Challenges of healthcare professionals in providing care to South Asian ethnic minority patients in Hong Kong: A qualitative study

Ethnic minorities across the globe encounter disparities in healthcare. While a great deal of research has been conducted on the experiences of these patients, studies focusing on the perspectives of healthcare professionals are limited, particularly in the context of Asia. This study explores the perceptions of and challenges faced by Hong Kong healthcare professionals in the provision of culturally appropriate care to South Asian ethnic minority patients. Taking a qualitative approach, interviews were conducted with 22 healthcare professionals. Two main themes were identified: ‘lack of support’ at the healthcare system level and ‘dysfunctional relationship with South Asian ethnic minority patients’ at the interpersonal level. Challenges at the healthcare system level include information outreach, cultural competency, utilisation of available resources and time and workload, whereas challenges at the interpersonal level include patient–provider interaction, patient–provider perceptions of illness and care and patient–provider sociocultural discordance. Intercultural care was found to be influenced by both the healthcare system and interpersonal characteristics. The study highlights the need for healthcare professional education and training in cultural competency, in order to improve the provision of intercultural care. Identifying the challenges faced by healthcare professionals and the implications of these challenges for the provision of healthcare to South Asian ethnic minority patients will help practitioners, policy makers and care provider agencies to improve quality of care and health outcomes for culturally diverse patients.     

Optimizing teacher basic need satisfaction in distributed healthcare contexts

Optimizing teacher motivation in distributed learning environments is paramount to ensure high-quality education, as medical education is increasingly becoming the responsibility of a larger variety of healthcare contexts. This study aims to explore teaching-related basic need satisfaction, e.g. teachers’ feelings of autonomy, competence and relatedness in teaching, in different healthcare contexts and to provide insight into its relation to contextual factors. We distributed a digital survey among healthcare professionals in university hospitals (UH), district teaching hospitals (DTH), and primary care (PC). We used the Teaching-related Basic Need Satisfaction scale, based on the Self-Determination theory, to measure teachers’ basic needs satisfaction in teaching. We studied relations between basic need satisfaction and perceived presence of contextual factors associated with teacher motivation drawn from the literature. Input from 1407 healthcare professionals was analyzed. PC healthcare professionals felt most autonomous, UH healthcare professionals felt most competent, and DTH healthcare professionals felt most related. Regardless of work context, teachers involved in educational design and who perceived more appreciation and developmental opportunities for teaching reported higher feelings of autonomy, competence, and relatedness in teaching, as did teachers who indicated that teaching was important at their job application. Perceived facilitators for teaching were associated with feeling more autonomous and related. These results can be utilized in a variety of healthcare contexts for improving teaching-related basic need satisfaction. Recommendations for practice include involving different healthcare professionals in educational development and coordination, forming communities of teachers across healthcare contexts, and addressing healthcare professionals’ intentions to be involved in education during job interviews.

     

Social support in the healthcare setting: the role of volunteers

The participation of volunteers in the National Health Service (NHS) has been actively promoted during recent years, particularly within community and primary healthcare services (National Health Service 1996, 1998). As a consequence, volunteers currently make a significant contribution to health and social care within the UK. Concerning this contribution, the literature often portrays the volunteers' role as one of providing social support. In the present paper, the authors attempt to explore this role in more detail, drawing on interview data from studies of two separate volunteer programmes. One of these considered the role of volunteers supporting older hospitalised patients (Davies et al. 2001), and the other was based within general practice (Faulkner 2003, 2004). The social support provided by these programmes is considered from the perspective of four broad support mechanisms described by Langford et al. (1997), namely: emotional support; informational support; appraisal support; and instrumental support. Secondary analysis examines the potential contribution of volunteers to patient well-being.     

Healthcare professionals’ accounts of challenges in managing motor neurone disease in primary healthcare: a qualitative study

Motor neurone disease (MND) is a progressive neurological disease causing muscle wasting, gradual paralysis and respiratory failure, with a life expectancy of 2–4 years. In order to better understand how MND is managed in the community, we conducted a qualitative study to explore the challenges healthcare professionals encounter when managing MND in primary healthcare. Based on data from 15 semi‐structured interviews with primary healthcare professionals in Norway, we found that MND is viewed as a condition that requires exceptional effort and detailed planning. Healthcare professionals reported five main challenges in managing MND in primary healthcare: (i) building relationships with those giving and receiving care in the home; (ii) preventing caregiver burnout and breakdown; (iii) providing tailored care; (iv) ensuring good working conditions in patients’ homes; and (v) recruiting and retaining qualified nursing assistants. Healthcare professionals reported needing working conditions that allow them to tailor their approach to the personal, emotional and existential nature of care preferences of those living with MND. However, people with MND and their families were sometimes perceived by healthcare professionals to prefer a strictly task‐focused relationship with care providers. Such relationships limited the healthcare professionals’ control over the MND trajectory and their capacity to prevent family caregiver burnout and breakdown. Adequate resources, along with training and support of nursing assistants, may increase the continuity of nursing assistants. Responsiveness to patient and family needs may enhance collaboration and promote tailored primary care and support for patients with MND and their families.     

Exploring Differences in Patient-Centered Practices among Healthcare Professionals in Acute Care Settings

There is limited evidence of the extent to which Healthcare professionals implement patient-centered care (PCC) and of the factors influencing their PCC practices in acute care organizations. This study aimed to (1) examine the practices reported by health professionals (physicians, nurses, social workers, other healthcare providers) in relation to three PCC components (holistic, collaborative, and responsive care), and (2) explore the association of professionals’ characteristics (gender, work experience) and a contextual factor (caseload), with the professionals’ PCC practices. Data were obtained from a large scale cross-sectional study, conducted in 18 hospitals in Ontario, Canada. Consenting professionals (n = 382) completed a self-report instrument assessing the three PCC components and responded to standard questions inquiring about their characteristics and workload. Small differences were found in the PCC practices across professional groups: (1) physicians reported higher levels of enacting the holistic care component; (2) physicians, other healthcare providers, and social workers reported implementing higher levels of the collaborative care component; and (3) physicians, nurses, and other healthcare providers reported higher levels of providing responsive care. Caseload influenced holistic care practices. Interprofessional education and training strategies are needed to clarify and address professional differences in valuing and practicing PCC components. Clinical guidelines can be revised to enable professionals to engage patients in care-related decisions, customize patient care, and promote interprofessional collaboration in planning and implementing PCC. Additional research is warranted to determine the influence of professional, patient, and other contextual factors on professionals’ PCC practices in acute care hospitals.     

Providing family planning and reproductive healthcare to Canadian immigrants: perceptions of healthcare providers

Cultural impacts on health experiences and behaviours are profound in the area of reproductive health and family planning. Explored through interviews with family planning healthcare professionals, this paper evaluates their experiences in providing family planning and reproductive healthcare to immigrants in the Greater Toronto and Hamilton area of Ontario, Canada. Results reveal the complexity of delivering care to members of this group, particularly when dealing with language barriers, situations when professional and non‐professional interpreters are used, and instances where healthcare professionals realize that they themselves have misconceptions and misunderstandings about other cultures. The paper concludes by discussing future research options and implications for the delivery of reproductive health family planning services to this population.     

Task shifting in primary care to tackle healthcare worker shortages: An umbrella review

BackgroundTask shifting is an approach to help address the shortage of healthcare workers through reallocating human resources but its impact on primary care is unclear.ObjectivesTo provide an overview of reviews describing task shifts from physicians to allied healthcare workers in primary care and its impact on clinical outcomes.MethodsSix electronic databases were searched up to 15 December 2020, to identify reviews describing task shifting in primary care. Two reviewers independently screened the references for relevant studies, extracted the data and assessed the methodological quality of included reviews using AMSTAR-2.ResultsTwenty-one reviews that described task shifting in primary care were included. Task shifted include provision of care for people with chronic conditions, medication prescribing, and health education. We found that task shifting could potentially improve several health outcomes such as blood pressure, HbA1c, and mental health while achieving cost savings. Key elements for successful implementation of task shifting include collaboration among all parties, a system for coordinated care, provider empowerment, patient preference, shared decision making, training and competency, supportive organisation system, clear process outcome, and financing.ConclusionEvidence suggests that allied healthcare workers such as pharmacists and nurses can potentially undertake substantially expanded roles to support physicians in primary care in response to the changing health service demand. Tasks include providing care to patients, independent prescribing, counselling and education, with comparable quality of care.     

Meeting patient expectations: healthcare professionals and service re-engineering.

A central theme underpinning the reform of healthcare systems in western economies since the 1980s has been the emphasis on reorienting service provision around the patient. Healthcare organizations have been forced to re-appraise the design of the service delivery process, specifically the service encounter, to take account of these changing patient expectations. This reorientation of healthcare services around the patient has fundamental implications for healthcare professionals, specifically challenging the dominance of service professionals in the design and delivery of health services. Utilizing a qualitative methodological framework, this paper explores the responses of healthcare professionals to service redesign initiatives implemented in acute NHS hospitals in Scotland and considers the implications of such professional responses for the development of patient-focused service delivery. Within this, it specifically examines evolving professional perspectives on the place of a service user focus in a publicly funded healthcare system, professional attitudes towards private sector managerial practices, and the dynamics of changing professional behaviour.     

Task shifting in the provision of home and social care in Ontario,Canada: implications for quality of care

Growing healthcare costs have caused home‐care providers to look for more efficient use of healthcare resources. Task shifting is suggested as a strategy to reduce the costs of delivering home‐care services. Task shifting refers to the delegation or transfer of tasks from regulated healthcare professionals to home‐care workers (HCWs). The purpose of this paper is to explore the impacts of task shifting on the quality of care provided to older adults from the perspectives of home healthcare workers. This qualitative study was completed in collaboration with a large home and community care organisation in Ontario, Canada, in 2010–2011. Using a purposive sampling strategy, semi‐structured telephone interviews were conducted with 46 home healthcare workers including HCWs, home‐care worker supervisors, nurses and therapists. Study participants reported that the most common skills transferred or delegated to HCWs were transfers, simple wound care, exercises, catheterisation, colostomies, compression stockings, G‐tube feeding and continence care. A thematic analysis of the data revealed mixed opinions on the impacts of task shifting on the quality of care. HCWs and their supervisors, more often than nurses and therapists, felt that task shifting improved the quality of care through the provision of more consistent care; the development of trust‐based relationships with clients; and because task shifting reduced the number of care providers entering the client's home. Nurses followed by therapists, as well as some supervisors and HCWs, expressed concerns that task shifting might compromise the quality of care because HCWs lacked the knowledge, training and education necessary for more complex tasks, and that scheduling problems might leave clients with inconsistent care once tasks are delegated or transferred. Policy implications for regulating bodies, employers, unions and educators are discussed.     

The healthcare volunteer

Every year, volunteers contribute billions of dollars worth of time to the healthcare industry. Despite their contributions, however, little is known about who these volunteers are, what they do, why they volunteer, as well as the costs and benefits they bring to institutions. This article examines these and other characteristics of the healthcare volunteer.     

Communicating with healthcare providers

Studies of risk communication have identified healthcare providers, especially physicians, as the source of information most trusted by the public on issues of environmental health. Nothing in medical, nursing or most healthcare provider training actually prepares practitioners to play this role and healthcare providers are generally more oriented toward treatment and medical care than prevention and public health. Healthcare providers require education in order to play this role but rarely seek it. Gaps in the knowledge of professional on the issue of Cryptosporidium illustrate the problem. For members of the professional water community, communicating with healthcare providers is best done when messages are delivered in familiar settings, such as hospital Grand Rounds (a universal format for teaching conferences) and provided in a narrative (case-based) form but gaining access is difficult if the topic is not obviously clinical in nature. In addition to being a critically important target group itself, public health professionals are easier to reach and may mediate good working relationships with medical practitioners. We suggest a strategy for water utilities based on partnerships with academic public health and providing education through well-recognized formats in continuing medical and nursing education.     

Paradoxes of professional autonomy: a qualitative study of U.S. neonatologists from 1978-2017

The professional autonomy of physicians often requires they take responsibility for life and death decisions, but they must also find ways to avoid bearing the full weight of such decisions. We conducted in-person, semi-structured interviews with neonatologists (n = 20) in four waves between 1978 and 2017 in a single Midwestern U.S. city. Using open coding analysis, we found over time that neonatologists described changes in their sense of professional autonomy and responsibility for decisions with life and death consequences. Through the early 1990s, as neonatology consolidated as a profession, physicians simultaneously enjoyed high levels of professional discretion and responsibility and were often constrained by bioethics and the law. By 2010s, high involvement of parents and collaboration with multiple subspecialties diffused the burden felt by individual practitioners, but neonatology’s professional autonomy was correlatively diminished. Decision-making in the NICU over four decades reveal a complex relationship between the professional autonomy of neonatologist and the burden they bear, with some instances of ceding autonomy as a protective measure and other situations of unwelcomed erosion of professional autonomy that neonatologists see as complicating provision of care.     

Communicating with healthcare providers

Studies of risk communication have identified healthcare providers, especially physicians, as the source of information most trusted by the public on issues of environmental health. Nothing in medical, nursing or most healthcare provider training actually prepares practitioners to play this role and healthcare providers are generally more oriented toward treatment and medical care than prevention and public health. Healthcare providers require education in order to play this role but rarely seek it. Gaps in the knowledge of professional on the issue of Cryptosporidium illustrate the problem. For members of the professional water community, communicating with healthcare providers is best done when messages are delivered in familiar settings, such as hospital Grand Rounds (a universal format for teaching conferences) and provided in a narrative (case-based) form but gaining access is difficult if the topic is not obviously clinical in nature. In addition to being a critically important target group itself, public health professionals are easier to reach and may mediate good working relationships with medical practitioners. We suggest a strategy for water utilities based on partnerships with academic public health and providing education through well-recognized formats in continuing medical and nursing education.     

Pattullo Lecture 2006. Crossing the educational chasm: preparing healthcare leaders for interprofessional practice

Despite marked differences in training and professional interests, physicians and hospital administrators face similar problems: failure of reimbursement to keep pace with rising costs, new therapeutic modalities, critical workforce shortages, increasing government and managed care regulation, heightened consumerism, & an aging patient population. In the face of these mounting challenges, both physicians and hospital administrators could benefit significantly from a climate of collaboration and interdependence to optimize interprofessional practice. Teaching people to work with other healthcare professionals who play key roles in healthcare delivery is an important educational mission for the Association of University Programs in Health Administration (AUPHA) and for society in general.     

Community-based post-stroke service provision and challenges: a national survey of managers and inter-disciplinary healthcare staff in Ireland

ABSTRACT: BACKGROUND: The extent of stroke-related disability typically becomes most apparent after patient discharge to the community. Maximising rehabilitation input at this point can minimise the impact of disability. As part of the Irish National Audit of Stroke Care (INASC), a national survey of community-based allied health professionals and public health nurses was conducted. The aim was to document the challenges to service availability for patients with stroke in the community and to identify priorities for service improvement. METHODS: The study was a cross-sectional tailored interview survey with key managerial and service delivery staff. As comprehensive listings of community-based health professionals involved in stroke care were not available, a cascade approach to information gathering was adopted. Representative regional managers for services incorporating stroke care (N=7) and disciplinary allied health professional and public health nurse managers (N=25) were interviewed (94% response rate). RESULTS: Results indicated a lack of formal, structured community-based services for stroke, with no designated clinical posts for stroke care across disciplines nationally. There was significant regional variation in availability of allied health professionals. Considerable inequity was identified in patient access to stroke services, with greater access, where available, for older patients (>65 years). The absence of a stroke strategy and stroke prevalence statistics were identified as significant impediments to service planning, alongside organisational barriers limiting the recruitment of additional allied health professional staff, and lack of sharing of discipline-specific information on patients. CONCLUSIONS: This study highlighted major gaps in the provision of inter-disciplinary team community-based services for people with stroke in one country. Where services existed, they were generic in nature, rarely inter-disciplinary in function and deficient in input from salient disciplines. Challenges to optimal care included the need for strategic planning; increased funding of healthcare staff; increased team resources and teamwork; and removal of service provision barriers based on age. There were notably many challenges beyond funding. Similar evaluations in other healthcare systems would serve to provide comparative lessons to serve to tackle this underserved aspect of care for patients with stroke and their families.     

The experiences of neighbour,volunteer and professional support‐givers in supporting community dwelling older people

Public policy increasingly emphasises the importance of informal support networks to meet the needs of the ageing population. Evidence for the types of support neighbours provide to older people and how neighbours collaborate with formal support‐givers is currently insufficient. Our study therefore explored (i) types of informal neighbour support and (ii) experiences of neighbours, volunteers and professionals providing support. Interviews with nine Dutch neighbour support‐givers, five volunteers and 12 professionals were conducted and subjected to latent content analysis. Findings indicate that commitment occurred naturally among neighbours; along with providing instrumental and emotional support, neighbour support seems to be a matter of carefully ‘watching over each other’. Neighbour support‐givers, however, are often frail themselves and become overburdened; they furthermore lack support from professionals. Neighbour, volunteer and professional support‐givers seem to operate in distinct, non‐collaborative spheres. Findings suggest that policy‐makers should consider the opportunities and limitations of neighbour and volunteer support. Professionals have an indispensable role in providing back‐up and accountable, specialised support. They may be trained to adopt a visible and proactive attitude in neighbourhoods to facilitate, cooperate with and mediate between neighbour and volunteer support‐givers.     

Using a tablet application about nutrition in home care—Experiences and perspectives of healthcare professionals

Undernutrition is an extensive problem among patients in community care services. The literature identifies several barriers that hinder health professionals in identifying nutritional problems and providing nutrition interventions. We developed Appetitus, a tablet application (app) focused on nutrition for older adults. Patients used the app, advised by healthcare professionals. In this study with qualitative design, we explored experiences and perspectives of healthcare professionals who used Appetitus when providing home care. We interviewed 24 healthcare professionals individually and in focus groups. We subjected the data to qualitative content analysis. Healthcare professionals used Appetitus as a mediator in dialogues with patients about nutrition. Giving the older adults an active role in nutrition assessment afforded opportunities to strengthen their involvement in care. Registrations of food and drink consumption gave the healthcare professionals insight into patients’ situations and revealed problems of which the healthcare professionals had not been aware. Based on their experience with Appetitus, healthcare professionals suggested using electronic tools to assess and document the nutritional situation of a larger patient group in home care. In future use of Appetitus, healthcare professionals’ levels of knowledge and confidence when advising patients about nutrition must be emphasised and addressed. Barriers such as time constraints and limited continuity of care are also areas that require attention when new nutrition practices are implemented.     

Twenty years of care for persons living with HIV/AIDS in Brazil: the health professionals' perspective

The aim of this study was to describe the meaning ascribed by health professionals to the care they provide for persons with HIV/AIDS. Data were collected through recorded interviews with 10 health professionals providing care to AIDS patients in different institutions in S?o Paulo State, Brazil. Three themes emerged from the analysis: (a) the overall scenario of healthcare provision for AIDS patients; (b) the relationship between healthcare professionals and patients; and (c) ethical aspects related to care. Despite significant advances, the study identified discriminatory behavior in the treatment. Such behaviors were related to feelings of insecurity and fear of infection on the part of healthcare professionals, which could be explained by the lack of appropriate training in general services and hospitals. Specific training for treating the patients mainly targeted health professionals in centers specializing in HIV/AIDS, resulting in difficulties for integrating the care of these patients with other services under the Unified National Health System. The data related to characteristics of professional training in the health field as a whole, leading one to reflect on the skills expected of health professionals in caring for (and relating to) persons with HIV/AIDS, as well as the impact on AIDS prevention.