Including children in medical decisions and treatments: perceptions and practices of healthcare providers

Background With growing awareness of the need to involve children in their own health‐related decisions, attention has primarily focused on the concept of assent, or a minor's participation in a research trial or experimental treatment. This study attempts to broaden that focus by examining the perceptions and practices of healthcare providers with respect to the role of children in more routine healthcare decisions and treatments. Methods In total, 103 nurses and 40 physicians who work in a hospital in Israel completed self‐administered perceptions and practices questionnaires. Results Many participants agreed that children should be included in decision making. Factors that respondents felt would influence their approach to a particular child included child behaviour (80%), child communication (66%), experience of child, parent and healthcare provider (90%) and type of medical intervention (60%). Responses differed between physicians and nurses. In response to the question ‘How often do you suggest the following methods to achieve child participation in treatment?’ most respondents reported that they provide an explanation (98%) and recruit the parents (90%). The use of play was reported by only 63% of the professionals. Conclusion This study demonstrated that many healthcare providers recognize the need to include children in routine health‐related practices and outlined factors healthcare providers use in deciding when to include children in medical decisions. Involving children in even the minute aspects of everyday decisions and treatments can allow children to feel part of the process, improve their co‐operation, increase their sense of control and affect future healthcare encounters.     

Recruitment and retention of health professionals across Europe: A literature review and multiple case study research

Many European countries are faced with health workforce shortages and the need to develop effective recruitment and retention (R&R) strategies. Yet comparative studies on R&R in Europe are scarce. This paper provides an overview of the measures in place to improve the R&R of health professionals across Europe and offers further insight into the evidence base for R&R; the interaction between policy and organisational levels in driving R&R outcomes; the facilitators and barriers throughout these process; and good practices in the R&R of health professionals across Europe. The study adopted a multi-method approach combining an extensive literature review and multiple-case study research. 64 publications were included in the review and 34 R&R interventions from 20 European countries were included in the multiple-case study. We found a consistent lack of evidence about the effectiveness of R&R interventions. Most interventions are not explicitly part of a coherent package of measures but they tend to involve multiple actors from policy and organisational levels, sometimes in complex configurations. A list of good practices for R&R interventions was identified, including context-sensitivity when implementing and transferring interventions to different organisations and countries. While single R&R interventions on their own have little impact, bundles of interventions are more effective. Interventions backed by political and executive commitment benefit from a strong support base and involvement of relevant stakeholders.     

Drivers for emigration among healthcare professionals: Testing an analytical model in a primary healthcare setting

This paper aims to contribute to the discussion on health workforce migration, notably by testing an analytical model of the individual drivers for a professional to decide to emigrate.A large database was obtained from all primary health care units on mainland Portugal. A professional satisfaction survey was conducted and information on social-economic, labour and job satisfaction characteristics, including burnout, was obtained.Results showed that healthcare professionals who reported intention to emigrate are mostly male, young, not married, and more educated; they consider their income insufficient for their needs, and show higher levels of burnout at work and professional dissatisfaction. This profile is slightly different for GPs and nurses.The results obtained contribute to the discussion on what motivates primary health care professionals, including GPs and nurses, to emigrate. They also provide insight into the design of policy measures that may mitigate the intention of these healthcare professionals in general to emigrate.     

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.     

Domains of importance for parents,medical professionals and youth with cerebral palsy considering treatment outcomes

Background The aim of this study was to assess the domains of importance in therapeutic intervention for cerebral palsy (CP) using categories of the International Classification of Functioning, Disability, and Health – Children and Youth Version (ICF‐CY). Methods A total of 17 youth, 19 parents and 39 medical professionals responded to the open‐ended query: ‘What are the things you find most important to consider when you evaluate the effects of an intervention for yourself/your child/your patient with cerebral palsy?’ Surveys were either mailed or conducted on‐line. Responses were coded by two reviewers using the ICF‐CY and discrepancies were resolved. Results Responses were distributed across the ICF‐CY domains of Body Functions and Structures, Activities and Participation, and Environmental Factors, as well as non‐ICF‐CY concepts including quality of life. The most common responses overall were pain, motor function, mobility, community life and public services. Youth identified strength, gait pattern, hand/arm use and use of assistive technologies as priorities whereas parents were concerned with motor function, communication, mobility and provision of public services. Medical professionals listed pain, function, mobility, community life and participation most often. Conclusions All surveyed groups indicate a desire to see changes in body functions and structures (pain, mental function, strength, movement), activities and participation (communication, hand/arm use, walking, school, recreation/community life) and quality of life following therapeutic interventions for CP. These results demonstrate the multiple, varied concerns regarding CP across the spectrum of functioning and health.     

Race-based experiences of ethnic minority health professionals: Arab physicians and nurses in Israeli public healthcare organizations

Increasing workforce diversity was found to contribute to the narrowing of disparities in health. However, racism toward ethnic minority health professionals has not been adequately researched. In Israel, public healthcare organizations that serve a mixed Jewish-Arab population employ Arab minority healthcare professionals. Instances of prejudice and manifestations of racism toward them, which frequently surface in public discussion and the media, have unfortunately gained little scholarly attention. We used the intergroup contact approach and the theory of the social process of everyday racism as a theoretical framework. The objective of the research was to study race-based experiences of Israeli Arab healthcare professionals.

Methodology: We used a qualitative research method that allows respondents to describe their views, experiences, beliefs and behavior in the way they think about them. During 2013 and 2014 we conducted in-depth interviews with a snowball sample of 10 Arab physicians and 13 Arab nurses who work in Israeli public hospitals. The study protocol was ethically approved.

Findings: Interviewees noted institutional efforts to maintain egalitarianism and equality. However, at the micro-level, interviewees, mostly nurses, reported instances that ranged from refusal to accept treatment from an Arab nurse, through verbal abuse, to the use of physical violence against them. At the meso-level, interviewees, mostly physicians, reported experiences of institutional discrimination. At the macro-level, one physician reported policy-related discrimination in the context of the immigration of Russian Jewish physicians to Israel.

Conclusions: We recommend combining the intergroup contact approach with the social process theory of racism to examine minorities’ subjective perceptions, especially in conflictual and violent contexts; conducting broad-based quantitative research in Israeli healthcare organizations, which may have important implications for the specific strategies to be used; and emphasizing the importance of institutional support. By reconstructing race-based experiences of ethnic minority health professionals, health organizations can better manage racial situations and reduce their frequency.     

Colonising the future: temporal perceptions and health-relevant behaviours across the adult lifecourse

Abstract Health promotion is premised upon a proactive approach to health and its management, one that requires a future‐orientated outlook, in which the threats of (future) ill‐health can be anticipated and thereby mitigated. Despite this, little is known about the extent to which concerns about morbidity and mortality actually feature in people's present and future perceptions of self, and whether such perceptions have any influence upon their present health‐relevant behaviours. By drawing upon interviews with 55 people aged 26–81, this article highlights the central role that embodiment plays in the mediation of health promotion messages. The embodied experience of ill‐health, it will be shown, is an important, underlying prerequisite for perceiving a future in which (further) ill‐health is anticipated. This pivotal finding will be used to illuminate the observation that, when lifestyles are changed to concur with professional recommendations, these changes tend to be reactive in nature.     

Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study

The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi‐structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision‐makers and planners are urged to identify HRH as the most important input for the success of PHC programmes and interventions, especially in the growing fields of mental health and geriatric care.     

Families' and healthcare professionals' perceptions of healthcare services for children and young people with medically unexplained symptoms: a narrative review of the literature

Children and young people frequently report physical complaints that have no observable physical pathology known as medically unexplained symptoms (MUS). Research suggests that MUS are associated with substantial physical and psychological impairments and may have a negative impact on children's and young people's functional status and well‐being in the long term. Due to the potentially complex needs of this group, children and young people with MUS may require timely access to suitable health and social care services to effectively manage symptoms and achieve their academic, social and personal potential. Families and professionals can offer important insights into the availability and appropriateness of current community and specialist health and social care services. This review is the first critical evaluation and synthesis of research that has examined families' and healthcare professionals' (HCP) perceptions of healthcare services for children and young people with MUS. A systematic search of electronic databases and manual searches of key journals and reference lists identified 17 papers from 15 studies for inclusion in the review. The review highlights the paucity of rigorously conducted research on this topic. Studies have been narrowly focused on the views of a homogeneous group of mothers and young people attending single centres. There has been some attempt to examine doctors' views, but the perceptions of children, fathers and health and social care professionals are absent or under‐represented, and multi‐site and longitudinal studies are lacking. Thematic analysis of the results from the included studies suggests that knowledge, communication, health beliefs and healthcare settings are factors that influence families' and HCPs' perceptions of services. Families report dissatisfaction with some HCPs' approach to managing MUS. The findings suggest that children and young people with MUS are at risk of receiving suboptimal care and support because there is insufficient research to inform high‐quality, evidence‐based practice.     

Seroprevalence of pertussis amongst healthcare professionals in Spain

IntroductionThis multi-center, hospital-based observational study determined the seroprevalence of pertussis antibodies amongst healthcare professionals from three different hospitals in Spain to ascertain the health status of professionals attending to susceptible groups who are at risk of contracting and transmitting pertussis.MethodsMedical professionals from three hospitals in Spain were recruited for this study (NCT01706224). Serum samples from subjects were assessed for anti-pertussis antibodies by ELISA. The percentage of subjects positive for anti-pertussis antibodies were determined by age-strata, gender, vaccination status, professional level (physicians, nurses, ancillary nurses and midwives), hospital department, number of working years, numbers of hours spent with the patient as well as number of children in the household.ResultsOverall, 31.2% of subjects were seropositive; 3.3% of these healthcare professionals had ELISA values indicative of current or recent infection. There were no significant differences in terms of pertussis prevalence with respect to age, gender, hospital department, profession, number of working years and number of hours spent with patients. These levels of seronegativity amongst healthcare workers further strengthen the rationale for vaccination amongst this specific population against pertussis.     

山西省200所二级及以上医院医院感染专职人员人力资源配置现状调查

目的 了解山西省二级及以上医疗机构医院感染专职人员人力资源配置现状,为山西省医院感染管理专职人员人才队伍建设提供参考依据。 方法 2023年1月17日—2月4日采用便利抽样法对山西省二级及以上医院医院感染专职人员进行问卷调查。 结果 共调查200所医院284名医院感染专职人员,包括三级医院45所,二级医院155所,其中56所(28.0%)医院医院感染专职人员配置充足。不同等级、床位数医院医院感染专职人员配置充足率比较,差异有统计学意义(P＜0.05),三级医院配置充足率优于二级医院,床位数为100~500张者配置充足率最低。医院感染专职人员以46~66岁(占50.4%)、女性(占94.4%)居多,专业背景以护理专业为主(占80.0%),学历硕士者仅占7.0%,高级职称占44.8%。虽医疗工作年限>20年者占61.6%,但医院感染工作年限 < 5年者却高达43.3%,已取得医院感染专职人员证书者占91.9%。 结论 山西省二级及以上医院医院感染专职人员配置不足、人员结构不合理,医疗机构应进一步加强医院感染专职人员人才队伍建设。     

我国基层卫生人力资源配置现状及公平性分析

目的:基层医疗卫生服务人员是提供基本医疗服务和基本公共卫生服务的主力军,是影响服务提供数量、质量和效果的核心要素。文章旨在通过分析我国各省市基层卫生机构卫生技术人员配置数量、结构和公平性,为进一步完善基层卫生人力资源相关政策奠定基础。方法:查阅中国卫生统计年鉴2006-2009年基层卫生人力资源数据,对其结构进行分析,并利用洛伦兹曲线和基尼系数对对其公平性进行评价。结果2006-2009年,全国每千非农业人口社区卫生服务机构卫生技术人员数呈迅速增长趋势,省际间Gini系数由2006年的0.65降低到2009年0.24,不公平性状况得到明显改善;每千农业人口乡镇卫生院和村卫生室卫生技术人员数较稳定,省际间Gini系数均小于0.1,公平性较好。社区卫生服务机构和乡镇卫生院人员年龄主要集中在25-44岁之间;大学及以上学历人员比例较低,中专及以下学历人员所占比例较高,尤其是在农村地区;以初级及以下职称为主;全科医师占执业医师总数的比例仅为3.5%。结论:基层卫生服务人员配置日益均衡,但是人员结构仍亟需改善。应逐步建立全科医生培养制度,完善激励机制,引导专业人才到基层执业,提升基层卫生服务能力。     

Improving access for Latino immigrants: evaluation of language training adapted to the needs of health professionals

The number of Latinos in North Carolina grew by almost 400% between 1990 and 2000. The rapid change in demographics in this state and other southeastern states has caught healthcare providers unprepared. Lack of ability to communicate with Latino patients may result in errors in diagnosis or reduced compliance with recommended treatments. The Culturally and Linguistically Appropriate Services (CLAS) Standards, published in 2001, mandate culturally and linguistically appropriate services for persons with limited English proficiency. This paper describes an innovative strategy to promote Spanish and culture-learning skills of healthcare providers and presents results of the evaluation conducted to determine its impact on access to quality care. The evaluation used a 360 degrees case study design, at 1-year follow-up. Use of Spanish language health-related materials is key to the training's success. The authors make recommendations for replication of the integrated language and culture-training model in other new settlement areas, especially those in the southeast of the United States.     

Home enteral tube feeding in children following percutaneous endoscopic gastrostomy: perceptions of parents, paediatric dietitians and paediatric nurses

BACKGROUND: The perceptions of parents and professionals are important in deciding to feed children by gastrostomy, yet there are few published studies in this field. This study explored and compared the perceptions of parents to those of paediatric outreach nurses and paediatric dietitians. METHODS: A cross-sectional mixed-method study with purposive sampling was undertaken using structured interviews and questionnaires to explore perceptions of percutaneous endoscopic gastrostomy (PEG) placement and feeding. Binomial regression was used to investigate differences in perceptions across the groups of participants. RESULTS: Parents, paediatric outreach nurses and dietitians shared similar perceptions regarding success of feeding, support for gastrostomy reinsertion and the acceptability of the child's quality of life. Much greater differences in perceptions were evident regarding the parents' involvement in the decision-making process for PEG placement and the adequacy of the support received from healthcare professionals. CONCLUSIONS: A high level of support for feeding was demonstrated together with strong perceptions across all groups that feeding was successful. It is important for healthcare professionals to consider the perceptions of the parents throughout decision making and provision of care following PEG placement because it is highly likely there will be differences in the perceptions between parents and healthcare professionals.     

Occupational health and safety policy and psychosocial risks in Europe: The role of stakeholders’ perceptions

Introduction

Psychosocial risks are now largely acknowledged throughout Europe as important challenges in occupational health and safety. However, there appear to be wide gaps in perception between experts and the general population on the nature and the relevance of psychosocial risks that have a potential impact on policy development and implementation in this area.

Methods

This study investigated the level of knowledge among European stakeholders, of legislation on occupational safety and health, focusing particularly on psychosocial risk factors. 75 members of employers’ associations, trade unions and government institutions from 21 countries in the European Union (EU) participated in the study. In addition, to further elaborate the findings of the survey, focus groups were organised during a 2-day stakeholder workshop.

Results

The level of application of European Directive 89/391 for the assessment and management of psychosocial risks and work-related stress was largely reported by the stakeholders as inadequate. This opinion was more marked in the new EU27 countries than the older EU15, and the difference was significant as regards the impact of the Directive on the assessment and management of psychosocial risks. Overall, psychosocial risks and work-related stress were reported to be important occupational health and safety concerns; however there were important differences among stakeholders in different countries.

Conclusions

Despite the development of knowledge and activities on both the policy and practice levels in recent years, further work is still needed to harmonize stakeholder perceptions in this area in the various EU member states.