Rural nurses’ perceptions of a volunteer program in an acute setting: Volunteers delivering person-centred care for patients with dementia and delirium

Community volunteers were recruited and trained to deliver person-centred care to patients with dementia or delirium in an acute hospital setting, in a small rural Australian hospital. The volunteer program was grounded in action research methodology, and modelled on a previous research project. As a form of evaluation, interviews were conducted with nursing staff eight weeks after implementation of the volunteer program to explore their opinions. Data were analysed through a collaborative process and findings revealed strong benefits from the perspectives of the nursing staff. These benefits included overall improved patient care and improved time management for nursing tasks.

Evidence of Linkages between Patient Safety and Person-Centred Care in the Maternity and Obstetric Context—An Integrative Review

The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of patient safety has expanded, as have the models of person-centred care. Inspired by this new trend, we collated and summarized the literature for evidence of the two topics. The study was guided by Russell, Whittemore and Knafl’s integrative review framework. An electronic database search was conducted for relevant articles from 2005 to 2016. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The structure and process of the evaluation of the evidence are described and the findings interpreted by means of a thematic synthesis. One theme emerged: trustful, safe communication in the relationship between the patient, family members and healthcare professionals and two domains;safety culture and multidisciplinary capacity building. The dominant dimension in the safety culture domain is respectful communication, which implies sharing experiences that lead to a sense of control during labour and birth and is related to the women’s feeling of personal capacity. The dominant dimensions in the multidisciplinary capacity building domain are collaborative teamwork, coordination and risk management, knowledge sharing and patient-centred communication. In conclusion, to enhance patient safety, it is necessary to develop patient-focused, evidence-based skills and guidelines as well as a supportive organization. Due to their interaction with patients, midwives’ communication competence on the part of midwives is essential for supporting the birth and fulfilling the women’s needs and expectations.

The Benefits of Person-Centred Clinical Supervision in Municipal Healthcare—Employees’Experience

Satisfied employees in healthcare services who have opportunities to develop their professional competence by reflecting on professional challenges play an important role in the quality of care. The aim of the present study was to describe the employees’ experience of the benefits of participating in a person-centred clinical supervision setting. The supervision, guided by a professional supervisor, was carried out with a group of six day- and night-shift municipal healthcare professionals for a period of four months during their mandatory work hours. Data were obtained from written individual evaluations and group interviews shortly after the last session and again twelve months later. The results showed that the participants experienced that their internal resources and coping skills had been strengthened by the supervision. They developed abilities to meet the challenges more constructively than before. New understandings gave them the opportunity to alternative actions in practice. Further intervention studies of person-centred clinical supervision must focus on such clinical outcomes as patient safety and professional development.

Comorbidities between tuberculosis and common mental disorders:a scoping review of epidemiological patterns and person-centred care interventions from low-to-middle income and BRICS countries

Background:There is increasing evidence that the substantial global burden of disease for tuberculosis unfolds in concert with dimensions of common mental disorders.Person-centred care holds much promise to ameliorate these comorbidities in low-to-middle income countries(LMICs)and emerging economies.Towards this end,this paper aims to review 1)the nature and extent of tuberculosis and common mental disorder comorbidity and 2)person-centred tuberculosis care in low-to-middle income countries and emerging economies.Main text:A scoping review of 100 articles was conducted of English-language studies published from 2000 to 2019 in peer-reviewed and grey literature,using established guidelines,for each of the study objectives.Four broad tuberculosis/mental disorder comorbidities were described in the literature,namely alcohol use and tuberculosis,depression and tuberculosis,anxiety and tuberculosis,and general mental health and tuberculosis.Rates of comorbidity varied widely across countries for depression,anxiety,alcohol use and general mental health.Alcohol use and tuberculosis were significantly related,especially in the context of poverty.The initial tuberculosis diagnostic episode had substantial sociopsychological effects on service users.While men tended to report higher rates of alcohol use and treatment default,women in general had worse mental health outcomes.Older age and a history of mental illness were also associated with pronounced tuberculosis and mental disorder comorbidity.Person-centred tuberculosis care interventions were almost absent,with only one study from Nepal identified.Conclusions:There is an emerging body of evidence describing the nature and extent of tuberculosis and mental disorders comorbidity in low-to-middle income countries.Despite the potential of person-centred interventions,evidence is limited.This review highlights a pronounced need to address psychosocial comorbidities with tuberculosis in LMICs,where models of person-centred tuberculosis care in routine care platforms may yield promising outcomes.

E-Health and Telemedicine: Current State and Future Steps

The article reviews the questions related to building the e-health systems. The key element of the system is electronic healthcare record to be formed according to the modular approach in the form of primary and satellite electronic medical records. Person-centred healthcare is proposed as a foundation for e-health. Such an approach provides a potential opportunity for all the medical doctors to obtain necessary information about their patients at any time via the teleconsultations in particular. Transition to e-health is associated with the creation of new opportunities for making diagnostic and therapeutic decisions based on the use of build-in decision support modules. The computer-assisted software design or hybrid systems are considered as the fourth generation medical information systems. It is reasonable to implement the entire information space of e-health, including the information systems of medical institutions and regional data repositories, based on cloud-optimized storage and computing solutions. This approach is expected to be implemented in Russia as a part of the unified state health information system. The authorized access to integrated databases for medical doctors of various specialties is required. In the framework of e-health, telemedicine is considered as an important component. Main elements comprise the real-time access of medical consultants to personified medical databases and remote follow-up of patients by the means of personal or home-based telemedicine. The use of personal portable devices for the control of vital signs of the organism is especially promising. Electronic stethoscopes and specialized video cameras for acquiring objective information should be increasingly used by remote consultants. Unfortunately, this trend is still underdeveloped in Russia. In perspective, e-health as unified medical space will provide a transition to the integrated analysis of population health by medical doctors of various specialties from different countries and will open new prospects for studying health based on the intelligent analysis of integrated data of patients.

Health, Wellbeing and Self-Esteem: Web-Based Support in Children with Urogenital or Bowel Malformation

Children with urogenital malformation or bowel disturbances are a vulnerable group and are at risk of experiencing ill health. At school they have to face and cope with situations they are unused to and often feel excluded. There is a lack of studies investigating prevention of ill health in this group of children. Objective: The aim of the study was to investigate the health/well-being and self-esteem, before and after a one-year intervention comprising person-centred, web-based learning support, in preschool children born with malformations in the urethra, bladder, genitals and/or bowel. Study design: Nine boys and one girl participated, aged 3 - 7 years (study group) with diagnoses of epispadia, bladder exstrophy, urethra valves and Hirschprung’s disease. Two questionnaires were used, developed to measure index of health/wellbeing and self-esteem in younger children. In the study group, the interviews were repeated after one year. The group was compared with a control group of 20 healthy, age-matched children. Results: Before the intervention, there were no differences in wellbeing (Children condition index) between the study group and the control group. One year after the start of the web-based preschool, wellbeing in the study group had slightly improved, but not significantly compared to before the intervention. No significant difference was found compared to the control group. When measured self-esteem (I think I am) before the intervention, the study group had significantly better self-esteem compared to the control group. One year later, there was a slight improvement in self-esteem, but two children scored worse in the domain Psychological wellbeing. In comparison with the group of healthy children, the self-esteem in the study group was better for total sum (p = 0.0002). Discussion: Wellbeing and self-esteem seem to be good in children aged 3 - 7 years with uro-genital and bowel malformations, according to the findings of this study. This is better than reports concerning older children. Despite high initial values compared to healthy children, continued, but not significant, improvement in wellbeing and self-esteem was shown one year after intervention. Conclusions: The results of the intervention aimed at promoting health, wellbeing and self-esteem are promising but a longer-term follow-up in a larger group of children is needed.

Identifying contextual determinants of problems in tuberculosis care provision in South Africa: a theory-generating case study

Background:Despite progress towards End TB Strategy targets for reducing tuberculosis(TB)incidence and deaths by 2035,South Africa remains among the top ten high-burden tuberculosis countries globally.A large challenge lies in how policies to improve detection,diagnosis and treatment completion interact with social and structural drivers ofTB.Detailed understanding and theoretical development of the contextual determinants of problems inTB care is required for developing effective interventions.This article reports findings from the pre-implementation phase of a study ofTB care in South Africa,contributing to HeAlth System StrEngThening in Sub-Saharan Africa(ASSET)-a five-year research programme developing and evaluating health system strengthening interventions in sub-Saharan Africa.The study aimed to develop hypothetical propositions regarding contextual determinants of problems inTB care to inform intervention development to reduce TB deaths and incidence whilst ensuring the delivery of quality integrated,person-centred care.Methods:Theory-building case study design using the Context and Implementation of Complex Interventions(CICI)framework to identify contextual determinants of problems in TB care.Between February and November 2019,we used mixed methods in six public-sector primary healthcare facilities and one public-sector hospital serving impoverished urban and rural communities in the Amajuba District of KwaZulu-Natal Province,South Africa.Qualitative data included stakeholder interviews,observations and documentary analysis.Quantitative data included routine data on sputum testing andTB deaths.Data were inductively analysed and mapped onto the seven CICI contextual domains.Results:Delayed diagnosis was caused by interactions between fragmented healthcare provision;limited resources;verticalised care;poorTB screening,sputum collection and record-keeping.One nurse responsible forTB care,with limited integration ofTB with other conditions,and policy focused on treatment adherence contributed to staff stress and limited consideration of patientsz psychosocial needs.Patients were lost to follow up due to discontinuity of information,poverty,employment restrictions and limited support for treatment side-effects.Infection control measures appeared to be compromised by efforts to integrate care.Conclusions:Delayed diagnosis,limited psychosocial support for patients and staff,patients lost to follow-up and inadequate infection control are caused by an interaction between multiple interacting contextual determinants.TB policy needs to resolve tensions between treating TB as epidemic and individually-experienced social problem supporting interventions which strengthen case detection,infection control and treatment,and also promote person-centred support for healthcare professionals and patients.