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1.
BMC Public Health ; 21(1): 578, 2021 04 09.
Article in English | MEDLINE | ID: covidwho-1175311

ABSTRACT

BACKGROUND: Communities with low vaccination rates are at greater risk during outbreaks of vaccine preventable diseases. Most Australian parents support vaccines, but some refuse and are often judged harshly by their community, especially during an outbreak. We sought the perspectives of Australian public health experts on the key issues faced when managing a measles outbreak in an area with high anti-vaccination sentiment. METHODS: A measles outbreak scenario formed the basis of a 3-round modified Delphi process to identify key practitioner concerns in relation to parents/carers who don't follow the recommended vaccination schedule. We surveyed a range of professionals in the field: policymakers, infectious disease experts, immunisation program staff, and others involved in delivering childhood vaccinations, to identify key priorities when responding to an outbreak in a community with low vaccination coverage. RESULTS: Findings indicate that responses to measles outbreaks in communities with high anti-vaccination sentiment are motivated by concerns about the potential for a much larger outbreak event. The highest operational priority is to isolate infected children. The two most highly ranked practical issues are mistrust from non-vaccinating members of the local region and combatting misinformation about vaccines. Trying to change minds of such individuals is not a priority during an outbreak, nor is vaccinating their children. Using media and social media to provide information about the outbreak and measures the public can take to limit the spread of the disease was a focus. CONCLUSIONS: Our findings provide a deeper understanding of the challenges faced during an outbreak and priorities for communicating with communities where there is a high level of anti-vaccination sentiment. In the context of a global pandemic, the results of this study also have implications for managing public health responses to community transmission of SARS-CoV-2, as COVID-19 vaccines becomes widely available.


Subject(s)
Attitude of Health Personnel , Disease Outbreaks , Measles Vaccine , Measles , Public Health , Vaccination , Australia/epidemiology , /prevention & control , Child , Disease Outbreaks/prevention & control , Humans , Measles/epidemiology , Measles/prevention & control , Measles Vaccine/administration & dosage , Vaccination/psychology
2.
BMC Health Serv Res ; 21(1): 88, 2021 Jan 26.
Article in English | MEDLINE | ID: covidwho-1055818

ABSTRACT

BACKGROUND: Hand hygiene (HH) among healthcare workers (HCWs) is critical for infection prevention and control (IPC) in healthcare facilities (HCFs). Nonetheless, it remains a challenge in HCFs, largely due to lack of high-impact and efficacious interventions. Environmental cues and mobile phone health messaging (mhealth) have the potential to improve HH compliance among HCWs, however, these remain under-studied. Our study will determine the impact of mhealth hygiene messages and environmental cues on HH practice among HCWs in the Greater Kampala Metropolitan Area (GKMA). METHODS: The study is a cluster-randomized trial, which will be guided by the behaviour centred design model and theory for behaviour change. During the formative phase, we shall conduct 30 key informants' interviews and 30 semi-structured interviews to explore the barriers and facilitators to HCWs' HH practice. Besides, observations of HH facilities in 100 HCFs will be conducted. Findings from the formative phase will guide the intervention design during a stakeholders' insight workshop. The intervention will be implemented for a period of 4 months in 30 HCFs, with a sample of 450 HCWs who work in maternity and children's wards. HCFs in the control arm will receive innovatively designed HH facilities and supplies. HCWs in the intervention arm, in addition to the HH facilities and supplies, will receive environmental cues and mhealth messages. The main outcome will be the proportion of utilized HH opportunities out of the 9000 HH opportunities to be observed. The secondary outcome will be E. coli concentration levels in 100mls of hand rinsates from HCWs, an indicator of recent fecal contamination and HH failure. We shall run multivariable logistic regression under the generalized estimating equations (GEE) framework to account for the dependence of HH on the intervention. DISCUSSION: The study will provide critical findings on barriers and facilitators to HH practice among HCWs, and the impact of environmental cues and mhealth messages on HCWs' HH practice. TRIAL REGISTRATION: ISRCTN Registry with number ISRCTN98148144 . The trial was registered on 23/11/2020.


Subject(s)
Hand Hygiene/methods , Telemedicine , Attitude of Health Personnel , Cues , Guideline Adherence , Health Personnel , Humans , Infection Control/methods , Randomized Controlled Trials as Topic , Uganda
3.
Br J Hosp Med (Lond) ; 82(3): 1-10, 2021 Mar 02.
Article in English | MEDLINE | ID: covidwho-1168178

ABSTRACT

Ever-developing changes to the working hours of junior doctors by the European Working Time Directive, the junior doctor contract of 2019 and most recently the COVID-19 pandemic have impacted the professional identity of doctors. There has been little investigation into its influence on the multifaceted aspects of postgraduate medical training, which feeds into how trainees consider themselves professionally and the concept of professional identity or 'being a doctor'. A review of the medical, socio-political and educational literature reveals that the impact on the professional identity development of trainees is influenced by several perspectives from the trainee, trainer and the public. Gross reduction in working hours has no doubt decreased the raw volume of clinical experiences. However, to counteract this, smarter learning processes have evolved, including narrative reflection, supervised learning events, and a greater awareness of coaching and training among trainers.


Subject(s)
Attitude of Health Personnel , Clinical Competence , Education, Medical, Graduate , Medical Staff, Hospital/education , Personnel Staffing and Scheduling , Social Identification , Continuity of Patient Care , Europe , Humans , Internship and Residency , State Medicine , United Kingdom
4.
Dimens Crit Care Nurs ; 40(3): 156-163, 2021.
Article in English | MEDLINE | ID: covidwho-1165530

ABSTRACT

BACKGROUND: Previous research on nurses during pandemics has focused on nurses working in one facility or type of unit; this study focuses on nurses caring for COVID-19 patients in a variety of units in different sites across the United States. OBJECTIVE: The aim of this study was to understand the experiences of registered nurses working with hospitalized COVID-19 patients. METHODS: This study used a hermeneutic phenomenology design. Semistructured interviews via telephone were conducted and then transcribed verbatim. Colaizzi's method of analysis was used. Data saturation was achieved with 14 participants. RESULTS: Three major themes were evident. They were "the human connection," "the nursing burden," and "coping." Subthemes were identified under each major theme. DISCUSSION: This study depicted nurses who are caring, empathetic, and resilient. They had many recommendations for fellow nurses, the public, and health care organizations.


Subject(s)
Adaptation, Psychological , /psychology , Nursing Staff, Hospital/psychology , Adult , Attitude of Health Personnel , Female , Humans , Male , Middle Aged , Pandemics , United States/epidemiology
5.
Appl Clin Inform ; 12(2): 259-265, 2021 03.
Article in English | MEDLINE | ID: covidwho-1164985

ABSTRACT

BACKGROUND: During the initial days of the coronavirus disease 2019 (COVID-19) pandemic, hospital-wide practices rapidly evolved, and hospital employees became a critical population for receiving consistent and timely communication about these changes. OBJECTIVES: We aimed to rapidly implement enterprise text messaging as a crisis communication intervention to deliver key COVID-related safety and practice information directly to hospital employees. METHODS: Utilizing a secure text-messaging platform already routinely used in direct patient care, we sent 140-character messages containing targeted pandemic-related updates to on-duty hospital employees three times per week for 13 weeks. This innovation was evaluated through the analysis of aggregate "read" receipts from each message. Effectiveness was assessed by rates of occupational exposures to COVID-19 and by two cross-sectional attitudinal surveys administered to all text-message recipients. RESULTS: On average, each enterprise text message was sent to 1,997 on-duty employees. Analysis of "read" receipts revealed that on average, 60% of messages were consistently read within 24 hours of delivery, 34% were read in 2 hours, and 16% were read in 10 minutes. Readership peaked and fell in the first week of messaging but remained consistent throughout the remainder of the intervention. A survey administered after 2 weeks revealed that 163 (79%) users found enterprise texts "valuable," 152 (73%) users would recommend these texts to their colleagues, and 114 (55%) users preferred texts to email. A second survey at 9 weeks revealed that 109 (80%) users continued to find texts "valuable." Enterprise messaging, in conjunction with the system's larger communication strategy, was associated with a decrease in median daily occupational exposure events (nine events per day premessaging versus one event per day during messaging). CONCLUSION: Enterprise text messages sent to hospital-employee smartphones are an efficient and effective strategy for urgent communications. Hospitals may wish to leverage this technology during times of routine operations and crisis management.


Subject(s)
/therapy , Health Personnel , Hospitals , Practice Guidelines as Topic , Text Messaging , Attitude of Health Personnel , Humans , Occupational Exposure , Surveys and Questionnaires
8.
PLoS One ; 16(3): e0248387, 2021.
Article in English | MEDLINE | ID: covidwho-1156077

ABSTRACT

OBJECTIVES: The study aims to investigate GPs' experiences of how UK COVID-19 policies have affected the management and safety of complex elderly patients, who suffer from multimorbidity, at the primary care level in North West London (NWL). DESIGN: This is a service evaluation adopting a qualitative approach. SETTING: Individual semi-structured interviews were conducted between 6 and 22 May 2020, 2 months after the introduction of the UK COVID-19 Action Plan, allowing GPs to adapt to the new changes and reflect on their impact. PARTICIPANTS: Fourteen GPs working in NWL were interviewed, until data saturation was reached. OUTCOME MEASURES: The impact of COVID-19 policies on the management and safety of complex elderly patients in primary care from the GPs' perspective. RESULTS: Participants' average experience was fourteen years working in primary care for the NHS. They stated that COVID-19 policies have affected primary care at three levels, patients' behaviour, work conditions, and clinical practice. GPs reflected on the impact through five major themes; four of which have been adapted from the Safety Attitudes Questionnaire (SAQ) framework, changes in primary care (at the three levels mentioned above), involvement of GPs in policy making, communication and coordination (with patients and in between medical teams), stressors and worries; in addition to a fifth theme to conclude the GPs' suggestions for improvement (either proposed mitigation strategies, or existing actions that showed relative success). A participant used an expression of "infodemic" to describe the GPs' everyday pressure of receiving new policy updates with their subsequent changes in practice. CONCLUSION: The COVID-19 pandemic has affected all levels of the health system in the UK, particularly primary care. Based on the GPs' perspective in NWL, changes to practice have offered opportunities to maintain safe healthcare as well as possible drawbacks that should be of concern.


Subject(s)
/prevention & control , General Practitioners/psychology , Patient Safety , Primary Health Care , Aged , Attitude of Health Personnel , /pathology , Health Policy , Humans , Interviews as Topic , Pandemics , Policy Making , Qualitative Research , United Kingdom/epidemiology
10.
Int J Environ Res Public Health ; 18(6)2021 03 22.
Article in English | MEDLINE | ID: covidwho-1154377

ABSTRACT

The COVID-19 pandemic may cause a nursing shortage. Prelicensure nursing students who are exposed to high-stress COVID-19 events are related to defective career decision-making. This study validated the COVID-19 attitude scale and clarified how their attitudes about COVID-19 affected their behavioral intentions toward career decision-making. We conducted a cross-sectional study and recruited a convenience sample of 362 prelicensure nursing students from Northern and Central Taiwan. Two measurements were applied, including the Nursing Students Career Decision-making instrument and COVID-19 attitude scale. We used AMOS (version 22.0) to perform a confirmatory factor analysis. The Cronbach α of the COVID-19 attitude scale was 0.74 and consisted of four factors. The most positive attitude was the nursing belief factor, and the least positive factor was emotional burden. Prelicensure nursing students' COVID-19 attitudes were significantly positively associated with their career decision-making attitudes and perceived control (ß = 0.41 and ß = 0.40, respectively; p < 0.001). All the key latent variables explained significantly 23% of the variance in the career decision-making behavioral intentions module. In conclusion, the COVID-19 attitude scale is valid. Although the prelicensure nursing students' COVID-19 attitudes had no direct effect on career decision-making intentions, they had a direct effect on career decision-making attitudes and the perceived control.


Subject(s)
Students, Nursing , Attitude , Attitude of Health Personnel , Cross-Sectional Studies , Humans , Pandemics , Surveys and Questionnaires , Taiwan/epidemiology
12.
Camb Q Healthc Ethics ; 30(2): 390-402, 2021 04.
Article in English | MEDLINE | ID: covidwho-1149670

ABSTRACT

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work.


Subject(s)
Ethics, Institutional , Health Personnel , Patient Participation , Policy Making , Resource Allocation/ethics , Attitude of Health Personnel , Health Care Rationing/ethics , Humans , Organizational Policy , Triage/ethics
14.
Nutrients ; 13(3)2021 Mar 22.
Article in English | MEDLINE | ID: covidwho-1146555

ABSTRACT

BACKGROUND: People with upper gastrointestinal cancer are at high risk for malnutrition without universal access to early nutrition interventions. Very little data exist on the attitudes and views of health professionals on providing nutrition care to this patient cohort delivered by electronic health methods. COVID-19 has fast-tracked the adoption of digital health care provision, so it is more important than ever to understand the needs of health professionals in providing health care via these modes. This study aimed to explore the perspectives of health professionals on providing nutrition care to upper gastrointestinal cancer patients by electronic methods to allow the future scaling-up of acceptable delivery methods. METHODS: Semi-structured qualitative interviews were conducted face-to-face or by telephone and recorded, de-identified and transcribed. Thematic analysis was facilitated by NVivo Pro 12. RESULTS: Interviews were conducted on 13 health professionals from a range of disciplines across several public and private health institutions. Thematic analysis revealed three main themes: (1) the ideal model, (2) barriers to the ideal model and (3) how to implement and translate the ideal model. Health professionals viewed the provision of nutrition interventions as an essential part of an upper gastrointestinal cancer patient's treatment with synchronous, telephone-based internal health service models of nutrition care overwhelmingly seen as the most acceptable model of delivery. Mobile application-based delivery methods were deemed too challenging for the current population serviced by these clinicians. CONCLUSION: The use of novel technology for delivering nutrition care to people receiving treatment for upper gastrointestinal cancers was not widely accepted as the preferred method of delivery by health professionals. There is an opportunity, given the rapid uptake of digital health care delivery, to ensure that the views and attitudes of health professionals are understood and applied to develop acceptable, efficacious and sustainable technologies in our health care systems.


Subject(s)
Attitude of Health Personnel , Gastrointestinal Neoplasms/therapy , Nutrition Therapy/methods , Adult , Female , Health Services Accessibility , Humans , Interviews as Topic , Male , Middle Aged , Mobile Applications , Nutrition Therapy/psychology , Telemedicine/methods , Trust
15.
Curationis ; 44(1): e1-e7, 2021 Mar 10.
Article in English | MEDLINE | ID: covidwho-1140729

ABSTRACT

BACKGROUND: The real-world problems and ever-changing challenges currently confronting the future of nursing education and healthcare require a problem-based learning approach using simulation strategy. This is exacerbated by the increasing burden of diseases such as tuberculosis, human immunodeficiency virus and acquired immune deficiency syndrome (HIV and AIDS) and more recently the coronavirus disease 2019 (COVID-19) pandemic, as well as advancing technology and changing regulations and policies. Problem-based learning is a student-centred learning strategy, where students are presented with situations drawn from practice, which can be used to bridge the theory-practice gap. OBJECTIVES: To explore the perceptions and views of healthcare educators on how problem-based learning can be facilitated through simulation. METHOD: A qualitative, exploratory, descriptive and contextual research design was used. Thirteen educators from the Faculty of Health Sciences of the University of Johannesburg, with 5 years' teaching experience, were purposively selected from the Dean's office, the Nursing Department, emergency medical care and the departments of podiatry, somatology and radiography. The participants were selected based on their extensive knowledge of problem-based learning and the use of simulation. Data were collected through in-depth, individual, semi-structured interviews. Thematic analysis provided six themes and 13 related sub-themes. The article focuses on the perceptions and views of educators regarding problem-based learning through simulation. RESULTS: Problem-based learning through simulation allows students to work together in teams, which demonstrates a new modus operandi and renders a holistic approach to patient care. CONCLUSION: Problem-based learning through simulation should be utilised to encourage reflective knowledge exchange. Students from various departments can learn about new innovations, creativity and develop critical thinking when solving complex health-related problems.


Subject(s)
Attitude of Health Personnel , Attitude to Computers , Computer-Assisted Instruction/methods , Education, Nursing/methods , Faculty, Nursing/psychology , Problem-Based Learning/methods , Adult , Curriculum , Female , Humans , Male , Middle Aged , Qualitative Research , Young Adult
16.
PLoS One ; 16(3): e0248627, 2021.
Article in English | MEDLINE | ID: covidwho-1138583

ABSTRACT

BACKGROUND: There has been a rapid increase in the number of cases of COVID-19 in Latin America, Africa, Asia and many countries that have an insufficient number of physicians and other health care personnel, and the need for the inclusion of medical students on health teams is a very important issue. It has been recommended that medical students work as volunteers, undergo appropriate training, not undertake any activity beyond their level of competence, and receive continuous supervision and adequate personal protective equipment. However, the motivation of medical students must be evaluated to make volunteering a more evidence-based initiative. The aim of our study was to evaluate the motivation of medical students to be part of health teams to aid in the COVID-19 pandemic. METHODS AND FINDINGS: We developed a questionnaire specifically to evaluate medical students' perceptions about participating in the care of patients with suspected infection with coronavirus during the COVID-19 pandemic. The questionnaire had two parts: a) one part with questions on individual characteristics, year in medical school and geographic location of the medical school and b) a second part with twenty-eight statements assessed on a 5-point Likert scale (totally agree, agree, neither agree nor disagree, disagree and totally disagree). To develop the questionnaire, we performed consensus meetings with a group of faculty and medical students. The questionnaire was sent to student organizations of 257 medical schools in Brazil and answered by 10,433 students. We used multinomial logistic regression models to analyze the data. Statements associated with greater odds ratios for participation of medical students in the COVID-19 pandemic were related to a sense of purpose or duty ("It is the duty of the medical student to put himself or herself at the service of the population in the pandemic"), altruism ("I am willing to take risks by participating in practice in the context of the pandemic"), and perception of good performance and professional identity ("I will be a better health professional for having experienced the pandemic"). Males were more prone than females to believe that only interns should participate in the care of patients with COVID-19 (odds ratio 1.36 [coefficient interval 95%:1.24-1.49]) and that all students should participate (OR 1.68 [CI:1.4-1.91]). CONCLUSIONS: Medical students are more motivated by a sense of purpose or duty, altruism, perception of good performance and values of professionalism than by their interest in learning. These results have implications for the development of volunteering programs and the design of health force policies in the present pandemic and in future health emergencies.


Subject(s)
/psychology , Pandemics/statistics & numerical data , Schools, Medical/statistics & numerical data , Students, Medical/psychology , Students, Medical/statistics & numerical data , Attitude of Health Personnel , Female , Health Personnel/psychology , Health Personnel/statistics & numerical data , Humans , Male , Motivation/physiology , Pandemics/prevention & control , Perception/physiology , Surveys and Questionnaires
19.
Fam Med ; 53(3): 207-210, 2021 03.
Article in English | MEDLINE | ID: covidwho-1136697

ABSTRACT

BACKGROUND AND OBJECTIVES: With the emergence of COVID-19, telemedicine use has increased dramatically as clinicians and patients have looked for alternatives to face-to-face care. Prior research has shown high levels of patient satisfaction and comparable quality of care. Video visits have been hypothesized to be one way to reduce burnout among clinicians, but there has been minimal research on physician views of virtual care. We sought to measure family physician experience with video visits at the start of the COVID-19 pandemic. METHODS: We identified all faculty and resident physicians at a large academic department of family medicine who had conducted a video visit in the prior month and conducted an anonymous online 12-question survey about their experiences, satisfaction, and barriers with care. RESULTS: Most eligible physicians responded (102/109, 94%), of whom half (52%) reported this was their first month trying a video visit. There was very high satisfaction (91% very or somewhat satisfied). The majority of respondents felt that video visits were shorter (54%) or took the same amount of time (38%) as in-person visits. There was concern that many physicians had experienced a visit in which they felt video was not the appropriate platform given patient concerns. CONCLUSIONS: This study is among the first to assess physician experience with video visits. As the visits are perceived as shorter, they may offer a unique opportunity to address clinician burnout. There was a high level of satisfaction at our institution despite multiple technical challenges.


Subject(s)
Attitude of Health Personnel , Physicians, Family/statistics & numerical data , Telemedicine/statistics & numerical data , Ambulatory Care/statistics & numerical data , Humans , Patient Satisfaction/statistics & numerical data , Physicians, Family/psychology , United States
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