Challenges in healthcare delivery in an economic downturn,in the Republic of Ireland

carney m . (2010) Journal of Nursing Management 18 , 509–514
Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland Aim The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. Background Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. Evaluation Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study’s aim. Key issues Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. Conclusions In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. Implications for nursing management As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.     

Science and Art at the Bedside

Abstract

Paramedics are increasingly seen as an integral component of health systems in high income countries. This editorial discusses the factors driving the evolution of paramedicine and the role paramedics may play in the delivery of community-based palliative care. The challenges facing paramedics in palliative care contexts are reviewed briefly. Ultimately, this editorial argues that paramedics are important stakeholders in the delivery of community-based palliative care and have been a notable omission in health service policy and planning.     

“Oh,older people,it's boring”: Nurse academics’ reflections on the challenges in teaching older person's care in Australian undergraduate nursing curricula

BackgroundNursing students encounter older people in all health care sectors; however, few choose a career primarily focused on older person's care.AimTo explore the challenges to teaching older person's care to Bachelor of Nursing students and how pre-registration nursing students are prepared to care for older people, part of a large study investigating content on care of older people in Australian nursing curricula.MethodsA purposive sample of Australian nurse academics involved in Bachelor of Nursing curriculum development or delivery completed a telephone-assisted survey. Qualitative content analysis of two open-ended questions was undertaken.ResultsAll Australian schools of nursing participated, and 45 nurse academics were interviewed. Reflecting on the challenges of teaching older person's care to nursing students, most participants felt the curriculum was too crowded and some called for a 4 year degree. In addition, students’ ageist attitudes, fuelled by unrealistic portrayals of nursing in popular culture, were reinforced by curricula being acute care focused and the ageist attitudes of some nurse academics.ConclusionsTeaching older person's care in Australian nursing curricula is challenged by insufficient time and ageism among students and academics. Regulatory bodies need to urgently provide direction so that nursing curricula content aligns with emerging Australian health care priorities, in particular the health care needs of older people.     

COVID-19-related disruptions in implementation of a randomized control trial: An autoethnographic report

Background and aimsThe SARS-Cov-2 virus (COVID-19) has not only threatened the health of the world's population but also presented challenges for conducting human subject research studies. Although many institutions have now established guidelines for conducting research during the COVID-19 pandemic, reports of the practical experiences of researchers are limited. This report presents the challenges nurse researchers encountered when conducting a randomized controlled trial to develop an arthritis self-management application during the COVID-19 pandemic in Taiwan and how researchers responded to the challenges.MethodsQualitative data from five nurse researchers were collected from August 2020 to July 2022 at a rheumatology clinic in northern Taiwan. This collaborative autoethnographic report was drawn from data comprised of detailed field notes and weekly discussions regarding research challenges we were confronting. Data were analyzed to determine successful strategies employed to overcome the challenges and allow for completion of the study.ResultsMinimizing the risk of exposure to the virus for researchers and participants resulted in four major challenges to conducting our research: patient screening and recruitment, delivery of the intervention, obtaining follow-up data, and unanticipated budget increases.ConclusionsChallenges reduced sample size, altered intervention delivery, increased time and money beyond what was originally budgeted, and delayed completion of the study. Adapting to a new healthcare environment required flexibility for recruitment, alternate means of providing intervention instructions, and an awareness of disparities in participants' internet proficiency. Our experiences can serve as an example for other institutions and researchers faced with similar challenges.     

Do attitudes and behavior of health care professionals exacerbate health care disparities among immigrant and ethnic minority groups? An integrative literature review

ObjectivesRecent investigations of ethnicity related disparities in health care have focused on the contribution of providers’ implicit biases. A significant effect on health care outcomes is suggested, but the results are mixed. The purpose of this integrative literature review is to provide an overview and synthesize the current empirical research on the potential influence of health care professionals’ attitudes and behaviors towards ethnic minority patients on health care disparities.DesignIntegrative literature review.Data sourcesFour internet-based literature indexes – MedLine, PsychInfo, Sociological Abstracts and Web of Science – were searched for articles published between 1982 and 2012 discussing health care professionals’ attitudes or behaviors towards ethnic minority patients.Review methodsThematic analysis was used to synthesize the relevant findings.ResultsWe found 47 studies from 12 countries. Six potential barriers to health care for ethnic minorities were identified that may be related to health care professionals’ attitudes or behaviors: Biases, stereotypes and prejudices; Language and communication barriers; Cultural misunderstandings; Gate-keeping; Statistical discrimination; Specific challenges of delivering care to undocumented migrants.ConclusionsData on health care professionals’ attitudes or behaviors are both limited and inconsistent. We thus provide reflections on methods, conceptualization, interpretation and the importance of the geographical or socio-political settings of potential studies. More empirical data is needed, especially on health care professionals’ attitudes or behaviors towards (irregular) migrant patients.     

Establishing Research Priorities for the Emergency Severity Index Using a Modified Delphi Approach

IntroductionThe accuracy of an initial ED triage decision has been reported to drive the clinical trajectory for ED patients, and, therefore, this assessment is critical to patient safety. The Emergency Severity Index—a 5-point score assigned by a triage nurse and based on disease acuity, patient potential for decompensation, and anticipated resource use—is used both in the United States and internationally. In the US, the Emergency Severity Index is used by up to 94% of the academic medical center emergency departments. In 2020, the Emergency Nurses Association acquired the intellectual property rights to the Emergency Severity Index and is responsible for its maintenance and improvement.ObjectiveThe purpose of this study was to establish a research agenda for the improvement of individual and institutional understanding and use of the Emergency Severity Index.MethodsModified Delphi process was used with 3 rounds of data collection.ResultsRound 1 yielded 112 issues, which were collapsed into 18 potential research questions in 4 general categories: education and training (6 questions), workplace environment (3 questions), emergency care services (7 questions), and special populations (2 questions). These questions were used in round 2 to establish importance. Round 3 yielded a rank ordering of both categories and research questions.DiscussionThe research priorities as set through the use of this modified Delphi process align well with current gaps in the literature. Research in these areas should be encouraged to improve the understanding of educational, environmental, and process challenges to emergency nurses’ triage decisions and accuracy of Emergency Severity Index assignments.     

The Role of Telehealth During the COVID-19 Pandemic Across the Interdisciplinary Cancer Team: Implications for Practice

ObjectiveThis literature review aims to explore the role of telehealth during the COVID-19 pandemic across the interdisciplinary cancer care team.Data SourcesElectronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and gray literature were searched using Google Scholar up until September 2020.ConclusionAlthough the safe and effective delivery of cancer care via telehealth requires education and training for health care professionals and patients, telehealth has provided a timely solution to the barriers caused by the COVID-19 pandemic on the delivery of interdisciplinary cancer services. Globally, evidence has shown that telehealth in cancer care can leverage an innovative response during the COVID-19 pandemic but may provide a long-lasting solution to enable patients to be treated appropriately in their home environment. Telehealth reduces the travel burden on patients for consultation, affords a timely solution to discuss distressing side effects, initiate interventions, and enable possible treatment additions and/or changes.Implications for Nursing PracticeGlobal public health disasters pose significant and unique challenges to the provision of necessary services for people affected by cancer. Oncology nurses can provide a central contribution in the delivery of telehealth through transformational leadership across all domains and settings in cancer care. Oncology nurses provide the “hub of cancer care” safely embedded in the interdisciplinary team. Telehealth provides a solution to the current global health crisis but could also benefit the future provision of services and broad reach clinical trials.     

An Online Competency-Based Spiritual Care Education Tool for Oncology Nurses

ObjectiveThe importance of spiritual care for the nursing profession has been long established. In many health care settings, including oncology, patients facing illness, suffering, and imminent death can struggle with existential questions of purpose and meaning-making. Recent research provided a competency-based educational framework to prepare nurses and nursing students to address these spiritual needs.Data SourcesThis qualitative study evaluated the impact of the implementation of online educational tools across four nursing bachelor's programs to acquire competencies focused on addressing spiritual care needs.ConclusionResults showed that the tool added to the awareness of students and impacted among between students, teachers, and patient.Implications for Nursing PracticeThe results underscored the need for structural and methodical implementation of technically challenging online tools because this impacts the feasibility and applicability of blended learning.     

A web-based patient activation intervention to improve hypertension care: Study design and baseline characteristics in the web hypertension study

BackgroundDespite the known health risks of hypertension, many hypertensive patients still have uncontrolled blood pressure. Clinical inertia, the tendency of physicians not to intensify treatment, is a common barrier in controlling chronic diseases. This trial is aimed at determining the impact of activating patients to ask providers to make changes to their care through tailored feedback.MethodsDiagnosed hypertensive patients were enrolled in this RCT and randomized to one of two study groups: (1) the intervention condition – Web-based hypertension feedback, based on the individual patient's self-report of health variables and previous BP measurements, to prompt them to ask questions during their next physician's visit about hypertension care (2) the control condition – Web-based preventive health feedback, based on the individual's self-report of receiving preventive care (e.g., pap testing), to prompt them to ask questions during their next physician's visit about preventive care. The primary outcome of the study is change in blood pressure and change in the percentage of patients in each group with controlled blood pressure.ConclusionFive hundred participants were enrolled and baseline characteristics include a mean age of 60.0 years; 57.6% female; and 77.6% white. Overall 37.7% participants had uncontrolled blood pressure; the mean body mass index (BMI) was in the obese range (32.4) and 21.8% had diabetes. By activating patients to become involved in their own care, we believe the addition of the web-based intervention will improve blood pressure control compared to a control group who receive web-based preventive messages unrelated to hypertension.     

Emergency Care Research Funding in the Global Health Context: Trends,Priorities, and Future Directions

Over the past few decades there has been a steady growth in funding for global health, yet generally little is known about funding for global health research. As part of the 2013 Academic Emergency Medicine consensus conference, a session was convened to discuss emergency care research funding in the global health context. Overall, the authors found a lack of evidence available to determine funding priorities or quantify current funding for acute care research in global health. This article summarizes the initial preparatory research and reports on the results of the consensus conference focused on identifying challenges and strategies to improve funding for global emergency care research. The consensus conference meeting led to the creation of near‐ and long‐term goals to strengthen global emergency care research funding and the development of important research questions. The research questions represent a consensus view of important outstanding questions that will assist emergency care researchers to better understand the current funding landscape and bring evidence to the debate on funding priorities of global health and emergency care. The four key areas of focus for researchers are: 1) quantifying funding for global health and emergency care research, 2) understanding current research funding priorities, 3) identifying barriers to emergency care research funding, and 4) using existing data to quantify the need for emergency services and acute care research. This research agenda will enable emergency health care scientists to use evidence when advocating for more funding for emergency care research.     

Exploring the Impact of the Coronavirus Pandemic on Pediatric Palliative Care Clinician Personal and Professional Well-Being: A Qualitative Analysis of U.S. Survey Data

ContextThe COVID-19 pandemic has had a dramatic impact on palliative care delivery and patient experiences. Less is known about the experiences and responses of palliative care clinicians.ObjectiveWe aimed to describe the pandemic's impact on pediatric palliative care clinicians' personal and professional well-being.MethodsThe Palliative Assessment of Needed DEvelopments & Modifications In the Era of Coronavirus (PANDEMIC) cross-sectional online survey was posted on 7 professional listservs between May and June 2020. We conducted a conventional content analysis of written responses to three open-ended questions regarding the lasting impact of COVID-19.ResultsOf 207 multidisciplinary respondents from 80 US cities, 148 (71%) provided written responses to open-ended questions, and 62 responses (42%) were related to personal, professional, or existential well-being. These responses were sorted into 4 major categories: personal burdens, professional burdens, personal benefits, and professional benefits. Respondents described burdens more commonly than they did benefits (67% vs. 33% of comments, respectively). Personal burdens related to increased fear and uncertainty, fear of bringing the virus home, and a sense of collective grief. Professional burdens included a sense of exhaustion, a challenge with work-life balance, personal experiences with colleagues infected with the virus, and considerations of leaving health care altogether. Personal benefits included lessons learned, an evolving sense of what matters, and improved work-life balance. Professional benefits included opportunities for professional development and a sense of professional purpose.ConclusionPediatric palliative care clinicians perceive a breadth of impacts from the COVID-19 pandemic. Ongoing clinician assessment is important as the pandemic continues.     

Disability and the COVID-19 Pandemic: A Survey of Individuals With Traumatic Brain Injury

ObjectivesTo identify the consequences of the coronavirus 2019 (COVID-19) pandemic for individuals with traumatic brain injury (TBI), with particular attention to unique effects for individuals with chronic disability.DesignIndividuals with and without a history of TBI completed a web-based survey.SettingParticipants were recruited from the Vanderbilt Brain Injury Patient Registry in Nashville, TN, and completed the survey from their homes between May and June 2020, during social distancing related to the COVID-19 pandemic.ParticipantsParticipants (N=47) in the chronic phase of moderate-severe TBI (>6mo postinjury) and 51 noninjured comparison (NC) peers completed the survey.InterventionsNot applicable.Main Outcome MeasuresParticipants, or respondents, answered a mix of multiple choice and free text questions about how the COVID-19 pandemic has affected their work, education, medical care, social communication, sources of information and decision making, and mental and physical well-being. Individuals with TBI also answered questions about how TBI has affected their experiences of the pandemic.ResultsAs a group, respondents with TBI reported less pandemic-related behavior change (eg, daily habits, virtual social visits, and masking) than NC peers. Both NCs and respondents with TBI identified health care providers as trusted sources of public health information. One-third of individuals with TBI indicated that brain injury has made coping with the pandemic more difficult, and respondents identified mental health challenges and social isolation as key barriers.ConclusionsThese results suggest that health care providers should look for ways to provide tailored education and reduce social isolation for individuals with disability during the ongoing COVID-19 pandemic. We discuss several direct suggestions from participant responses.     

Midwives’ perspectives of the challenges in mentoring students: A qualitative survey

ProblemNational professional standards dictate that all practitioners should provide mentorship to students, however students often report a lack of interest from many mentors while on placement.BackgroundIt is important that academic researchers investigate issues that can inform us of how the student/mentor relationship is facilitated and supported.AimThe aim of the project was to explore the perspectives of midwifery mentors who had experienced challenges with mentoring students, to determine what the challenges are, and what support they need, as mentors.MethodsAn online anonymous survey containing qualitative questions was used to identify the challenges faced by mentors, and asked them to provide recommendations for improving their delivery of mentorship. Three themes emerged; challenges of providing mentorship – student related; challenges of providing mentorship – work related; and what needed to be done to improve mentoring.DiscussionMentors shared their experiences of mentoring students and the issues they had faced.ConclusionsRecommendations are made that acknowledges the important role of midwifery mentorship and suggest the introduction of preparation for mentorship training for midwives working with students.     

Equity in clinical practice requires organisational and system-level change – The role of nurse leaders

BackgroundIn the International Year of the Nurse and Midwife 2020, nurses in Australia and around the world are being encouraged to lend their voices to lead change. The COVID-19 global health crisis has highlighted the critical role of nurses in our community in ensuring that the challenges to our health care system are being met and overcome. It has also brought attention to existing health inequities in our community, in particular the poorer health of refugees, some culturally and linguistically diverse communities and Aboriginal and Torres Strait Islander peoples.AimTo call on nurses and nurse leaders to take greater action to improve health equity.MethodsThis paper presents a discussion with regard to the importance of equitable and safe clinical practice and the urgent need to address organisational and system-level barriers to the provision of equitable health care.FindingsClinicians’ abilities and capacities to provide equitable care is ultimately shaped by health care organisations and the broader historical, political, social and economic context of our community.DiscussionEquity should not only be reflected in clinical practice, but also in organisational policies and procedures, embedded in key performance indicators and supported by adequate funding and resources.ConclusionSystemic inadequacies are likely to be further amplified during times when the health system is under additional pressure. Nurses and nurse leaders should take this opportunity to reflect upon the integral role they play in addressing organisational and system-level change to ensure equity in health care delivery. We call on nurse leaders and the nursing profession to lead us all to a more equitable health care system and society.     

Strengthening policy research and development through foreign aid: the case of reducing deforestation and forest degradation in Indonesia

ABSTRACT

This paper discusses work carried out in Indonesia to strengthen research capacity and support policy development for the implementation of the United Nations Framework Convention on Climate Change’s mechanism for Reducing Emissions from Deforestation and Forest Degradation (REDD+). It addresses the questions: in an apparently receptive policy environment, what are the challenges facing the adoption of recommendations generated by policy research funded by foreign-funded projects, and what are the implications for the evaluation of the research? The paper reflects on some of the key research findings, on the contributions that capacity building for research can make to policy development, and on some of the challenges faced by policy-focused research projects and their assessment. It shows that many factors can influence the adoption of policy recommendations generated by research, leading to significant challenges for the evaluation of policy research activities.     

Defining and classifying aggression and violence in health care work

BackgroundThere is considerable contention in defining workplace aggression, especially in health care. This can lead to challenges in effectively researching workplace aggression, and ensuring a sound basis for developing strategies to prevent and minimise its likelihood and consequences.AimThe aim of this discussion paper is to provide a pragmatic definition of workplace aggression, based on a contemporary conceptualisation of human aggression, followed by a discussion on key classifications of workplace aggression.MethodsThe argument presented draws on theoretical and applied literature to develop a case for adopting a pragmatic definition of aggression, with key classification components.Findings and DiscussionA highly practical conceptualisation of workplace aggression differentiates two main forms – verbal or written and physical aggression – and two main source groups – internal (co-workers) and external (patients, their relatives or carers and others external to the workplace).ConclusionClarity and consensus on defining and classifying workplace aggression, should provide a sound and coherent basis for researchers, policy makers, clinicians and health care organisations to successfully prevent and minimise this challenging and serious work health and safety concern.     

Electronic Collaboration: Using Technology to Solve Old Problems of Quality Care

The participants of the Electronic Collaboration working group of the 2010 Academic Emergency Medicine consensus conference developed recommendations and research questions for improving regional quality of care through the use of electronic collaboration. A writing group devised a working draft prior to the meeting and presented this to the breakout session at the consensus conference for input and approval. The recommendations include: 1) patient health information should be available electronically across the entire health care delivery system from the 9‐1‐1 call to the emergency department (ED) visit through hospitalization and outpatient care, 2) relevant patient health information should be shared electronically across the entire health care delivery system, 3) Web‐based collaborative technologies should be employed to facilitate patient transfer and timely access to specialists, 4) personal health record adoption should be considered as a way to improve patient health, and 5) any comprehensive reform of regionalization in emergency care must include telemedicine. The workgroup emphasized the need for funding increases so that research in this new and exciting area can expand. ACADEMIC EMERGENCY MEDICINE 2010; 17:1312–1321 © 2010 by the Society for Academic Emergency Medicine