In-hospital interventions to promote relational practice with families in acute care settings: A scoping review

Relational practice is characterised by genuine interaction between families and healthcare professionals that promotes trust and empowerment. Positive clinical outcomes have been associated with relational practice. To assess and examine in-hospital interventions designed to promote relational practice with families in acute care settings of emergency departments, intensive care units and high care units. The preferred reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the design of this scoping review. To identify relevant studies, databases (Academic Search Complete; CINAHL; PubMed; PsyInfo) and the search engine Google Scholar were searched using terms for core elements of relational practice and family engagement. Of the 117 articles retrieved, eight interventional studies met the search criteria. The interventions focused on relational practice elements of collaborating with and creating safe environments for families, whilst only one addressed healthcare professionals being respectful of families' needs and differences. In relation to the nature of engagement of families in interventions, the focus was mainly on improving family functioning. Family engagement in the interventions was focused on involving families in decision-making. The scoping review revealed a limited number of in-hospital interventions designed to promote relational practice with families in acute care settings. Further research is encouraged to develop such interventions. Contribution: The scoping review has highlighted specific elements of relational practice that have been overlooked in the mapped interventions. This provides guidance on where future interventional research may be focused.

'Treating a patient should be approached in a holistic manner': collaboration of doctors and physiotherapists in the rehabilitation of people living with HIV

People living with HIV facing impairments and subsequent disabilities related to the virus and its treatment require involvement of a collaborative team of healthcare professionals to ensure reintegration into daily life and community living. Healthcare teams responsible for this care include doctors and physiotherapists. This paper explores the collaboration of doctors and physiotherapists in the rehabilitation of people living with HIV in a semi-rural healthcare setting in KwaZulu-Natal, South Africa. Six doctors and two physiotherapists were interviewed using a semi-structured interview guide. The qualitative approach led to the emergence of five themes, namely a biomedical versus biopsychosocial approach; scope of practice challenge; multidisciplinary team enigma; institutional structure limitations; and recommendations from healthcare professionals. Both groups of professionals believed that a lack of understanding of the scope of practice and role of the associate profession in the multidisciplinary team led to poor referrals and lack of communication. Furthermore, shortage of personnel and resource limitations posed barriers to effective team interaction. Timely referrals, good communication and understanding of roles were suggested as endorsements to improved collaboration

Prévalence des accidents d'exposition au sang et facteurs associés chez les professionnels de santé à l'hôpital de zone de Menontin, Bénin

Introduction: Les accidents d'exposition au sang (AES) constituent une réelle préoccupation pour les professionnels de santé à cause de la gravité des affections qu'ils engendrent. La présente étude a été menée pour évaluer la fréquence des accidents d'exposition au sang (AES) au sein du personnel de l'hôpital de zone de Mènontin et les facteurs qui lui sont associés. Méthode d'étude : Enquête descriptive transversale et analytique incluant 90 agents de santé. Le recueil des données a été fait sur la base d'un questionnaire anonyme et de deux grilles d'observation. Le questionnaire a été remis à chaque agent de santé volontaire après explication des objectifs de l'étude. Une visite de tous les services a été réalisée pour compléter les grilles d'observation. Résultats : L'âge moyen de notre échantillonnage est de 37 ans ± 10. Les femmes ont représentées dans 70% de notre échantillonnage et le sexe ratio est de 0,42.Les infirmiers (32,2%), les techniciens de laboratoire (25,56%) et les aidessoignants (16,7%) étaient les classes professionnelles plus représentées. La fréquence des AES chez les professionnels de santé à l'hôpital de zone de Mènontin est de 40%. Les types d'AES les plus fréquents sont les piqures (44,4%), les projections sur muqueuse (25%) et les coupures (16,7%).le sang a été impliqué dans 86,11% des cas. Les mécanismes de survenue des AES répertoriés étaient essentiellement le recapuchonnage (66,7%) et l'élimination de déchets (25%). L'absence de formation sur les AES et de port de gants influence significativement la survenue des AES. Les AES n'ont pas été déclarés dans 66,7% des cas. Les mesures de prévention et de prise en charge des AES sont inexistantes au sein de l'hôpital de zone de Mènontin. Conclusion : Des séances de sensibilisation du personnel sur les risques liés aux AES s'imposent en vue de leur prévention

Client Confidentiality: Perspectives of Students in a Healthcare Training Programme

Background. Confidentiality is an important ethical principle for all health professionals and also has a legal bearing on duty. One of the most difficult issues health professionals face in their daily fieldwork practice is a conflict between their professional duties; as illustrated in keeping a patient's medical information confidential; and having empathy with a family member's need to know. This moral dilemma is difficult for students to circumvent and therefore this paper presents healthcare students' perspectives of confidentiality.Methods. We aimed to explore healthcare students' views and experiences of confidentiality as an ethical principle by adopting a qualitative explorative approach. Purposeful sampling was undertaken where specific individuals with specific experiences were identified. Data were collected by means of written responses from two open-ended questions and analysed thematically. Two themes emerged.Conclusion. Confidentiality; as with other ethical principles; is an important obligation of a good client-therapist relationship as identified by students. However; the students' responses illustrate that it cannot be absolute; and cognisance must be taken as to when it is acceptable; and even desirable; to override confidentiality because of conflicting; greater duties

Reasons for inpatients not to seek clarity at Dr George Mukhari Academic Hospital, Pretoria

Background: Healthcare practitioners should provide patients with information regarding their clinical conditions. Patients should also feel free to seek clarity on information provided. However; not all patients seek this clarity. Objectives: To explore the reasons inpatients gave for not seeking clarity on information that was received but not understood. Methods: This was a qualitative arm of a larger study; titled 'Are inpatients aware of the admission reasons and management plans of their clinical conditions? A survey at a tertiary hospital in South Africa'; conducted in 2010. Of the 264 inpatients who participated in the larger study; we extracted the unstructured responses from those participants (n = 152) who had indicated in the questionnaire that there was information they had not understood during their encounter with healthcare practitioners; but that they had nonetheless not sought clarity.Data were analysed thematically. Results: Themes that emerged were that inpatients did not ask for clarity as they perceived healthcare practitioners to be 'too busy'; aloof; non-communicators and sometimes uncertain about patients' conditions. Some inpatients had unquestioning trust in healthcare practitioners;whilst others had experiences of bad treatment. Inpatients had poor self-esteem; incapacitating clinical conditions; fear of bad news and prior knowledge of their clinical conditions. Some inpatients stated that they had no reason for not seeking clarity. Conclusion: The reasons for not seeking clarity were based on patients' experiences with the healthcare practitioners and their perceptions of the latter and of themselves. A programme should be developed in order to educate inpatients on effective communication with their healthcare practitioners

Speaking to Experts and Patients: Recommendations for Improving Antiretroviral Therapy (ART) Adherence

This article reports on the findings of a study that aimed to explore experts' and patients' opinions and recommendations regarding adherence to antiretroviral medication. This study was prompted firstly by the lack of existing local research on adherence to antiretroviral therapy (ART) and secondly by the importance of adherence; given the recent introduction of ART to the public health sector. Four experts and seven patients were interviewed. The experts had worked within the HIV/AIDS field for at least two years while the patients (chosen from public antiretroviral roll-out programmes) had been on ART for at least six months. These interviews were transcribed and analysed using thematic content analysis. This article focuses specifically on the recommendations for improving adherence that emerged from the experts' and patients' interviews. While the experts and patients generated two fairly distinct sets of recommendations (clearly informed by their different experiences and knowledge); both groups emphasised the importance of the mediating effects of social support and the healthcare provider-patient relationship in adherence to ART medication