Rules of engagement: The role of mistreatment from patients in the nurse, physician and advanced practice provider experience

The objective of this study is to examine the incidence of reported stress due to mistreatment by patients toward clinicians and the role of mistreatment from patients along with organizational factors in clinician distress. A survey of clinicians was conducted at a large academic medical center, resulting in a final analytic sample of 1,682 physicians, nurses, advanced practice providers and clinical support staff. Nurses reported the greatest incidence of mistreatment by patients as a major stressor (18.69%), followed by Advanced Practice Providers (11.26%), Clinical Support Staff (10.36%), and Physicians (7.69%). Logistic regression analysis was conducted to determine the relationship of individual- and organization-level characteristics with the odds of reporting mistreatment from patients as a major stressor. Overall findings indicate that nurses and those who work in the ER and ambulatory or outpatient clinics were more likely to be stressed from mistreatment by patients than other clinicians. Stress due to mistreatment by patients was also associated with higher Well-Being Index (WBI) distress scores, rapid changes in workflows or policies, ongoing care of COVID-19 patients, under-staffing, and low perceived organizational support. Gender or sexual minorities (not identifying as male or female) and younger (18-34 years of age) healthcare workers were also more likely to experience stress from mistreatment by patients. Individual resilience was not statistically significantly associated with reported stress from mistreatment by patients. Organizations must examine expectations for patient and visitor behavior in tandem with service standards for clinicians toward patients. © The Author(s), 2022.

Promise and peril-defining ethical telehealth practice from the clinician and patient perspective: A qualitative study.

OBJECTIVES: We undertook a qualitative study to examine and compare the experience of ethical principles by telehealth practitioners and patients in relation to service delivery theory. The study was conducted prior to and during the recent global increase in the use of telehealth services due to the COVID-19 pandemic. METHODS: We conducted semi-structured interviews with 20 telehealth practitioners and patients using constructionist grounded theory methods to collect and analyse data. Twenty-five axial coded data categories were then unified and aligned through selective coding with the Beauchamp and Childress (2013) framework of biomedical ethics. The groups were then compared. RESULTS: Thirteen categories aligned to the ethical framework were identified for practitioners and 12 for patients. Variance existed between the groups. Practitioner results were non-maleficence 4/13 or (31%), beneficence 4/13 (31%), professional-patient relationships 3/12 (22%), autonomy 1/13 (8%) and justice 1/13 (8%). Patient data results were non-maleficence 4/12 (33%), professional-patient relationships 3/12 (33%), autonomy 2/12 (18%), beneficence 1/12 (8%) and justice 1/12 (8%). CONCLUSIONS: Ethical principles are experienced differently between telehealth practitioners and patients. These differences can impact the quality and safety of care. Practitioners feel telehealth provides better care overall than patients do. Patients felt telehealth may force a greater share of costs and burdens onto them and reduce equity. Both patients and practitioners felt telehealth can be more harmful than face-to-face service delivery when it creates new or increased risk of harms. Building sufficient trust and mutual understanding are equally important to patients as privacy and confidentiality.

A qualitative exploration of videoconferencing technology in clinical neuropsychology: Clinicians' perspectives

Objective: The implementation of videoconferencing technology (VCT) in healthcare has been expedited by the Covid-19 pandemic. This study aimed to explore clinicians' experiences of using VCT and their views on its suitability for delivering neuropsychological care. Method: An exploratory thematic analysis was conducted using data from two focus groups of professionals working in clinical neuropsychology (N=9). Results were reported in accordance with COREQ criteria for qualitative research. Results: Six key themes were developed. Clinician experiences of using 'technology', the perceived 'suitability' of VCT for patients, and the potential 'impact on wellbeing' that VCT could have on both clinicians and patients, were highlighted. 'Changing the therapeutic milieu' and 'neuropsychological considerations' - such as assessment validity and opportunities for cognitive rehabilitation - were also conceptualised. VCT was also viewed as a means of 'facilitating access', particularly throughout Covid-19 restrictions. Conclusions: Whilst benefits of VCT were identified, a number of concerns were raised about how routine use of VCT may impact clinicians and their patients. Clinicians tended to view VCT as an adjunct to traditional services in the context of Covid-19, rather than a potential replacement. Further research is required to better understand the perspectives of professionals working in neuropsychology and their patients. [ FROM AUTHOR] Copyright of Neuropsychologist is the property of British Psychological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)