Referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state,Nigeria

Objective:This study aimed to examine the referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state of Nigeria.Materials and Methods:A concurrent embedded descriptive mixed method consisting of both quantitative and qualitative methods was adopted for the study.Participants(104)were recruited using multistage sampling and 8 participants using purposive sampling techniques for quantitative and qualitative aspects of the study,respectively.The three-phase delay model directed the study.A self-developed structured questionnaire and an in-depth interview guide were used to elicit quantitative and qualitative responses from the participants.Quantitative instrument was tested for reliability,while the qualitative instrument went through the rigors of qualitative data.Results:Findings revealed low level of referral and counter-referral practices as only 19(18.27%)and 30(28.85%),respectively,of care providers referred patients above 10 times in a year.The study also revealed inadequate human and material resources for referrals and counter-referrals.The mean on barriers to referral was 2.90,which was above the cutoff of mean of 2.50,which indicates that the barriers are militating against referral and counter-referral in obstetric emergencies.Conclusions:Low levels of referral and counter-referral practices are identified with inadequate resources among others posing as barriers.Therefore,provision of standard operational procedures/protocols in every health-care facility as well as provision of adequate material and skilled human resources among others is recommended to enhance referral and counter-referral network in obstetric emergencies.There is also a need for teamwork and synergy among all stakeholders in the referral chain.

DOST Model’ for DR-TB Patients, New Delhi: Perspectives of Healthcare Providers

Introduction: In India, tuberculosis continues to be a major public health problem and there is a growing concern about drug-resistant tuberculosis as most of the patients are from private sector. The National TB Elimination Programme (NTEP) in collaboration with TB Alert, India (TBAI) and Clinton Health Association of India (CHAI) had implemented a collaborative project to strengthen the network between the private practitioners and public healthcare facilities in New Delhi during 2019 and 2020. Methods: A study was conducted to understand the enablers and challenges encountered by them during the implementation of the project. This is a qualitative exploration of the “healthcare providers” on a project linking DR-TB patients in private sector with government health facilities. The process of data collection involved face-to-face in-depth interviews of healthcare providers, the Doctors mainly from private and public health facilities, the paramedical workers from general health system and paramedical from the project using an interview guide administered through a trained researcher. Results: The study findings revealed that all healthcare providers were completely aware of the DOST project in the health system, the model led to early diagnosis and initiation of quality treatment. There were no major challenges to the implementation of the project. The healthcare providers wish to have this project implemented for a longer duration. Conclusion: The perspectives of healthcare providers towards the “DOST” project were optimistic and call for re-initiating the project in the area.

The Extent of Partograph Use and Associated Factors among Obstetric Care Providers in Government Hospitals in Southern Ethiopia: A Cross-Sectional Study

Background: Prolonged labor is a significant contributor to maternal morbidity and mortality. The World Health Organization encourages using the partograph to keep track and solve this issue. The extent of partograph use in Ethiopia, however, is hardly understood. This study aimed to ascertain the level of partograph use and related variables among obstetric care providers in government hospitals in southern Ethiopia. Methods: A cross-sectional institutional study was conducted among obstetric care providers in government hospitals in southern Ethiopia, from March to December 2015. The data were collected using a pre-tested questionnaire and format. To establish a statistical relationship, an odds ratio with a 95% confidence interval was utilized. Results: A total of 212 (55.1%) obstetric providers reported routine use of partograph to monitor labor. Midwives [AOR: 3.4, 95% CI: (1.2, 9.4)], clinical nurses [AOR: 3.0, 95% CI: (1.1, 7.6)], knowledge of partographs [AOR: 2.0, 95% CI: (1.2, 3.5)], positive attitudes toward partograph use [AOR: 3.7, 95% CI: (1.7, 7.7)], service of 2 - 5 years [AOR: 3.4, 95% CI: (2.8, 4.4)] and service of more than five years [AOR: 2.3, 95% CI: (2.0, 3.3)] were associated with partograph use. Conclusion: This study has shown that the use of partographs to monitor labor among obstetricians is consistent with other studies from developing countries. However, this does not mean that obstetric care does not need to be strengthened, as a significant proportion of obstetricians still do not use the partograph for labor monitoring. Therefore, it is recommended that midwives and nurses be given preference in the delivery of obstetric services, the knowledge and attitudes of providers be improved, and mechanisms be developed that can help keep senior care providers.

The impact of Hurricane Maria on Puerto Rico’s health system:post-disaster perceptions and experiences of health care providers and administrators

Background:After its landfall in Puerto Rico in 2017,Hurricane Maria caused the longest blackout in United States history,producing cascading effects on a health care system that had already been weakened by decades of public sector austerity and neoliberal health reforms.This article addresses how health care professionals and administrators experienced the health care system’s collapse and the strategies used by them to meet their communities’health needs.Methods:Data were collected between September 2018 and February 2020.Ethnographic observations in health care facilities and semi-structured qualitative interviews with representatives of the health care system were conducted.This paper focuses on data from interviews with health care providers(n=10)and administrators(n=10),and an ethnographic visit to a pop-up community clinic.The analysis consisted of systematic thematic coding of the interview transcripts and ethnographic field notes.Results:Results provide insight on how participants,who witnessed first-hand the collapse of Puerto Rico’s health care system,responded to the crisis after Maria.The prolonged power outage and lack of a disaster management plan were partly responsible for the death of 3,052 individuals who experienced extended interruptions in access to medical care.Participants reported a sense of abandonment by the government and feelings of mistrust.They also described the health sector as chaotic and lacking clear guidelines on how to provide services or cope with personal crises while working under extreme conditions.In such circumstances,they developed resilient responses to meet communities’health needs(e.g.,itinerant acupuncture services,re-locating physicians to local pharmacies).Conclusions:Participants’narratives emphasize that the management of Hurricane Maria was fraught with political and economic constraints affecting Puerto Rico.Ineffective planning and post-Maria responses of the local and federal governments were determinants of the disaster’s impact.The findings contribute to a growing scientific literature indicating that Hurricane Maria revealed‘the collapse before the collapse,’alluding to the structural deficiencies that presaged the catastrophic event.In the context of governmental abandonment,the authors argue for the importance of developing alternative strategies in post-disaster health care provision among health professionals and administrators who work at the front lines of recovery.

Reasons for informal payments from the perspective of health care providers and recipients:a qualitative study in Iran

Background:Informal payments are one of the major obstacles to health system reform in many developing countries,and its elimination is on the agenda of health system policymakers in many countries,including Iran.This study was conducted to identify the causes of informal payments in the Iranian health system.Methods:This was a qualitative and exploratory study.The study environment included the Ministry of Health,physicians’offices,medical universities,and hospitals and health centers.The study population included health care providers(physicians and hospital staff,managers,supervisors,and nurses)and health care recipients(patients or patients who had a history of dealing with informal payments).Data were collected using open-ended questions and semi-structured interviews.Snowball sampling method was used to select managers,chief executive officers(CEOs)and nurses.Convenience sampling was used to select physicians due to their lack of participation and cooperation.Content analysis method was used to analyze the data.Results:Reasons for informal payments were divided into 4 themes including:Economic factors(improper tariff valuation of services;failure to increase tariffs proportionate to inflation;lack of comprehensive participation of stakeholders in determining tariffs;tariff inconsistency in the public,private and charity sectors;etc.);socio-cultural factors(decreased social capital of the medical community among the people;improving the quality of life;incorrect comparison of providers’income levels with the income of doctors in other countries;existence of a culture of gratitude and appreciation;health as a priority for society;pride of service recipients;pride of service providers;etc.);service delivery challenges(high professional skills of the doctor;use of modern medical equipment;the monopoly of some doctors,etc.)and legal-political factors(inadequate monitoring by upstream organizations;lack of strict rules;difficulty of proving informal payments;presence of stakeholders in management and policy making processes).Conclusions:Knowing the causes of informal payments can help reduce or eliminate it.The results of this study identified the causes of informal payments in the Iranian health system.Accurate knowledge of the needs and motivations of both health care providers and recipients can be effective in accurately identifying and eliminating this phenomenon.

Association between change of health care providers and pregnancy exposure to FDA category C, D and X drugs

Background Changing health care providers frequently breaks the continuity of care,which is associated with many health care problems.The purpose of this study was to examine the association between a change of health care providers and pregnancy exposure to FDA category C,D and X drugs.Methods A 50% random sample of women who gave a birth in Saskatchewan between January 1,1997 and December 31,2000 were chosen for this study.The association between the number of changes in health care providers and with pregnancy exposure to category C,D,and X drugs for those women with and without chronic diseases were evaluated using multiple logistical regression,with adjusted odds ratios （ORs） and its 95% confidence intervals （C/s） as the association measures.Results A total of 18 568 women were included in this study.Rates of FDA C,D,and X drug uses were 14.35%,17.07%,21.72%,and 31.14%,in women with no change of provider,1-2 changes,3-5 changes,and more than 5 changes of health care providers.An association between the number of changes of health care providers and pregnancy exposure to FDA C,D,and X drugs existed in women without chronic diseases but not in women with chronic disease.Conclusion Change of health care providers is associated with pregnancy exposure to FDA category C,D and X drugs in women without chronic diseases.

People-Centered Care: Concept Analysis

Purpose: This study aims to clarify the definition, attributes, antecedents, and consequences of the concept of people-centered care (PCC). Method: Rogers and Knafl’s evolutionary method was used to analyze the concept of People-centered care. The cords such as “Attributes,” “Antecedent,” and “Consequences” were extracted on the coding sheet. The extracted contents of each of the “Attributes,” “Antecedent,” and “Consequences” from the created coding sheets were summarized as codes, and similar codes were categorized. Result: We included 33 studies in the analysis. As a result of the analysis, we identified four attributes (the subject is people, approaches to improving and enhancing health issues, relationships as a basis for partnership building, and behavioral attitudes for building partnerships), four antecedents (changes in social conditions, increasing people’s ownership of their health, health issues in modern society, and care in a variety of settings), and three consequences (achieving goals set by the people themselves, self-transformations of both people and healthcare providers, and social transformations). Discussion: Based on the analysis results, PCC was defined as “an initiative in which people step forward and partner with health care providers to improve and enhance health issues in individuals and communities.” In various social and individual changes, the realization of PCC is expected to result in the achievement of goals set by the people themselves together with health care providers and the transformation of individuals and society.

Influential factors of healthcare provider resilience in disasters:A thematic analysis

Objective:To identify the influential factors of healthcare staff resilience in disasters.Methods:In this qualitative study,the influential factors of healthcare staff resilience in disasters were investigated through interviewing 20 experts.The interviews were conducted face-to-face,and MAXQDA software version 10 was used to organize the data and thematic analysis.Results:The participants included 5 medical emergency technicians,5 physicians,2 Red Crescent technicians,and 8 nurses.The main influential factors of healthcare providers’resilience were limited relief infrastructure,supportive empowerment,organizational capitals,and contradictory consequences.Other important factors were resource limitation,confusion and uncertainty,empowerment training,comprehensive support,human and value capital,social capital,physical capital,suffering,disability,calm,and excellence.Conclusion:Improving healthcare providers’resilience can be achieved by reducing uncertainty,providing the physical,economic,and human resources,strengthening motivation and comprehensive supports.It is suggested that disaster managers consider all identified dimensions to improve the resilience of healthcare providers to serve better in disasters.Moreover,researchers should study each dimension to provide profound knowledge regarding resilience in disasters.

Closing the Gap: Characterizing Key Factors Leading to the Disparity in Suicide Rates along the Urban-Rural Continuum

Suicide is a top ten cause of mortality in the United States.In previous literature the suicide rates in rural com-munities have been reported to be greater than those of more urban communities.Additionally,these studies have discussed many potential causes for the unfortunate disparity in rates.One cause often discussed is lack of mental health care providers in rural communities.The data for this study was gathered from the CDC’s WONDER data-base and the NPPES NPI Registry.The urban-rural categorization of counties used the 2013 NCHS Urban-Rural Scheme.Statistical analysis included chi-square tests,paired t-tests,and stepwise regression analyses.Results indi-cate that both the number of residents per provider(r=0.35,p≤0.005),and urbanization level(r=0.49,p≤0.001)were significantly related to suicide rate.Additionally,even after controlling for provider rates,each additional level of rurality predicted an increase of 1.2 suicides per 100,000 residents.Ultimately,the number of providers may play a major role in suicide rates,but extra effort must also be made in rural communities to combat the other contextual factors leading to increased suicide rates.

Translation, Cultural Adaption and Validation of Hospital Survey on Patient Safety Culture in Kosovo

Background: An essential condition to improve patient safety is considered to ensure a supportive patient safety culture. Measuring the culture of patient safety in all health care institutions may be a first step to target improvements. Creating a culture of safety requires eliminating the culture of blame. In order to formulate actions for improvement, it is important for hospitals to assess their baseline scores for the existing safety culture and to determine the areas of priority. Aim: The aim of this study was first to measure the use, translation in Albanian and adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) assessment as a tool for improving patient safety in Kosovo Hospitals. The second aim was to measure the level of patient safety culture in Kosovo, in seven hospitals and one University Clinical Center (hospitals with over 50 beds, including psychiatric hospitals). Method: The questionnaire (HSOPSC) was translated into Albanian for use in the Kosovo. It was used forward-backward translation: the questions were translated into Albanian by one translator and then translated back into English by an independent translator who was blinded to the original questionnaire. Results: In the eight-factor model, the internal consistency of the factors and the construct validity of the HSOPSC questionnaire were mostly satisfactory. The construct validity was sufficient for all subscales, except for the 4 other subscale regarding intention to report incidents which correlated poorly with other subscales. In total, HSOPSC has 12 dimensions. Cronbach’s α showed that in Kosovarian society, we could use only 8 dimensions model. Conclusion: The hypothesis that HSOPSC would be a suitable instrument to provide important indicators for the improvement of patient safety culture was tested and it was confirmed, that HSOPSC could be used as 8 dimension model. HSOPSC is suitable to improve patient safety culture and provide each hospital with a basic profile on patient safety culture and recommendations for an oriented intervention plan.

Hand Hygiene by Ward Staff at Dapaong Regional Hospital in Togo

Introduction: Hand hygiene (HH) is an effective way to fight infections in healthcare settings. The general purpose of our study was to explore the knowledge, attitudes and practices of health care providers on HH at Dapaong regional hospital (DRH). Methodology: This was a prospective, descriptive cross-sectional study conducted from March to June 2022 in the DRH wards. Data were collected using a questionnaire and observation grid. Results: 90 care providers were surveyed. Males and non-physician personnel predominated with 57.8%, and 94.4% respectively. The survey on staff’s knowledge reported: 31.1% of practitioners did not wash their hands on arrival and departure in services. 24% did not know the difference between simple hand washing (SHW) and hygienic hand washing (HHW). 23.3% did not know the type of soap to use for HHW. The caregivers did not know the type of hand washing (HW) required after a septic and non-septic procedure in respectively 41.6%, and 37.8%. They did not know that there are two types of hand antiseptics (45.4%), nor the amount of antiseptic for HW (78.9%). The survey on staff’s attitude regarding HW found that: 70% did not remove all jewels prior HW, and 51.1% did not know that wearing gloves cannot replace the HW. For HW Staff Practice: 62.2% did not wash their hands before treatment. 91.1% did not spread the soap on their hands and forearms after wetting them. 65.55% did not rinse hands from nails to elbows. Conclusion: The HH was poorly known, the attitude of the staff was dangerous in relation to the HH and the practice of HH was very inadequate at the RHC-Dapaong. As a result, there is a need to retrain staff to increase their capacity to prevent care-related infections and enhance patient safety in the hospital.

Are there differences between the expectations of parents, nurses and physicians when using music in NICU?

This paper aimed to describe and explain the expectations concerning the use of music in NICU from the viewpoints of parents, nurses and physicians. The relevant questionnaires were distributed to 836 participants who were recruited from the country’s five university hospitals (n = 508, response rate 61). Slightly over half of the participants preferred recorded music versus live music in the NICU. They strongly expected that their preferred music could be beneficial both for the infants, parents and staff. The parents agreed most that live music is the most suitable choice for infants (p < 0.001), and that the music could especially benefit the infant (p < 0.001) and parents (p < 0.001) compared with the nurses’ and physicians’ preferences. Some background details such as age, average length of time listening to music, musical training and experiences of using music provided significant explanations for the participants’ expectations. In conclusion, there were significant differences between the groups of the respondents concerning the type of the preferred music and its expected effects. This highlights the importance of discussion with the caregivers when taking music into regular use in the neonatal intensive care units.

Promoting Clinician Well-Being and Patient Safety Using Human Factors Science: Reducing Unnecessary Occupational Stress

Our healthcare delivery system has accumulated complexity of payment, regulation systems, expectations and requirements. Often these are not designed to align with clinical thinking process flow of patient care. As a result, clinicians are utilizing enormous mental (cognitive) resource to comply with these complexities, over and above the baseline mental effort required to give good care to the patient. Recent studies suggest a significant number of physicians, advanced practice providers and nurses no longer want to stay in healthcare due to difficult work expectations and conditions that have become unreasonable. Technology has benefitted healthcare delivery, but also is a conduit of many expectations that have been grafted upon clinician workloads, exceeding the resources provided to accomplish them. Cognitive load is a measure of mental effort and is divided into Intrinsic, Germane and Extraneous Cognitive Load. Extraneous Cognitive Load (ECL) is what is not necessary and can be removed by better design. High cognitive load is associated with increased risk of both medical error and clinician burnout. Chronic high level occupational stress occurs from dealing with this job/resource imbalance and is showing serious personal health impact upon clinicians and the quality of the work they can provide for patients. Since organizational systems have become more complex, leadership methods, clinician wellbeing and patient safety efforts need to adjust to adapt and succeed. Safety efforts have tended to predominantly follow methods of a few decades ago with predominant focus upon how things go wrong (Safety I) but are now being encouraged to include more of the study of how things go right (Safety II). Human Factors/Ergonomics (HFE) science has been used in many industries to preserve worker wellbeing and improve system performance. Patient safety is a product of good system performance. HFE science helps inform mechanisms behind Safety I and II approach. HFE concepts augment existing burnout and safety interventions by providing a conceptual roadmap to follow that can inform how to improve the multiple human/technology, human/system, and human/work environment interfaces that comprise healthcare delivery. Healthcare leaders, by their influence over culture, resource allocation, and implementation of requirements and workflows are uniquely poised to be effective mitigators of the conditions leading to clinician burnout and latent medical error. Basic knowledge of HFE science is a strategic advantage to leaders and individuals tasked with achieving quality of care, controlling costs, and improving the experiences of receiving and providing care.

Views of health service providers on obstacles to tuberculosis control in Ghana

Background:Although Ghana does not fall into the category of those countries which have a high burden of tuberculosis(TB),the disease does present considerable economic and health limitations to individuals infected with,and affected by,the disease,as well as to the health system in general.Despite this fact,insufficient studies have been done on the key barriers to controlling the disease.This paper presents results from an exploratory study on the constraints of controlling TB in Ghana based on the opinions of health service providers.Methods:In-depth interviews were conducted with frontline health workers involved in TB control in the country.Participants were purposively selected from a pool of national and regional,and district and facility level coordinators of the National Tuberculosis Control Programme(NTP).One key informant was also selected from an international non-governmental organisation(NGO)involved in TB-related activities in Ghana.Observations were utilised to complement the study.Data were analysed inductively.Results:Respondents identified the following as being constraints to TB control:clinical complication,bottlenecks in funding administration,quality of physical infrastructure,competition for attention and funding,unsatisfactory coordination between TB and HIV control programmes,a poor public-private partnership,and weak monitoring and evaluation of interventions.Conclusions:This paper provides evidence of some key barriers to TB control.The barriers,as reported,were generally health system-based.Although this list of barriers is not exhaustive,it would be useful to take them into account when planning for TB control,thus adopting a more rounded approach to TB management in the country.As well as that,further studies should be done to explore patients’views on health service-related barriers to TB control.

Sexual counseling and cardiovascular disease： practical approaches

Patients with cardiovascular disease and their partners expect health care providers to provide sexual counseling to assist them in maintaining sexual quality of life. Evidence suggests however, that there is a gap in integrating evidence into practice and that relatively few cardiac patients receive sexual counseling. This can result in negative psychological, physical, and quality of life outcomes for couples who may needlessly decide sexual activity is too risky and cease all sexual activity. Two scientific statements now exist that provide ample guidance to health care providers in discussing this important topic. Using a team approach that includes physicians, nurses, physical therapists, rehabilitation staff, and others is important to ensure that sexual counseling occurs throughout recovery. In addition, several trials using interventional approaches for sexual counseling provide insight into successful approaches for sexual counseling in practice. This article provides practical strategies and evidence-based approaches for assessment and sexual counseling for all cardiac patients and their partners, and specific counseling for those with ischemic conditions, heart failure, and implanted devices.