twice daily. Conclusions: Thus, it shows that these patients have uncontrolled hyperglycemia and often presents in emergency with ketoacidosis and deranged biochemical profile. The regular administration of insulin, frequent monitoring of blood sugar and health education are required to have better metabolic control and good quality of life.Keywords: type I diabetes mellitus, hyperglycemia, outcome, glycemic control
Procedia PDF Downloads 2522867 Generation of Medical Waste in Hospitals in Interior of São Paulo, Brazil
Authors: Silvia Carla Da Silva André, Angela Maria Magosso Takayanagui
Abstract:
Introduction: The Medical Waste (MW) are responsible per 2% of total waste generated for a city and has merited attention due the risks that offers to the public health and environment, representing an important aspect in waste management. In Brazil, the Resolution 306/04 of the National Health Surveillance Agency classifies the MW into 5 groups as follows: Group A (GA) biological, Group B (GB) chemical, Group C (GC) radioactive waste, Group D (GD) common, and Group E (GE) sharps. Objective: This study aimed to determine the amount of waste generated in hospitals of Ribeirão Preto, São Paulo, Brazil. Material and Methods: This is a field research, exploratory, using quantitative variables. The survey was conducted in 11 hospitals in Ribeirão Preto, located in the State of São Paulo, Brazil. It is noted that the study sample included general hospitals, skilled, university, maternity, and psychiatric; public, private, and philanthropic; and large, medium, and small. To quantify the MW, the weighing of the waste was held for six days, following methodology adapted from PAHO. Data were analyzed using descriptive statistics, determining the average global generation of MW and for each group. This research was carried out after approval by the Ethics in Research of the University of São Paulo. Thus, in order to comply with the ethical principles of research, to present the results hospitals were numbered from 1 to 11. Results: The data revealed a greater generation of biological waste among teaching hospitals, which can be justified by the use of materials for the realization of techniques.Keywords: environmental health, management of medical waste, medical waste, public health
Procedia PDF Downloads 3622866 A Multilevel Analysis of Predictors of Early Antenatal Care Visits among Women of Reproductive Age in Benin: 2017/2018 Benin Demographic and Health Survey
Authors: Ebenezer Kwesi Armah-Ansah, Kenneth Fosu Oteng, Esther Selasi Avinu, Eugene Budu, Edward Kwabena Ameyaw
Abstract:
Background: Maternal mortality, particularly in Benin, is a major public health concern in Sub-Saharan Africa. To provide a positive pregnancy experience and reduce maternal morbidities, all pregnant women must get appropriate and timely prenatal support. However, many pregnant women in developing countries, including Benin, begin antenatal care late. There is a paucity of empirical literature on the prevalence and predictors of early antenatal care visits in Benin. As a result, the purpose of this study is to investigate the prevalence and predictors of early antenatal care visits among women of productive age in Benin. Methods: This is a secondary analysis of the 2017/2018 Benin Demographic and Health Survey (BDHS) data. The study involved 6,919 eligible women. Data analysis was conducted using Stata version 14.2 for Mac OS. We adopted a multilevel logistic regression to examine the predictors of early ANC visits in Benin. The results were presented as odds ratios (ORs) associated with 95% confidence intervals (CIs) and p-value <0.05 to determine the significant associations. Results: The prevalence of early ANC visits among pregnant women in Benin was 57.03% [95% CI: 55.41-58.64]. In the final multilevel logistic regression, early ANC visit was higher among women aged 30-34 [aOR=1.60, 95% CI=1.17-2.18] compared to those aged 15-19, women with primary education [aOR=1.22, 95% CI=1.06-142] compared to the non-educated women, women who were covered by health insurance [aOR=3.03, 95% CI=1.35-6.76], women without a big problem in getting the money needed for treatment [aOR=1.31, 95% CI=1.16-1.49], distance to the health facility, not a big problem [aOR=1.23, 95% CI=1.08-1.41], and women whose partners had secondary/higher education [aOR=1.35, 95% CI=1.15-1.57] compared with those who were not covered by health insurance, had big problem in getting money needed for treatment, distance to health facility is a big problem and whose partners had no education respectively. However, women who had four or more births [aOR=0.60, 95% CI=0.48-0.74] and those in Atacora Region [aOR=0.50, 95% CI=0.37-0.68] had lower odds of early ANC visit. Conclusion: This study revealed a relatively high prevalence of early ANC visits among women of reproductive age in Benin. Women's age, educational status of women and their partners, parity, health insurance coverage, distance to health facilities, and region were all associated with early ANC visits among women of reproductive in Benin. These factors ought to be taken into account when developing ANC policies and strategies in order to boost early ANC visits among women in Benin. This will significantly reduce maternal and newborn mortality and help achieve the World Health Organization’s recommendation that all pregnant women should initiate early ANC visits within the first three months of pregnancy.Keywords: antenatal care, Benin, maternal health, pregnancy, DHS, public health
Procedia PDF Downloads 572865 Private and Public Health Sector Difference on Client Satisfaction: Results from Secondary Data Analysis in Sindh, Pakistan
Authors: Wajiha Javed, Arsalan Jabbar, Nelofer Mehboob, Muhammad Tafseer, Zahid Memon
Abstract:
Introduction: Researchers globally have strived to explore diverse factors that augment the continuation and uptake of family planning methods. Clients’ satisfaction is one of the core determinants facilitating continuation of family planning methods. There is a major debate yet scanty evidence to contrast public and private sectors with respect to client satisfaction. The objective of this study is to compare quality-of-care provided by public and private sectors of Pakistan through a client satisfaction lens. Methods: We used Pakistan Demographic Heath Survey 2012-13 dataset (Sindh province) on a total of 3133 Married Women of Reproductive Age (MWRA) aged 15-49 years. Source of family planning (public/private sector) was the main exposure variable. Outcome variable was client satisfaction judged by ten different dimensions of client satisfaction. Means and standard deviations were calculated for continuous variable while for categorical variable frequencies and percentages were computed. For univariate analysis, Chi-square/Fisher Exact test was used to find an association between clients’ satisfaction in public and private sectors. Ten different multivariate models were made. Variables were checked for multi-collinearity, confounding, and interaction, and then advanced logistic regression was used to explore the relationship between client satisfaction and dependent outcome after adjusting for all known confounding factors and results are presented as OR and AOR (95% CI). Results: Multivariate analyses showed that clients were less satisfied in contraceptive provision from private sector as compared to public sector (AOR 0.92,95% CI 0.63-1.68) even though the result was not statistically significant. Clients were more satisfied from private sector as compared to the public sector with respect to other determinants of quality-of-care (follow-up care (AOR 3.29, 95% CI 1.95-5.55), infection prevention (AOR 2.41, 95% CI 1.60-3.62), counseling services (AOR 2.01, 95% CI 1.27-3.18, timely treatment (AOR 3.37, 95% CI 2.20-5.15), attitude of staff (AOR 2.23, 95% CI 1.50-3.33), punctuality of staff (AOR 2.28, 95% CI 1.92-4.13), timely referring (AOR 2.34, 95% CI 1.63-3.35), staff cooperation (AOR 1.75, 95% CI 1.22-2.51) and complications handling (AOR 2.27, 95% CI 1.56-3.29).Keywords: client satisfaction, family planning, public private partnership, quality of care
Procedia PDF Downloads 4152864 Increasing the Dialogue in Workplaces Enhances the Age-Friendly Organisational Culture and Helps Employees Face Work-Related Dilemmas
Authors: Heli Makkonen, Eini Hyppönen
Abstract:
The ageing of employees, the availability of workforce, and employees’ engagement in work are today’s challenges in the field of health care and social services, and particularly in the care of older people. Therefore, it is important to enhance both the attractiveness of the work in the field of older people’s care and the retention of employees in the field, and also to pay attention to the length of careers. The length of careers can be affected, for example, by developing an age-friendly organisational culture. Changing the organisational culture in a workplace is, however, a slow process which requires engagement from employees and enhanced dialogue between employees. This article presents an example of age-friendly organisational culture in an older people’s care unit and presents the results of the development of this organisational culture to meet the identified development challenges. In this research-based development process, cycles used in action research were applied. Three workshops were arranged for employees in a service home for older people. The workshops worked as interventions, and the employees and their manager were given several consecutive assignments to be completed between them. In addition to workshops, the employees benchmarked two other service homes. In the workshops, data was collected by observing and documenting the conversations. After that, thematic analysis was used to identify the factors connected to an age-friendly organisational culture. By analysing the data and comparing it to previous studies, some dilemmas we recognised that were hindering or enhancing the attractiveness of work and the retention of employees in this nursing home. After each intervention, the process was reflected and evaluated, and the next steps were planned. The areas of development identified in the study were related to, for example, the flexibility of work, holistic ergonomics, the physical environment at the workplace, and the workplace culture. Some of the areas of development were taken over by the work community and carried out in cooperation with e.g. occupational health care. We encouraged the work community, and the employees provided us with information about their progress. In this research project, the focus was on the development of the workplace culture and, in particular, on the development of the culture of interaction. The workshops showed employees’ attitudes and strong opinions, which can be a challenge from the point of view of the attractiveness of work and the retention of employees in the field. On the other hand, the data revealed that the work community has an interest in developing the dialogue in the work community. Enhancing the dialogue gave the employees the opportunity and resources to face even challenging dilemmas related to the attractiveness of work and the retention of employees in the field. The psychological safety was also enhanced at the same time. The results of this study are part of a broader study that aims at building a model for extending older employees’ careers.Keywords: age-friendliness, attractiveness of work, dialogue, older people, organisational culture, workplace culture
Procedia PDF Downloads 712863 Development and Psychometric Validation of the Hospitalised Older Adults Dignity Scale for Measuring Dignity during Acute Hospital Admissions
Authors: Abdul-Ganiyu Fuseini, Bernice Redley, Helen Rawson, Lenore Lay, Debra Kerr
Abstract:
Aim: The study aimed to develop and validate a culturally appropriate patient-reported outcome measure for measuring dignity for older adults during acute hospital admissions. Design: A three-phased mixed-method sequential exploratory design was used. Methods: Concept elicitation and generation of items for the scale was informed by older adults’ perspectives about dignity during acute hospitalization and a literature review. Content validity evaluation and pre-testing were undertaken using standard instrument development techniques. A cross-sectional survey design was conducted involving 270 hospitalized older adults for evaluation of construct and convergent validity, internal consistency reliability, and test–retest reliability of the scale. Analysis was performed using Statistical Package for the Social Sciences, version 25. Reporting of the study was guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Results: We established the 15-item Hospitalized Older Adults’ Dignity Scale that has a 5-factor structure: Shared Decision-Making (3 items); Healthcare Professional-Patient Communication (3 items); Patient Autonomy (4 items); Patient Privacy (2 items); and Respectful Care (3 items). Excellent content validity, adequate construct and convergent validity, acceptable internal consistency reliability, and good test-retest reliability were demonstrated. Conclusion: We established the Hospitalized Older Adults Dignity Scale as a valid and reliable scale to measure dignity for older adults during acute hospital admissions. Future studies using confirmatory factor analysis are needed to corroborate the dimensionality of the factor structure and external validity of the scale. Routine use of the scale may provide information that informs the development of strategies to improve dignity-related care in the future. Impact: The development and validation of the Hospitalized Older Adults Dignity Scale will provide healthcare professionals with a feasible and reliable scale for measuring older adults’ dignity during acute hospitalization. Routine use of the scale may enable the capturing and incorporation of older patients’ perspectives about their healthcare experience and provide information that informs the development of strategies to improve dignity-related care in the future.Keywords: dignity, older adults, hospitalisation, scale, patients, dignified care, acute care
Procedia PDF Downloads 842862 Social Influences on HIV Services Engagement among Sexual Minorities Experiencing Intersectional Stigma and Discrimination during COVID-19 Pandemic in Uganda
Authors: Simon Mwima, Evans Jennifer Mann, Agnes Nzomene, Edson Chipalo, Eusebius Small, Moses Okumu, Bosco Mukuba
Abstract:
Introduction: In Uganda, sexual minorities experience exacerbated intersectional stigma and discrimination that exposes them to elevated HIV infections and impedes access to HIV testing and PrEP with low treatment adherence. We contribute to the lack of information about sexual minorities living with HIV in Uganda by using modified social-ecological theory to explore social influences impacting HIV services engagement. Findings from focused group discussion (FGD) involving 31 sexual minorities, ages 18-25, recruited through urban HIV clinics in Kampala reveal the protective and promotive social influence within the individual and interpersonal relationships (sexual partners and peers). Further, inhibitive social influences were found within family, community, societal, and healthcare settings. During the COVID-19 pandemic, these adolescents strategically used promotive social influences to increase their engagement with HIV care services. Interviews were recorded in English, transcribed verbatim, and analyzed using Dedoose. Conclusions: The findings revealed that young people (identified as sexual minorities) strategically used promotive social influences and supported each other to improve engagement with HIV care in the context of restrictive laws in Uganda during the COVID-19-Pandemic. Future HIV prevention, treatment, and care responses could draw on how peers support each other to navigate the heavily criminalized and stigmatized settings to access healthcare services.Keywords: HIV/AIDS services, intersectional stigma, discrimination, adolescents, sexual minorities, COVID-19 pandemic Uganda
Procedia PDF Downloads 1142861 Effectiveness of Mobile Health Augmented Cardiac Rehabilitation (MCard) on Health-Related Quality of Life among Post-Acute Coronary Syndrome Patients: A Randomized Controlled Trial
Authors: Aliya Hisam, Zia Ul Haq, Sohail Aziz, Patrick Doherty, Jill Pell
Abstract:
Objective: To determine the effectiveness of Mobile health augmented Cardiac rehabilitation (MCard) on health-related quality of life (HRQoL) among post-acute coronary syndrome(post-ACS) patients. Methodology: In a randomized controlled trial, post-ACS patients were randomly allocated (1:1) to an intervention group (received MCard; counseling, empowering with self-monitoring devices, short text messages, in addition to standard post-ACS care) or control group (standard post-ACS care). HRQoL was assessed by generic Short Form-12 and MacNew quality of life myocardial infarction (QLMI) tools. Participants were followed for 24 weeks with data collection and analysis at three-time points (baseline, 12 weeks and 24 weeks). Result: At baseline, 160 patients (80 in each group; mean age 52.66+8.46 years; 126 males, 78.75%) were recruited, of which 121(75.62%) continued and were analyzed at 12-weeks and 119(74.37%) at 24-weeks. The mean SF-12 physical component score significantly improved in the MCard group at 12 weeks follow-up (48.93 vs. control 43.87, p<.001) and 24 weeks (53.52 vs. 46.82 p<.001). The mean SF-12 mental component scores also improved significantly in the MCard group at 12 weeks follow-up (44.84 vs. control 41.40, p<.001) and 24 weeks follow-up (48.95 vs 40.12, p<.001). At 12-and 24-week follow-up, all domains of MacNew QLMI (social, emotional, physical and global) were also statistically significant (p<.001) improved in the MCard group, unlike the control group. Conclusion: MCard is feasible and effective at improving all domains of HRQoL. There was an improvement in physical, mental, social, emotional and global domains among the MCard group in comparison to the control group. The addition of MCard programs to post-ACS standard care may improve patient outcomes and reduce the burden on the health care setting.Keywords: acute coronary syndrome, mobile health augmented cardiac rehabilitation (MCard), cardiovascular diseases, cardiac rehabilitation, health-related quality of life, short form 12, MacNew QLMI
Procedia PDF Downloads 1632860 Attitude of Staff Nurses on Nursing Research and Its Utilization
Authors: Y. N. Shashidhara, B. S. Shakuntala
Abstract:
Introduction: Nursing practice is undergoing tremendous changes and challenges. In order to meet social challenges and needs, nursing practice must be research based. Research is needed to evaluate the effectiveness of nursing treatment modalities, to determine the impact of nursing care on the health of the patients or to test the theory of nursing practice. Objective of the study to explore the attitude of staff nurses on Nursing research and its utilization Methodology: The descriptive study design was adopted and 300 staff nurses were selected by systematic random sampling technique from eight hospitals. The attitude on nursing research was assessed by validated and reliable self-administered attitude scale which consists of 40 items. Results: The overall attitude mean score 130.2 (SD 11.5) regarding attitude on Nursing research and its utilization. Some of the findings are the majority of staff nurses (51% agreed and 18.3% strongly agreed) that they have all the motivation to use research findings if they get support. Nearly 25.3 percent of staff nurses agreed and 10.7 percent strongly agreed that they do not have time to conduct research. The majority of staff nurses 53.7 percent agreed that research will help in updating Nursing profession. Nearly 32.6 percent of staff nurses agreed and 20.5 percent strongly agreed that being able to use will make them better nurses. About 45.3 percent and 17.3 percent agreed and strongly agreed that knowledge gained through experience is more useful than research. Most (40%) of nurses agreed that thy do not have the authority to change the patient care practice. The majority of staff nurses (45.7 percent agreed and 13 percent strongly agreed) feel the research will consume their personal time. Majority, 50 percent of staff nurses agreed and 16.7 percent strongly agreed that to conduct and utilize research findings requires financial support. Majority 50 percent of staff nurses agreed and 12 percent strongly agreed that physicians will cooperate and value nursing research findings. Majority 67.3 percent of staff nurses had moderate positive and 32.7 percent of staff nurses had highly positive attitude towards Nursing research and its utilization. Conclusion: With this study we understanding that, the staff nurses have positive attitude regarding nursing research. If the nurses are supported and motivated for research utilization we can improve the patient care.Keywords: nurses, attitude, nursing research, research utilization
Procedia PDF Downloads 247